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Yang YP, Zhang GL, Zhou HL, Dai HX, Huang X, Liu LJ, Xie J, Wang JX, Li HJ, Liang X, Yuan Q, Zeng YH, Xu XH. Diagnostic efficacy of the contrast-enhanced ultrasound thyroid imaging reporting and data system classification for benign and malignant thyroid nodules. Quant Imaging Med Surg 2024; 14:5721-5736. [PMID: 39144013 PMCID: PMC11320530 DOI: 10.21037/qims-24-457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/21/2024] [Indexed: 08/16/2024]
Abstract
Background The contrasted-enhanced ultrasound thyroid imaging reporting and data system (CEUS TI-RADS) is the first international risk stratification system for thyroid nodules based on conventional ultrasound (US) and CEUS. This study aimed to evaluate the diagnostic efficacy of CEUS TI-RADS for benign and malignant thyroid nodules and to assess the related interobserver agreement. Methods The study recruited 433 patients who underwent thyroid US and CEUS between January 2019 and June 2023 at the Affiliated Hospital of Guangdong Medical University. A retrospective analysis of 467 thyroid nodules confirmed by fine-needle aspiration (FNA) and/or surgery was performed. Further, a CEUS TI-RADS classification was assigned to each thyroid nodule based on the CEUS TI-RADS scoring criteria for the US and CEUS features of the nodule. The nodules were grouped based on their sizes as follows: size ≤1 cm, group A; size >1 and ≤4 cm, group B; and size >4 cm, group C. Multivariate logistic regression was used to analyze independent risk factors for malignant thyroid nodules. Pathological assessment was the reference standard for establishing the sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) of CEUS TI-RADS in diagnosing malignant thyroid nodules. The area under the curve (AUC) in the receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficacy of the scoring system in predicting malignancy in three groups of nodules. The intragroup correlation coefficient (ICC) was adopted to assess the interobserver agreement of the CEUS TI-RADS score. Results Out of the 467 thyroid nodules, 262 were malignant and 205 were benign. Logistic regression analysis revealed that the independent risk factors for malignant thyroid nodules included punctate echogenic foci (P<0.001), taller-than-wide shape (P=0.015), extrathyroidal invasion (P=0.020), irregular margins/lobulation (P=0.036), hypoechoicity on US (P=0.038), and hypoenhancement on CEUS (P<0.001). The AUC for the CEUS TI-RADS in diagnosing malignant thyroid nodules was 0.898 for all nodules, 0.795 for group A, 0.949 for group B, and 0.801 for group C, with the optimal cutoff values of the CEUS TI-RADS being 5 points, 6 points, 5 points, and 5 points, respectively. Among these groups of nodules, group B had the highest AUC, with the SEN, SPE, ACC, PPV, and NPV for diagnosing malignant nodules being 95.9%, 88.1%, 92.8%, 92.6%, and 93.2%, respectively. The ICC of the CEUS TI-RADS classification between senior and junior physicians was 0.862 (P<0.001). Conclusions In summary, CEUS TI-RADS demonstrated significant efficacy in distinguishing thyroid nodules. Nonetheless, there were variations in its capacity to detect malignant nodules across diverse sizes, and it demonstrate optimal performance in 1- to 4-cm nodules. These findings may serve as important insights for clinical diagnoses.
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Affiliation(s)
- Yu-Ping Yang
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Guo-Li Zhang
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Hong-Lian Zhou
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Hai-Xia Dai
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xing Huang
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Li-Juan Liu
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jun Xie
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jie-Xin Wang
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Hua-Juan Li
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xin Liang
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qian Yuan
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yan-Hