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Suh PS, Baek JH, Lee JH, Chung SR, Choi YJ, Chung KW, Kim TY, Lee JH. Effectiveness of microvascular flow imaging for radiofrequency ablation in recurrent thyroid cancer: comparison with power Doppler imaging. Eur Radiol 2024:10.1007/s00330-024-10977-0. [PMID: 39042304 DOI: 10.1007/s00330-024-10977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/13/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES To compare microvascular flow imaging (MVFI) and power Doppler ultrasonography imaging (PDUS) for detecting intratumoral vascularity in recurrent thyroid cancer both before and after radiofrequency ablation (RFA). METHODS This retrospective study included 80 patients (age, 57 ± 12 years; 54 women) with 110 recurrent tumors who underwent RFA between January 2021 and June 2023. A total of 151 PDUS and MVFI image sets were analyzed (85 pre-RFA, 66 post-RFA). Two readers assessed vascularity on the images using a four-point scale with a 2-week interval between PDUS and MVFI to estimate inter-reader agreement. Intra-reader agreement was determined by reinterpreting images in reverse order (MVFI-PDUS) after a 1-month gap. Additionally, diagnostic performance for identifying viable tumors after RFA was assessed in 44 lesions using thyroid-protocol CT as a reference standard. RESULTS MVFI demonstrated higher vascular grades than PDUS, both before (reader 1: 3.04 ± 1.15 vs. 1.93 ± 1.07, p < 0.001; reader 2: 3.20 ± 0.96 vs. 2.12 ± 1.07, p < 0.001) and after RFA (reader 1: 2.44 ± 1.28 vs. 1.67 ± 1.06, p < 0.001; reader 2: 2.62 ± 1.23 vs. 1.83 ± 0.99, p < 0.001). Inter-reader agreement was substantial (κ = 0.743) and intra-reader agreement was almost perfect (κ = 0.840). MVFI showed higher sensitivity (81.5%-88.9%) and accuracy (84.1%-86.4%) than PDUS (sensitivity: 51.9%, p < 0.01; accuracy: 63.6-70.5%, p < 0.04), without sacrificing specificity. CONCLUSION MVFI was superior to PDUS for assessing intratumoral vascularity and showed good inter- and intra-reader agreement, highlighting its clinical value for assessing pre-RFA vascularity and accurately identifying post-RFA viable tumors in recurrent thyroid cancer. CLINICAL RELEVANCE STATEMENT Microvascular flow imaging (MVFI) is superior to power-Doppler US for assessing intratumoral vascularity; therefore, MVFI can be a valuable tool for assessing vascularity before radiofrequency ablation (RFA) and for identifying viable tumors after RFA in patients with recurrent thyroid cancer. KEY POINTS The value of microvascular flow imaging (MVFI) for evaluating intratumoral vascularity is unexplored. MVFI demonstrated higher vascular grades than power Doppler US before and after ablation. Microvascular flow imaging showed higher sensitivity and accuracy than power Doppler US without sacrificing specificity.
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Affiliation(s)
- Pae Sun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jae Ho Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Yong Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Negroni D, Maddalena G, Bono R, Abruzzese F, Cesano S, Conte P, Airoldi C, Carriero A. Superb microvascular imaging (SMI) and elastosonography in thyroid nodule: diagnostic value in a real-time cohort. J Ultrasound 2024:10.1007/s40477-024-00898-5. [PMID: 38967880 DOI: 10.1007/s40477-024-00898-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/20/2024] [Indexed: 07/06/2024] Open
Abstract
PURPOSE In clinical practice, thyroid nodules are classified according to TI-RADS by B-mode and color-flow Doppler study. The aim of the study is to evaluate the possible added value of Superb microvascular imaging (SMI) and elastosonography in the stratification of malignancy risk of thyroid nodules. METHODS All patients with thyroid nodules who were candidates for needle aspiration were enrolled. Experienced operators performed a standard examination with TI-RADS calculation, followed by SMI and elastosonography on the nodules. The needle aspiration outcome was used as the gold standard. Statistical analysis calculated the ROC curves of the techniques applied individually and serially. RESULTS In this prospective study, we analysed 260 nodules, found in 251 patients (mean age 58.6 yo ± 14). 11.2% were TI-RADS 1, 18.9% TI-RADS 2, 41.1% TI-RADS 3, 28.1% TI-RADS 4, and 0.8% TI-RADS 5. The SMI technique showed an AUC of 0.57 (95% CI 0.49; 0.66) while elastosonography had an AUC of 0.58 (95% CI 0.49; 0.67) when used individually. SMI together with elastosonography had AUC of 0.62 (95% CI 0.52; 0.71). TI-RADS had AUC of 0.67 (95% CI 0.59; 0.75). SMI and elastosonography applied together with TI-RADS had AUC of 0.69 (95% CI 0.61; 0.77). CONCLUSION In the real-world cohort of patients, the SMI technique and elastosonography slightly increase the AUC of TI-RADS. Taken individually, SMI and elastosonography do not have a very strong AUC.
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Affiliation(s)
- Davide Negroni
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy.
| | - Gaetano Maddalena
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Romina Bono
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Flavia Abruzzese
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Sara Cesano
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Patrizio Conte
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
| | - Chiara Airoldi
- Department of Translation Medicine, University of "Piemonte Orientale", Novara, Piedmont, Italy
| | - Alessandro Carriero
- Department of Radiology, "Maggiore della Carità" Hospital, Novara, Piedmont, Italy
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Kin T, Motoya M, Hayashi T, Takahashi K, Katanuma A. Transabdominal ultrasound evaluation of vascularity of gallbladder lesions: particularly those with wall thickening. J Med Ultrason (2001) 2024; 51:429-436. [PMID: 38879837 DOI: 10.1007/s10396-024-01467-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/17/2024] [Indexed: 07/26/2024]
Abstract
Gallbladder wall thickening is relatively common in clinical settings, and for appropriate diagnosis, the size, shape, internal structure, surface contour, and vascularity of the gallbladder wall must be evaluated. Morphological evaluation is the most important; however, some gallbladder lesions resemble gallbladder cancer in imaging studies, making differential diagnosis challenging. Vascular evaluation is indispensable for a precise diagnosis in these cases. In this review, we present the current status of vascular evaluation using US and diagnosis using vascular imaging for gallbladder lesions, including those presenting with wall thickening. To date, several ultrasound imaging techniques have been developed to assess vascularity, including Doppler imaging with high sensitivity, use of contrast agents, and microvascular imaging using a novel filter for Doppler imaging. Although conventional color Doppler imaging is rarely used for the diagnosis of gallbladder lesions, the efficacy of contrast-enhanced ultrasound in assessing the vascularity, enhancement pattern, or timing of enhancement/washout has been reported. Presence of multiple irregular microvessels has been speculated to indicate malignancy. However, few reports on microvessels have been published, and further studies are required for the precise diagnosis of gallbladder lesions with microvascular evaluation.
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Affiliation(s)
- Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan.
| | - Masayo Motoya
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kuniyuki Takahashi
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, 1-40-1-12 Maeda, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
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Liu M, Pan N. Quantitative ultrasound imaging parameters in patients with cancerous thyroid nodules: development of a diagnostic model. Am J Transl Res 2024; 16:2645-2653. [PMID: 39006293 PMCID: PMC11236663 DOI: 10.62347/wedg9279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/24/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE This study aimed to develop a diagnostic model utilizing quantitative ultrasound parameters to accurately differentiate benign from malignant thyroid nodules. METHODS A retrospective analysis of 194 patients with thyroid nodules, encompassing 65 malignant and 129 benign cases, was performed. Clinical data, ultrasound characteristics, and hemodynamic indicators were compared. Receiver operating characteristic (ROC) curves and logistic regression analysis identified independent diagnostic markers. RESULTS No significant differences in clinical data were observed between the groups (P>0.05). Malignant nodules, however, were more likely to exhibit solid composition, hypoechoicity, irregular shapes, calcifications, central blood flow, and unclear margins (P<0.05). Hemodynamic parameters showed that malignant nodules had lower end-diastolic volume (EDV) but higher peak systolic velocity (PSV), resistive index (RI), and vascularization flow index (VFI) (P<0.001). Independent diagnostic factors identified included calcification, margin definition, RI, and VFI. A risk prediction model was formulated, demonstrating significantly lower scores for benign nodules (P<0.0001), achieving an ROC area of 0.964. CONCLUSION Color Doppler ultrasound effectively distinguishes malignant from benign thyroid nodules. The diagnostic model emphasizes the importance of calcification, margin clarity, RI, and VFI as critical elements, enhancing the accuracy of thyroid nodule characterization and facilitating informed clinical decisions.
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Affiliation(s)
- Mingyang Liu
- Department of Ultrasound, Xingtai People's Hospital No. 16 Hongxing Street, Xingtai 054500, Hebei, China
| | - Na Pan
- Department of Hematology, Xingtai People's Hospital No. 16 Hongxing Street, Xingtai 054500, Hebei, China
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Ning J, Wang F, Liu SQ, Zhang RZ, Liu DM, Li Y. Clinical Observation on the Therapeutic Effect of Port-Wine Stains with Intravenous Injection of Hematoporphyrin Monomethyl Ether (HMME). Clin Cosmet Investig Dermatol 2024; 17:1183-1191. [PMID: 38800356 PMCID: PMC11127686 DOI: 10.2147/ccid.s459613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
Background Hematoporphyrin monomethyl ether (HMME) is a promising photosensitizer for photodynamic therapy (PDT) and has found wide application in the treatment of port-wine stains (PWS). Objective This study aims to observe and analyze the clinical efficacy and safety of HMME-PDT in the treatment of PWS patients. It also aims to evaluate the usefulness of color Doppler flow imaging (CDFI), an ultrasound technique for detecting blood flow in skin lesions, in assessing clinical efficacy. Methods Thirty-three patients with PWS underwent HMME-PDT at our dermatology outpatient clinic between January 2019 and March 2020. Data on patient demographics, lesion location, lesion type (pink, purple, nodular thickening), treatment frequency, and pre- and post-treatment images were collected and retrospectively analyzed. CDFI was performed on three patients. Results All patients received intravenous HMME and underwent irradiation with 532 nm green LED light. Of these, 5 patients received 1 session of HMME-PDT, 14 received 2 sessions, 9 received 3 sessions and the remaining 5 patients received more than 3 sessions. Of the 33 patients, 9 were cured (27.27%), 10 showed improvement (30.30%), 11 experienced a reduction in symptoms (33.33%), and 3 showed no significant improvement (9.09%). Most patients reported local pain and oedema, and no systemic adverse effects were observed. Clinical efficacy correlated with lesion type and total number of treatment sessions. CDFI appears to be an excellent technique for assessing clinical efficacy. Conclusion HMME-PDT is a safe and effective method for the treatment of PWS. CDFI examination appears to be a promising assessment tool. However, further validation with larger sample sizes is warranted.
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Affiliation(s)
- Jing Ning
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| | - Fang Wang
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| | - Shui-Qing Liu
- Department of Ultrasound in Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| | - Ru-Zhi Zhang
- Department of Dermatology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 240000, People’s Republic of China
| | - Dan-Min Liu
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
| | - Yan Li
- Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People’s Republic of China
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Tian J, Liang J, Lin Y, Wang L, Chen X. Diagnostic performance of ACR-TIRADS combined with superb microvascular imaging for differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas. Endocr Connect 2024; 13:e230388. [PMID: 38235807 PMCID: PMC10895311 DOI: 10.1530/ec-23-0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 01/19/2024]
Abstract
Objective The aim was to investigate the ability of superb microvascular imaging (SMI) to improve the differential diagnosis of mummified thyroid nodules (MTNs) and papillary thyroid carcinomas (PTCs) using the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Materials and methods We enrolled 110 cases of MTNs and 110 cases of PTCs confirmed by fine needle aspiration (FNA) or surgery. Conventional ultrasound (US) and the quantity of microvessels detected by SMI were analyzed for all nodules. Thyroid nodules were initially categorized by ACR-TIRADS based on US imaging features and then reclassified based on ACR-TIRADS combined with SMI blood-flow grade (SMI-TIRADS). We compared the diagnostic performances of ACR-TIRADS and SMI-TIRADS by receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results US-detected margin, shape, and echogenic foci differed between MTNs and PTCs (P < 0.05). The SMI blood-flow grade was significantly greater in PTCs compared with MTNs (Χ2 = 158.78, P < 0.05). There was no significant difference in ACR-TIRADS indicators between MTNs and PTCs (Χ2 = 1.585, P = 0.453); however, reclassification by SMI-TIRADS showed significant differences between the groups (Χ2 = 129.521, P < 0.001). The area under the curve was significantly lower for ACR-TIRADS compared with SMI-TIRADS (0.517 vs 0.887, P < 0.05). SMI-TIRADS had significantly higher diagnostic value for distinguishing MTNs and PTCs than ACR-TIRADS (sensitivity: 91.82% vs 74.55%, P < 0.05; specificity: 84.55% vs 21.82%, P < 0.05; accuracy: 88.18% vs 48.18%, P < 0.05; PPV: 85.59% vs 48.81%, P < 0.05; and NPV: 91.18% vs 46.15%, P < 0.05). Conclusion The detection of microvascular flow and large vessels in thyroid nodules by SMI resulted in high diagnostic specificity and sensitivity. ACR-TIRADS combined with SMI could effectively distinguish between MTNs and PTCs, to avoid unnecessary FNA or surgical excision.
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Affiliation(s)
- Jiali Tian
- Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Jinlei Liang
- Ultrasound Department, Zhuhai People's Hospital, Zhuhai, China
| | - Yuhong Lin
- Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Liping Wang
- Ultrasound Department, Zhuhai Xiangzhou District People's Hospital, Zhuhai, China
| | - Xiaobo Chen
- Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
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Matsui M, Jikuzono T, Kure S, Ishibashi O, Akasu H, Sugitani I. Usefulness of Ultrasonographic Detective Flow Imaging for Detecting Parathyroid Tumors: A Report of Two Cases. J NIPPON MED SCH 2024; 90:460-464. [PMID: 36273907 DOI: 10.1272/jnms.jnms.2023_90-604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Parathyroid tumors (PTs) are sometimes difficult to diagnose because they are small and have low-velocity blood flow, which can be missed by current imaging modalities. PTs consist of parathyroid adenoma (PA), parathyroid cyst, and parathyroid carcinoma (PC). Detective flow imaging (DFI) is a new imaging technology that displays low-velocity blood flow. Herein, we report two cases in which DFI was useful for diagnosis of PTs. One patient had a PA and a parathyroid cyst in close proximity, and the other had a PC. To our knowledge, this is the first report to demonstrate the usefulness of DFI in the diagnosis of PTs.
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Affiliation(s)
- Mami Matsui
- Department of Endocrine Surgery, Nippon Medical School
| | - Tomoo Jikuzono
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Osamu Ishibashi
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Haruki Akasu
- Department of Endocrine Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
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Jiang L, Zhang D, Chen YN, Yu XJ, Pan MF, Lian L. The value of conventional ultrasound combined with superb microvascular imaging and color Doppler flow imaging in the diagnosis of thyroid malignant nodules: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1182259. [PMID: 37415660 PMCID: PMC10321595 DOI: 10.3389/fendo.2023.1182259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To evaluate and compare the value of conventional ultrasound-based superb microvascular imaging (SMI) and color Doppler flow imaging (CDFI) in the diagnosis of malignant thyroid nodule by meta-analysis. Methods The literature included in the Cochrane Library, PubMed, and Embase were searched by using " superb microvascular imaging (SMI), color Doppler flow imaging (CDFI), ultrasound, thyroid nodules" as the keywords from inception through February 1, 2023. According to the inclusion and exclusion criteria, the clinical studies using SMI and CDFI to diagnose thyroid nodules were selected, and histopathology of thyroid nodules was used as reference standard. The diagnostic accuracy research quality assessment tool (QUADAS-2) was used to evaluate the quality of included literature, and the Review Manager 5.4 was used to make the quality evaluation chart. The heterogeneity test was performed on the literature that met the requirements, the combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were pooled, and a comprehensive ROC curve analysis was performed. Meta-DiSc version 1.4, StataSE 12, and Review Manager 5.4 software were used. Results Finally, 13 studies were included in this meta-analysis. A total of 815 thyroid malignant nodules were assessed. All thyroid nodules were histologically confirmed after SMI or CDFI. The combined sensitivity, specificity, PLR, NLR, DOR, and area under the SROC curve of SMI for the diagnosis of malignant thyroid nodules were 0.80(95%CI: 0.77-0.83), 0.79(95%CI: 0.77-0.82), 4.37(95%CI: 3.0-6.36), 0.23(95%CI: 0.15-0.35), 22.29(95%CI: 12.18-40.78), and 0.8944, respectively; the corresponding values of CDFI were 0.62(95%CI: 0.57-0.67), 0.81(95%CI: 0.78-0.85), 3.33(95%CI: 2.18-5.07), 0.41(95%CI: 0.27-0.64), 8.93(95%CI: 3.96-20.16), and 0.8498. Deek funnel pattern showed no significant publication bias. Conclusion The diagnostic efficiency of SMI for malignant thyroid nodules is better than CDFI, and SMI technology can provide significantly more information on vascularity, make up for the deficiency of CDFI, and has better clinical application value. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023402064.
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Affiliation(s)
- Li Jiang
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Dian Zhang
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Yue-Nan Chen
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Xue-Juan Yu
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Mei-Fang Pan
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Lian Lian
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Oncology, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
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Luo H, Yin L. Diagnostic value of superb microvascular imaging and color doppler for thyroid nodules: A meta-analysis. Front Oncol 2023; 13:1029936. [PMID: 37091165 PMCID: PMC10113672 DOI: 10.3389/fonc.2023.1029936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
ObjectiveSuperb micro-vascular imaging (SMI) is a new noninvasive modality for the diagnosis of thyroid nodules. However, the performance of SMI in differentiating malignant and benign thyroid nodules has not been systematically evaluated. This meta-analysis was performed to assess the accuracy of SMI in diagnosing thyroid nodules.MethodsPubMed, Cochrane Library, Embase, Web of Science, Sinomed, Scopus were searched. We recorded the characteristics of the included studies and assessed the quality of each study using the QUADAS-2 tool. The pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated. We also evaluated the publication bias.ResultsThis meta-analysis included 10 studies with a total of 1083 thyroid nodules. The pooled the sensitivity, specificity, and positive and negative LR were 0.84, 0.86, 6.2, and 0.18, respectively. The DOR and AUC were 33 and 0.91, respectively. Heterogeneity existed between the included studies. No significant publication bias was observed.ConclusionCompared with CDFI, Superb micro-vascular imaging (SMI) has higher diagnostic sensitivity and specificity, better diagnostic efficiency, and could be used to diagnose benign and malignant nodules in the display of blood flow distribution capabilities of thyroid nodules; at the same time, Fagan plot showed that the SMI technique had a good clinical application value, and it could supplement the deficiencies of color Doppler imaging in the diagnosis of thyroid nodules.
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Affiliation(s)
- Haorou Luo
- Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lixue Yin
- Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, School of Medicine University of Electronic Science and Technology of China (UESTC), Chengdu, Sichuan, China
- *Correspondence: Lixue Yin,
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Zhou T, Huang H, Dong H, Ni Z, Sun H, He T, Ma C. Ultrasound-Based Risk Stratification System for the Assessment of Partially Cystic Thyroid Nodules. Endocr Pract 2023:S1530-891X(23)00346-4. [PMID: 37004871 DOI: 10.1016/j.eprac.2023.03.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE To develop and validate a risk stratification system for the prediction of malignancy in Partially Cystic Thyroid Nodules (PCTNs). METHODS From January 2020 to December 2021, we retrospectively reviewed the sonography data of PCTNs patients from Hangzhou TCM Hospital, Hangzhou First People's Hospital two medical centers. The independent risk factors of malignant PCTNs were evaluated using univariate and multivariate logistic regression analysis. The nomogram prediction efficiency was assessed using Area Under the Curve (AUC) and calibration curves. To determine the clinic value of the predictive model, Decision Curve Analysis (DCA) was used. RESULTS In this retrospective study, a total of 285 patients (301 PCTNs) were enrolled, 242 nodules were benign, and 59 nodules were malignant. Younger age, hypoechoic, irregular margin and microcalcifications were found to be the independent risk factors associated with malignant PCTNs. The AUC, sensitivity, and specificity were 0.860, 77.1%, and 84.7% in the training set and 0.897, 91.7%, and 87.0% in the external validation set, respectively. The total point of nomogram is greater than 161, which shows the best to predict the malignancy of PCTNs. CONCLUSIONS Our findings demonstrated that the risk stratification system for the assessment of PTCNs showed good prediction capacities.
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Su HZ, Zhang F, Zhang XD, Hong LC, Huang SJ, Su YQ, Su YM. Polar Vessel: A New Ultrasound Sign for Complementary Diagnosis of Major Salivary Gland Adenoid Cystic Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:603-611. [PMID: 35722660 DOI: 10.1002/jum.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To investigate the characteristic ultrasonographic findings of adenoid cystic carcinoma (ACC) in major salivary glands and identify the value of polar vessel in color Doppler flow imaging (CDFI) for the diagnosis of ACC. METHODS From January 2017 to December 2021, 76 patients with parotid and submandibular gland tumors, including 14 patients with ACC, as confirmed by surgery and histopathology, were enrolled. Their clinicopathologic information and ultrasound (US) features were recorded and analyzed. The performance of polar vessel in CDFI for differentiating ACC from non-ACC (benign tumors and mucoepidermoid carcinoma [MEC]) was analyzed. RESULTS ACC in the major salivary gland was more likely to be associated with pain symptoms (P = .027) and unclear borders and rough edges in grayscale US (P = .002, .015, respectively) than benign tumors. Compared to MEC, ACC tended to feature a homogeneous internal echo (P = .008). ACC of the major salivary gland had a significantly higher incidence of polar vessel sign than that of non-ACC (benign tumors and MEC) (P < .0001, .0001, respectively). The polar vessel sign showed good performance in distinguishing between ACC and non-ACC, with an area under the receiver operating characteristic curve of 0.857, a sensitivity of 71.4%, a specificity of 100%, and an accuracy of 94.7%. Positive predictive value and negative predictive value were calculated at 100% and 93.9%, respectively. CONCLUSIONS The US sign of polar vessel has high diagnostic efficiency, and it may have important potential for use as a new complementary sign for the diagnosis of ACC in major salivary glands.
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Affiliation(s)
- Huan-Zhong Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Feng Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiao-Dong Zhang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Long-Cheng Hong
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Shu-Jing Huang
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yu-Qing Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yi-Ming Su
- Department of Ultrasound, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Department of Ultrasound, Siming Branch Hospital, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Yang L, Lin N, Wang M, Chen G. Diagnostic efficiency of existing guidelines and the AI-SONIC™ artificial intelligence for ultrasound-based risk assessment of thyroid nodules. Front Endocrinol (Lausanne) 2023; 14:1116550. [PMID: 36875473 PMCID: PMC9975494 DOI: 10.3389/fendo.2023.1116550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION The thyroid ultrasound guidelines include the American College of Radiology Thyroid Imaging Reporting and Data System, Chinese-Thyroid Imaging Reporting and Data System, Korean Society of Thyroid Radiology, European-Thyroid Imaging Reporting and Data System, American Thyroid Association, and American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines. This study aimed to compare the efficiency of the six ultrasound guidelines vs. an artificial intelligence system (AI-SONICTM) in differentiating thyroid nodules, especially medullary thyroid carcinoma. METHODS This retrospective study included patients with medullary thyroid carcinoma, papillary thyroid carcinoma, or benign nodules who underwent nodule resection between May 2010 and April 2020 at one hospital. The diagnostic efficacy of the seven diagnostic tools was evaluated using the receiver operator characteristic curves. RESULTS Finally, 432 patients with 450 nodules were included for analysis. The American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines had the best sensitivity (88.1%) and negative predictive value (78.6%) for differentiating papillary thyroid carcinoma or medullary thyroid carcinoma vs. benign nodules, while the Korean Society of Thyroid Radiology guidelines had the best specificity (85.6%) and positive predictive value (89.6%), and the American Thyroid Association guidelines had the best accuracy (83.7%). When assessing medullary thyroid carcinoma, the American Thyroid Association guidelines had the highest area under the curve (0.78), the American College of Radiology Thyroid Imaging Reporting and Data System guidelines had the best sensitivity (90.2%), and negative predictive value (91.8%), and AI-SONICTM had the best specificity (85.6%) and positive predictive value (67.5%). The Chinese-Thyroid Imaging Reporting and Data System guidelines had the best under the curve (0.86) in diagnosing malignant tumors vs. benign tumors, followed by the American Thyroid Association and Korean Society of Thyroid Radiology guidelines. The best positive likelihood ratios were achieved by the Korean Society of Thyroid Radiology guidelines and AI-SONICTM (both 5.37). The best negative likelihood ratio was achieved by the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines (0.17). The highest diagnostic odds ratio was achieved by the American Thyroid Association guidelines (24.78). DISCUSSION All six guidelines and the AI-SONICTM system had satisfactory value in differentiating benign vs. malignant thyroid nodules.
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Affiliation(s)
- Linxin Yang
- Department of Ultrasound, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Ultrasound, Fujian Provincial Hospital, Fuzhou, China
| | - Ning Lin
- Department of Ultrasound, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Ultrasound, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Ning Lin,
| | - Mingyan Wang
- Department of Ultrasound, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Gaofang Chen
- Department of Ultrasound, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
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Diagnostic Value of AngioPLUS Microvascular Imaging in Thyroid Nodule Diagnosis Using Quantitative and Qualitative Vascularity Grading. Biomedicines 2022; 10:biomedicines10071554. [PMID: 35884858 PMCID: PMC9313421 DOI: 10.3390/biomedicines10071554] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
This study investigated the diagnostic value of the Angio Planewave Ultrasensitive (AngioPLUS) Doppler ultrasound in improving the efficacy of grey scale ultrasound in thyroid nodule diagnosis. The EU TIRADS was used for the grey scale ultrasound assessment of 94 thyroid nodules. conventional Doppler and AngioPLUS Doppler ultrasound images were evaluated using qualitative vascularity grading, where predominant central vascularity indicated malignancy-suspicion, and quantitative regional vascularity assessment, where predominant peripheral vascularity using a ratio vascularity index (RVI) of > 1 indicated benign disease. Diagnostic performance outcomes of sole and combination approaches were calculated based on final pathologic results. Using sole EU TIRADS and AngioPLUS + power Doppler imaging (APDI) based on qualitative vascularity and RVI, the results were a sensitivity of 83.3% vs. 83.3 vs. 66.7% and a specificity of 50% vs. 81.3% vs. 73.4, respectively. EU TIRADS combined with APDI significantly improved the specificity using both qualitative vascularity and RVI assessment approaches (84.4% and 81%, respectively, p < 0.05); and slightly reduced the sensitivity (76.7% and 58.1%). For cytologically-equivocal thyroid nodules, the combination approach using qualitative vascularity assessment outperformed the EU TIRADS (sensitivity: both were 88.9%; specificity: 77.4% vs. 38.7%, p < 0.05; and AUROC: 0.83 vs. 0.62, p < 0.05). APDI combined with EU TIRADS is diagnostically efficient in stratifying thyroid nodules, particularly cytologically-equivocal nodules.
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Jin H, Wang C, Jin X. Superb microvascular imaging for distinguishing thyroid nodules: A meta-analysis (PRISMA). Medicine (Baltimore) 2022; 101:e29505. [PMID: 35713460 PMCID: PMC9276439 DOI: 10.1097/md.0000000000029505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Earlier studies have shown that the superb microvascular imaging (SMI) can detect tumor angiogenesis to distinguish thyroid nodules, but there is no systematic review. This meta-analysis aimed to identify the accuracy of ultrasound SMI for the diagnosis of thyroid nodules. METHODS We searched PubMed, Cochrane Library, and CBM databases. A meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 software. We calculated the summary statistics for sensitivity, specificity, positive and negative likelihood ratio (LR+/LR-), diagnostic odds ratio, and the synthetic receiver operating characteristic curve. Data will be pooled by either a fixed-effects model or a random-effects model according to the results of heterogeneity identification. RESULTS 11 studies that met the inclusion criteria were included in this meta-analysis. The quality assessment of the study of diagnostic accuracy studies scores of all included studies were ≥22. A total of 1003 thyroid malignant nodules and 957 thyroid benign nodules were assessed. The main outcome included: the pooled sensitivity was 0.81 (95% confidence intervals (CI) = 0.79-0.84), and the pooled specificity was 0.86 (95% CI = 0.84-0.88); the pooled LR+ was 5.79 (95% CI = 4.44-7.54), and the pooled negative LR- was 0.23 (95% CI = 0.20-0.26); the pooled diagnostic odds ratio of SMI in the diagnosis of thyroid nodules was 26.84 (95% CI = 19.13-37.60). The area under the synthetic receiver operating characteristic curve was 0.89 (95% CI = 0.86-0.91). We found no evidence for publication bias (t = 0.72, P = .49). CONCLUSION Our meta-analysis indicates that SMI may have high diagnostic accuracy in distinguishing benign and malignant thyroid nodules. SYSTEMATIC REVIEW REGISTRATION INPLASY202080084.
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Affiliation(s)
- Hui Jin
- Department of Pediatrics, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Wang
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xin Jin
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
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15
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Baek HS, Park JY, Jeong CH, Ha J, Kang MI, Lim DJ. Usefulness of Real-Time Quantitative Microvascular Ultrasonography for Differentiation of Graves' Disease from Destructive Thyroiditis in Thyrotoxic Patients. Endocrinol Metab (Seoul) 2022; 37:323-332. [PMID: 35413779 PMCID: PMC9081314 DOI: 10.3803/enm.2022.1413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Microvascular ultrasonography (MVUS) is a third-generation Doppler technique that was developed to increase sensitivity compared to conventional Doppler. The purpose of this study was to compare MVUS with conventional color Doppler (CD) and power Doppler (PD) imaging to distinguish Graves' disease (GD) from destructive thyroiditis (DT). METHODS This prospective study included 101 subjects (46 GDs, 47 DTs, and eight normal controls) from October 2020 to November 2021. All ultrasonography examinations were performed using microvascular flow technology (MV-Flow). The CD, PD, and MVUS images were semi-quantitatively graded according to blood flow patterns. On the MVUS images, vascularity indices (VIs), which were the ratio (%) of color pixels in the total grayscale pixels in a defined region of interest, were obtained automatically. Receiver operating characteristic curve analysis was performed to verify the diagnostic performance of MVUS. The interclass correlation coefficient and Cohen's kappa analysis were used to analyze the reliability of MVUS (ClinicalTrials.gov:NCT04879173). RESULTS The area under the curve (AUC) for CD, PD, MVUS, and MVUS-VI was 0.822, 0.844, 0.808, and 0.852 respectively. The optimal cutoff value of the MVUS-VI was 24.95% for distinguishing GD and DT with 87% sensitivity and 80.9% specificity. We found a significant positive correlation of MVUS-VI with thyrotropin receptor antibody (r=0.554) and with thyroid stimulating immunoglobulin bioassay (r=0.841). MVUS showed high intra- and inter-observer reliability from various statistical method. CONCLUSION In a real time and quantitative manner, MVUS-VI could be helpful to differentiate GD from thyroiditis in thyrotoxic patients, with less inter-observer variability.
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Affiliation(s)
- Han-Sang Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Yeon Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chai-Ho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moo Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hong MJ, Ahn HS, Ha SM, Park HJ, Oh J. Quantitative analysis of vascularity for thyroid nodules on ultrasound using superb microvascular imaging: Can nodular vascularity differentiate between malignant and benign thyroid nodules? Medicine (Baltimore) 2022; 101:e28725. [PMID: 35119020 PMCID: PMC8812680 DOI: 10.1097/md.0000000000028725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/11/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to investigate the utility of adding superb microvascular imaging (SMI) to B-mode ultrasound (US) for distinguishing between benign and malignant thyroid nodules and evaluate the usefulness of SMI quantification of nodular vascularity for diagnosing thyroid cancer.The malignancy likelihood was scored for 3 datasets before versus after additional color Doppler imaging or SMI using 4-scale visual analysis (i.e., B-mode US alone, B-mode US + color Doppler image, and B-mode US + SMI). Further, the SMI pixel count was measured in the region of interest, including the whole nodule, on the longitudinal view. It was compared between benign and malignant nodules and analyzed according to the US patterns of thyroid nodules based on the Korean thyroid imaging reporting and data system. We calculated the area under the receiver operating characteristic curve values, sensitivities, and specificities.There was no significant difference in the area under the receiver operating characteristic curve values among B-mode, B-mode + color Doppler, and B-mode + SMI. However, the SMI pixel count was significantly higher in malignant thyroid nodules than in benign ones. The optimal cut-off value for the SMI pixel count for predicting malignant thyroid nodules obtained using a receiver operating characteristic curve was 17 (40.54% in sensitivity, 91.3% in specificity). Analysis based on the US pattern of thyroid nodules revealed significant differences in the nodules with low-to-intermediate suspicious US features between malignant and benign nodules.Quantification analysis of vascularity using SMI can differentiate malignant thyroid nodules from benign ones.
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Affiliation(s)
- Min Ji Hong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jiyun Oh
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Zhu YC, Zhang Y, Shan J, Deng SH, Shi XR, Jiang Q. Added Value of Superb Microvascular Imaging and Virtual Touch Imaging Quantification in Assisting Thyroid Cancer Classification. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3364-3371. [PMID: 34489133 DOI: 10.1016/j.ultrasmedbio.2021.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/17/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
This prospective study determined the value added by superb microvascular imaging (SMI) and Virtual Touch imaging quantification (VTIQ) to conventional ultrasonography in classifying malignant and benign thyroid nodules. One hundred eighty-three thyroid nodules (TNs) in 120 patients (112 benign and 71 malignant TNs) were evaluated. SMI revealed noticeable variance between benign and malignant TNs (p < 0.001). Malignant nodules tended to have rich vascularity (grade 3: 38/71, 53.5%) compared with benign nodules (grade 3: 33/112, 29.5%). There is a statistically significant difference between malignant and benign TNs with respect to shear-wave speed (SWS) values (all p values <0.001). The SWS mean, maximum and ratio of malignant nodules were 3.97 ± 1.34, 4.79 ± 1.70 and 1.25 ± 0.39, respectively. The SWS mean, maximum and ratio of benign nodules were 2.65 ± 0.42, 2.97 ± 0.46 and 1.15 ± 0.35, respectively. With respect to area under the curve values, the combined use of SMI or VTIQ improved the diagnostic performance of classifying malignant and benign TNs compared with that of ultrasonography alone. The combination of three modalities achieved the greatest area under the curve values (0.9811, 95% confidence interval: 0.95529-1.000), followed by US + VTIQ (0.9747, 0.94543-1.000), US + SMI (0.9032, 0.85345-0.95391) and ultrasonography (0.8291, 0.76417-0.89403).
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Affiliation(s)
- Yi-Cheng Zhu
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yuan Zhang
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jun Shan
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Shu-Hao Deng
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Xiu-Rong Shi
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China.
| | - Quan Jiang
- Department of Ultrasonography, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
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18
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Zhao D, Jing Y, Lin X, Zhang B. The value of color Doppler ultrasound in the diagnosis of thyroid nodules: a systematic review and meta-analysis. Gland Surg 2021; 10:3369-3377. [PMID: 35070897 PMCID: PMC8749106 DOI: 10.21037/gs-21-752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/10/2021] [Indexed: 10/13/2023]
Abstract
BACKGROUND This study aimed to analyze the value of color Doppler ultrasound in the diagnosis of thyroid nodules. METHODS We searched the PubMed, Web of Science, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) on using color Doppler ultrasound, thyroid nodules, thyroid tumors, and Doppler ultrasound to diagnose the thyroid nodules. The outcome indicators in the articles had to include the numbers of true positives (TP), false positives (FP), false negatives (FN), and true negatives (TN). Subsequently, the Jadad tool was adopted to evaluate the quality of the included articles, and Review Manager 5.3 software was used to conduct a meta-analysis of the experimental data. RESULTS A total of eight suitable articles were selected. The results showed that the estimated sensitivity and specificity of color Doppler ultrasound for the diagnostic of thyroid nodules were 0.46-0.89 and 0.00-1.00, respectively. The pooled estimate of sensitivity for the different articles was 0.71 [95% confidence interval (CI): 0.46-0.89], and the pooled estimate of specificity was 0.77 (95% CI: 0.00-1.00). The area under the summary receiver operating characteristic (SROC) curve (AUC) was 0.917, which was larger than 0.9, signifying high diagnostic accuracy. This suggests that color doppler ultrasound can realize the clinical diagnosis of thyroid nodules. DISCUSSION In summary, the results of this study could provide a clinical data for the promotion and application of color Doppler ultrasound in the clinical diagnosis of thyroid nodules, as well as further reliable data for follow-up clinical research on the diagnosis and treatment of thyroid nodules.
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Affiliation(s)
- Danbo Zhao
- Ultrasonic Image Center, The First People’s Hospital of Wenling, Wenling, China
| | - Yi Jing
- Ultrasonic Image Center, The First People’s Hospital of Wenling, Wenling, China
| | - Xiaoyi Lin
- Ultrasonography Lab, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Bixia Zhang
- Ultrasonic Image Center, The First People’s Hospital of Wenling, Wenling, China
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Studeny T, Kratzer W, Schmidberger J, Graeter T, Barth TFE, Hillenbrand A. Analysis of vascularization in thyroid gland nodes with superb microvascular imaging (SMI) and CD34 expression histology: a pilot study. BMC Med Imaging 2021; 21:159. [PMID: 34717558 PMCID: PMC8557585 DOI: 10.1186/s12880-021-00690-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Doppler sonography technique known as "superb microvascular imaging" (SMI) is advancing sonographic micro vascularization imaging in various disciplines. In this study, we aimed to determine whether SMI could reliably reproduce the blood flow in thyroid nodes and whether malignancy could be diagnosed, based on vascularization properties. Immunhistochemical staining by CD34 and SMI where used to determine the vascularization of nodes in terms of quantified vascularization parameters gained by computational evaluation. Methods We used image analysis programs to investigate whether the quantitative value for vascularization strength in the thyroid node, measured with SMI, was correlated with the actual degree of vascularization, determined microscopically. We included 16 patients that underwent thyroid resections. We prepared thyroid gland tissue slices for immunohistochemistry and labelled endothelial cells with CD34 to visualize blood vessels microscopically. We used image analysis programs, ImageJ, to quantify SMI Doppler sonographic measurements and CellProfiler to quantify CD34 expression in histological sections. We evaluated the numeric values for diagnostic value in node differentiation. Furthermore, we compared these values to check for correlations. Results Among the 16 nodes studied, three harboured malignant tumours (18.75%): two papillary and one follicular carcinoma. Among the 13 benign lesions (81.25%), four harboured follicular adenomas. Malignant and benign nodes were not significantly different in sonographic (0.88 ± 0.89 vs. 1.13 ± 0.19; p = 0.2790) or immunohistochemical measurements of vascularization strength (0.05 ± 0.05 vs. 0.08 ± 0.06; p = 0.2260). Conclusion We found a positive, significant correlation (r = 0.55588; p = 0.0254) between SMI (quantitative values for vascularization strength) and immunohistochemistry (CD34 staining) evaluations of thyroid nodes.
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Affiliation(s)
- Thomas Studeny
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Alee 23, 89081, Ulm, Germany
| | - Thomas F E Barth
- Institute of Pathology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Alee 23, 89081, Ulm, Germany
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20
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Fu Z, Zhang J, Lu Y, Wang S, Mo X, He Y, Wang C, Chen H. Clinical Applications of Superb Microvascular Imaging in the Superficial Tissues and Organs: A Systematic Review. Acad Radiol 2021; 28:694-703. [PMID: 32418782 DOI: 10.1016/j.acra.2020.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 12/12/2022]
Abstract
Superb microvascular imaging (SMI) is an innovative Doppler technique for vascular examination. It uses an intelligent algorithm that efficiently separates low-speed flow signals from motion artifacts so that it can assess microvessels and the vessel distribution in detail. This article reviews the clinical applications of SMI in the disorders of superficial tissues and organs including thyroid nodules, breast tumors and lymph node diseases etc. More information of diseases that are closely associated with angiogenesis can be shown by SMI than other noninvasive examinations. Although some limitations exist, this safe and convenient technique is becoming acceptable and would play a more important role in disease diagnosis and therapeutic responses evaluation.
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21
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Sato W, Suto Y, Yamanaka T, Watanabe H. An advanced ultrasound application used to assess peripheral vascular diseases: superb microvascular imaging. J Echocardiogr 2021; 19:150-157. [PMID: 33856650 DOI: 10.1007/s12574-021-00527-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
Over the past several years, a novel ultrasound imaging modality termed superb microvascular imaging (SMI) has enabled visualization of microvessels. SMI ultrasound studies of peripheral artery diseases have significantly extended our knowledge of tissue microcirculation and the arterial microenvironments of atherosclerotic lesions. We here present an overview of current knowledge on the utility of SMI assessment of vascular diseases and highlight certain peripheral microcirculation disorders for which SMI is particularly valuable. The evidence indicates that SMI can detect intraplaque neovascularization and usefully assess carotid plaque vulnerability; vascularization of the carotid arterial wall detected by SMI is a potential marker of disease activity in patients with Takayasu arteritis; SMI reveals the foot microcirculation and yields a quantitative vascular index (in line with the angiosome concept); and, SMI may serve as an auxiliary diagnostic modality for hereditary hemorrhagic telangiectasia and Raynaud syndrome. In general, microcirculatory evaluation by SMI is an attractive field for future research on therapeutic strategies for peripheral vascular diseases.
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Affiliation(s)
- Wakana Sato
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Yuta Suto
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Takayuki Yamanaka
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, 1-1-1, Hondoh, Akita, 010-8543, Japan.
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Kılınçer A, Durmaz MS, Kıraç CO, Baldane S, Ateş F, Batur A. Evaluation of parenchymal vascularity of the thyroid gland with vascularization index by color superb microvascular imaging in patients with Graves' disease. J Ultrason 2021; 21:41-47. [PMID: 33796339 PMCID: PMC8010367 DOI: 10.15557/jou.2021.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/20/2021] [Indexed: 01/07/2023] Open
Abstract
Aim of the study To determine the parenchymal vascularity of the thyroid gland with color superb microvascular imaging in patients with Graves’ disease, and compare the vascularization index values with healthy subjects. Materials and methods The thyroid glands of 37 patients whose laboratory and clinical findings were consistent with Graves’ disease, and 40 asymptomatic subjects with normal laboratory values, were examined using color superb microvascular imaging. Measurements of the vascularization index were performed with a free region of interest which was drawn along the outer margin of the gland on the color superb microvascular imaging mode. The vascularization index values obtained in the Graves’ disease and control groups were compared. A correlation analysis was performed between the vascularization index values and laboratory and grayscale US parameters. Results The median vascularization index value of the thyroid parenchyma in patients with Graves’ disease was significantly higher than in the asymptomatic group [median (min–max); 12 (2.3–32.1) vs 5.04 (1.1–10.8), p <0.001]. When the cutoff value of the vascularization index is determined as 6.3, Graves’ disease can be diagnosed with 83.8% sensitivity and 70% specificity. Conclusions The vascularization index obtained with color superb microvascular imaging can be a quantitative indicator of parenchymal vascularity in the diagnosis of Graves’ disease, and serve as a supportive tool.
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Affiliation(s)
- Abidin Kılınçer
- Department of Radiology, Selçuk University School of Medicine, Konya, Turkey
| | - Mehmet Sedat Durmaz
- Department of Radiology, Selçuk University School of Medicine, Konya, Turkey
| | - Cem Onur Kıraç
- Division of Endocrinology, Department of Internal Medicine, Selçuk University School of Medicine, Konya, Turkey
| | - Süleyman Baldane
- Division of Endocrinology, Department of Internal Medicine, Selçuk University School of Medicine, Konya, Turkey
| | - Fatih Ateş
- Department of Radiology, Selçuk University School of Medicine, Konya, Turkey
| | - Abdüssamet Batur
- Department of Radiology, Selçuk University School of Medicine, Konya, Turkey
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Evaluation of Multimode Color Doppler Flow Imaging in the Diagnosis of Solid Renal Tumor. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:6656877. [PMID: 33880110 PMCID: PMC8032533 DOI: 10.1155/2021/6656877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Abstract
Background Renal cell carcinoma is one of the most common malignant tumors in urinary system, seriously affecting people's health and life. This study aimed to evaluate the clinical value of multi-mode color Doppler flow imaging for diagnosis of solid renal tumor. Methods Sixty-six renal solid tumors from 63 patients were examined by color Doppler flow imaging (CDFI), power Doppler flow imaging (PDFI), superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) before surgery. The diagnostic efficacy of the four methods was compared by determining blood flow grade and ring-like blood flow with Adler's method. Chi-square test and Fisher's test were performed to compare the results of sensitivity and specificity among four methods. Results Statistically significant differences in blood flow grade and ring-like blood flow were observed between benign and malignant renal tumors as detected by SMI and CEUS (P < 0.05), whereas no difference was found as detected by CDFI and PDFI (P > 0.05). The results indicated that the sensitivity and specificity of SMI (82.46%, 88.89%) and CEUS (84.21%, 88.89%) were higher than those of CDFI (42.11%, 66.67%) and PDFI (47.37%, 77.78%). Compared with the abilities of CDFI and PDFI, SMI and CEUS can better display the micro-blood flow in the tumors and evaluate the blood flow grading, which indicated that SMI and CEUS may have high values in the differential diagnosis of benign and malignant solid renal tumors. Conclusion SMI and CEUS can improve the sensitivity and specificity of the diagnosis of benign and malignant renal tumors and have a high application value.
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Huang H, Li M, Pan J, Tong W, Cheng M, Liang J, Zheng Y, Xie X. Ultrasound combined with biochemical parameters can be used to differentiate parathyroid carcinoma from benign tumors in patients with primary hyperparathyroidism. Clin Hemorheol Microcirc 2021; 76:351-359. [PMID: 32675398 DOI: 10.3233/ch-200846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) results from excessive secretion of parathyroid hormone from parathyroid tumors. Differentiating parathyroid tumors can be challenging before operation. OBJECTIVES To differentiate parathyroid carcinoma from benign tumors in patients with PHPT by the application of ultrasound and biochemical parameters. METHODS This study is a retrospective study. The study enrolled 17 patients with parathyroid carcinoma (PC) and 57 patients with parathyroid adenoma (PA), confirmed by postoperative pathology, between September 2010 and July 2017. This study retrospectively compared the ultrasonic features of the tumors included echotexture, maximum lesion diameter, shape, margin, blood flow inside the mass, intralesional calcifications, cysts in the mass, and biochemical parameters included serum calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase (ALP) levels, gender distribution and age of patients between patients with PC and those with PA. RESULTS In the US images, the two groups showed significant differences in heterogeneity, the appearance of a taller-than-wide shape, irregular or lobulated margins, and intralesional calcifications (p < #x003C;< #x200A;0.05). However, no significant difference was found in echogenicity, maximum lesion diameter, blood flow, and cystic components of the mass (p > #x003E;> #x200A;0.05). The mean PTH levels were significantly different between the two groups (p < #x003C;< #x200A;0.05). The PC and PA patients did not differ significantly in terms of mean serum calcium, mean serum phosphorus, and mean ALP levels (p > #x003E;> #x200A;0.05). There were significant differences to distinguish PC from PA in calcifications in mass or/and taller-than-wide shape combine with PTH > #x003E;> #x200A;1000 pg/mL (p < #x003C;< #x200A;0.05). Significant difference existed in the age between the two groups (p < #x003C;< #x200A;0.001). No significant difference existed in the gender distribution between the two groups (p > #x003E;> #x200A;0.05). CONCLUSION Ultrasound features especially intralesional calcifications and taller-than-wide shape combine with an extremely high serum PTH (>1000 pg/mL) are helpful in differentiating between benign and parathyroid tumors in patients with PHPT.
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Affiliation(s)
- Hui Huang
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Manying Li
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiamin Pan
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenjuan Tong
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Meiqing Cheng
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jinyu Liang
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanling Zheng
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Non-enhanced ultrasound is not a satisfactory modality for measuring necrotic ablated volume after radiofrequency ablation of benign thyroid nodules: a comparison with contrast-enhanced ultrasound. Eur Radiol 2020; 31:3226-3236. [PMID: 33128600 DOI: 10.1007/s00330-020-07398-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/02/2020] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the intra- and inter-observer reliability and agreement between gray-scale and Doppler ultrasound (US) and contrast-enhanced ultrasound (CEUS) in measuring ablated volume (Va) after radiofrequency ablation (RFA) for benign thyroid nodules. METHODS A total of 173 patients with 190 benign thyroid nodules who underwent RFA were included in this study. After RFA, the total volume of ablated nodule was divided into Va and the incompletely treated vital volume. Patients were followed up at 1, 3, 6, 12 months, and every 12 months thereafter. Two independent observers measured Va using US and CEUS during the same follow-up visit. The intra- and inter-observer reliability of the two measurement modalities was assessed using intraclass correlation coefficient (ICC) with 95% confidence interval. The Bland-Altman analysis was used to evaluate agreement, which was expressed as a mean difference with 95% limits of agreement (LOA). RESULTS The mean follow-up time was 23.17 ± 12.70 months. Va measured by US was significantly larger than by CEUS (p < 0.001). The intra- and inter-observer reliability decreased over the follow-up period and became moderate in both subgroups at 12 months (all ICC < 0.75). The mean difference and LOA became larger and wider during the follow-up. The best agreement was found in nodules < 10 ml at 1 month with a mean difference of 1.166 and LOA between 0.413 and 3.294. CONCLUSIONS The intra- and inter-observer reliability and agreement of US and CEUS in measuring Va were unsatisfactory. CEUS should be considered when Va was needed for further evaluation or in the case of nodules with suspected regrowth. KEY POINTS • Va measured by gray-scale and Doppler US was significantly larger than that by CEUS. • Va measured by gray-scale and Doppler US lacked intra- and inter-observer reliability and agreement with CEUS. • CEUS should be preceded to gray-scale and Doppler US for the measurement of Va.
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Kin T, Nagai K, Hayashi T, Takahashi K, Katanuma A. Efficacy of superb microvascular imaging of ultrasound for diagnosis of gallbladder lesion. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:977-983. [PMID: 33073532 DOI: 10.1002/jhbp.841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE The diagnosis of gallbladder (GB) lesions is occasionally difficult. Recently, superb microvascular imaging (SMI) of ultrasound has been developed as a novel microvascular imaging technique. We evaluated the feasibility of SMI for the diagnosis of GB lesions and compared microvascular imaging between benign and malignant GB lesions. METHODS Twenty patients with GB-protruded lesions or wall thickening who underwent SMI from August 2015 to July 2017 were included in this retrospective study. The measured outcomes were the quality of microvascular imaging when compared between normal SMI (N-SMI) and contrast-enhanced SMI (CE-SMI), and the microvascular findings (vascularity, vascular morphology, presence of branching, and presence of caliber change) when compared between benign and malignant GB lesions. RESULTS The quality of microvascular imaging of CE-SMI was evaluated as better than that of N-SMI, showing a significant difference (P < .001). From the CE-SMI microvascular findings, the evaluation of vascular morphology and the presence of caliber change showed a significant difference between benign and malignant GB lesions (P = .005, P < .001). CONCLUSIONS The evaluation of GB lesions using SMI was feasible with a contrast agent. Vascular morphology and the presence of caliber change may help in the differential diagnosis of GB lesions.
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Affiliation(s)
- Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Kazumasa Nagai
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
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Chung J, Lee YJ, Choi YJ, Ha EJ, Suh CH, Choi M, Baek JH, Na DG. Clinical applications of Doppler ultrasonography for thyroid disease: consensus statement by the Korean Society of Thyroid Radiology. Ultrasonography 2020; 39:315-330. [PMID: 32892523 PMCID: PMC7515666 DOI: 10.14366/usg.20072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Doppler ultrasonography (US) is widely used for the differential diagnosis of thyroid nodules, metastatic cervical lymph nodes in patients with thyroid cancer, and diffuse parenchymal disease, as well as for guidance in various US-guided procedures, including biopsy and ablation. However, controversies remain regarding the appropriate use and interpretation of Doppler US. Therefore, the Korean Society of Thyroid Radiology organized a taskforce to develop a consensus statement on the clinical use of Doppler US for thyroid disease. The review and recommendations in this article are based on a comprehensive analysis of the current literature and the consensus of experts.
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Affiliation(s)
- Jin Chung
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea.,Human Medical Imaging and Intervention Center, Seoul, Korea
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Shen TT, Xue JL. Impact of a novel ultrasound microvascular imaging and elastography on prostate cancer classification. Transl Androl Urol 2019; 8:696-702. [PMID: 32038966 DOI: 10.21037/tau.2019.11.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background This study was aimed to compare the sensitivity of transrectal ultrasound (TRUS) guided systematic biopsy (TRUS-SB), superb microvascular imaging guided targeted biopsy (SMI-TB), and elastography ultrasound guided targeted biopsy (EU-TB) in detecting prostate cancer (PCa). Methods One hundred and eighty-four patients with suspicious PCa were randomly divided into two groups, SMI-TB group (n=92) and EU-TB group (n=92). All the patients received a 2-core SMI-TB or a 2-core EU-TB before receiving a 12-core TRU-SB depending on the group. The 2-core SMI-TB was conducted at the most increased vascularity areas rated by a radiologist on a semi-quantitative criterion. The 2-core EU-TB was performed at the dark blue areas that identified as suspicious areas. The PCa detection rate was compared among TRUS-SB, SMI-TB, and EU-TB in the total population and in two groups. Results PCa was detected in 65 out of 184 patients. The SMI-TB group patients received 1,272 cores in total with a positive rate of 23.81% (40/168) for SMI-TB cores and 4.17% (46/1,104) for TRUS-SB cores. The EU-TB group patients received a total of 1,262 cores with a positive rate of 31.01% (49/158) for EU-TB cores and 5.34% (59/1,104) for TRUS-SB cores. Targeted cores (27.30%, 89/326) achieved significantly higher sensitivity in PCa detection than systematic cores (4.76%, 105/2,208) (SMI-TB vs. TRUS-SB: OR 7.188, P<0.001; EU-TB vs. TRUS-SB: OR 7.962, P<0.001). Conclusions Superb microvascular imaging and elastography ultrasound guided targeted biopsy may result in higher prostate cancer detection rate as adjunct to gray-scale ultrasound guided systematic biopsy. However, targeted biopsy alone is not sufficient to detect PCa, compared with systematic biopsy.
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Affiliation(s)
- Ting-Ting Shen
- Department of Ultrasound, Shanghai Ji Ai Genetics & IVF Institute, Shanghai 200011, China
| | - Jun-Li Xue
- Department of Oncology, Shanghai Oriental Hospital, Shanghai 200120, China
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Zhu YC, Shan J, Zhang Y, Jiang Q, Wang YB, Deng SH, Qu QH, Li Q. Prostate Cancer Vascularity: Superb Microvascular Imaging Ultrasonography with Histopathology Correlation. Med Sci Monit 2019; 25:8571-8578. [PMID: 31723116 PMCID: PMC6873636 DOI: 10.12659/msm.918318] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to evaluate the association between prostate cancer (PCa) vascularity detected by superb microvascular imaging (SMI) and Gleason score in biopsy specimens. Material/Methods A total of 119 patients with suspected PCa before biopsy underwent gray-scale ultrasound (US), color Doppler ultrasound (CDUS), and SMI imaging between June 2018 and March 2019. Vascularity quantity was assessed by SMI and compared with that of CDUS. The vessel parameter was also compared with the Gleason score. The sensitivity of PCa was compared between transrectal ultrasound guided systematic biopsy (SB) and SMI-guided targeted biopsy (SMI-guided TB). Results Pathology confirmed 74 of 119 patients had PCa. The microvascular quantity of PCa patients was significantly higher than that of non-malignant patients. SMI detected blood vessels in 97.3% (72/74) in the malignant group, while CDUS identified blood flow signals in 90.5% (67/74) of the PCa group. SMI visualized enriched microvascular in PCa of Gleason 8 (54.5%) and Gleason 9 (92.3%). There was a positive correlation between microvascular quantity detected by SMI and Gleason score, with a correlation coefficient of 0.373 (P<0.001). SMI-guided TB cores were significantly more likely than SB cores to detect PCa (OR=12.83, P<0.001). Conclusions SMI could be promising as a useful imaging technique in the detection and characterization of PCa. There was a positive correlation between microvascular quantity detected by SMI and Gleason score.
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Affiliation(s)
- Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Jun Shan
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Yuan Zhang
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Quan Jiang
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Yong-Bing Wang
- Department of General Surgery, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Shu-Hao Deng
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Qing-Hua Qu
- Department of Urology, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Qing Li
- Department of Pathology, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
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Zu DM, Feng LL, Zhang L, Ma SL, Zhu YC. Evaluation of Mesenteric Lymph Nodes in a Pediatric Population with Mesenteric Lymphadenitis Using Superb Microvascular Imaging. Med Sci Monit 2019; 25:5336-5342. [PMID: 31318849 PMCID: PMC6659467 DOI: 10.12659/msm.914903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate superb microvascular imaging (SMI) as an adjunctive imaging method to evaluate mesenteric lymph nodes in children with mesenteric lymphadenitis compared with healthy children. Material/Methods A retrospective study compared children with mesenteric lymphadenitis (n=27) and healthy children (n=30). Lymph node size was determined using grayscale ultrasonography and parameters of lymph node vascularity were compared using color Doppler flow imaging (CDFI) and SMI. The diagnostic performance of ultrasound (US), US combined with SMI, and US combined with CDFI were compared. Results Lymph nodes from children with mesenteric lymphadenitis (n=77) and normal lymph nodes (n=84) were evaluated by SMI, which showed that the least diameter of lymph nodes in cases of mesenteric lymphadenitis was 0.58±0.15 mm and of normal mesenteric lymph nodes was 0.47±0.08 mm (p<0.001). SMI identified 92.6% of abnormal mesenteric lymph nodes while CDFI detected 85.2%. US combined with SMI had the highest sensitivity (81.5%), and specificity (78.9%) compared with US alone (sensitivity, 63.0%; specificity, 64.9%), and compared with US combined with CDFI (sensitivity, 74.1%; specificity, 75.4%). US combined with SMI and US combined with CDFI achieved the same specificity (76.7%), which was higher than that of US alone (66.7%). Conclusions SMI was superior to color Doppler flow imaging in evaluating the microvasculature in lymphadenopathy in mesenteric lymphadenitis. SMI may be used as an adjunct to grayscale ultrasonography to assist in identifying mesenteric lymphadenopathy in pediatric patients.
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Affiliation(s)
- Dao-Ming Zu
- Department of Pediatrics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Ling-Ling Feng
- Department of Gynecology and Obstetrics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Lei Zhang
- Department of Pediatrics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Su-Li Ma
- Department of Pediatrics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
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A comparative study on superb microvascular imaging and conventional ultrasonography in differentiating BI-RADS 4 breast lesions. Oncol Lett 2019; 18:3202-3210. [PMID: 31452797 PMCID: PMC6676576 DOI: 10.3892/ol.2019.10603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/11/2019] [Indexed: 11/06/2022] Open
Abstract
This prospective study aimed to explore the diagnostic value of superb microvascular imaging (SMI) in differentiating Breast Imaging Reporting and Data System (BI-RADS) 4 breast lesions compared with conventional ultrasonography (US). A total of 111 patients with 116 breast lesions underwent grayscale ultrasound (US), colour Doppler flow imaging (CDFI) and SMI breast imaging between February 2016 and May 2018. CDFI and SMI were performed to evaluate vascular quantity, morphology, and distribution characteristics. The detection of malignancy was compared between grayscale US alone, US + CDFI and US + SMI in terms of the BI-RADS stratification system. SMI was observed to be significantly more accurate in distinguishing malignant breast lesions (86.67%) compared with CDFI (80.00%) (P<0.001). Among malignant lesions, SMI detected 80.00% of those that contained ≥4 vessels, while CDFI only detected 56.67%. Penetrating and branching vessels were identified by SMI in 53.33% of malignant breast lesions and by CDFI in 10.00%. There was no significant difference in vascular distribution by SMI (P=0.094) and by CDFI (P=0.087). US + SMI was associated with higher sensitivity, specificity, and accuracy rates (86.67, 83.72 and 84.48%, respectively) compared with US + CDFI (80.00, 72.09 and 74.14%, respectively). The area under the curve values from receiver operating characteristic analysis of US + SMI, US + CDFI and US alone were 0.852 [95% confidence interval (CI): 0.768–0.936)] 0.760 (95% CI: 0.660–0.860), 0.698 (95% CI: 0.589–0.807), respectively (P<0.001). SMI yielded more detailed vascular information associated with malignant breast masses when compared with conventional US. Therefore, as an adjunct to grayscale, SMI exhibited a markedly improved diagnostic capability in distinguishing malignant and benign breast lesions, particularly those of BI-RADS category 4.
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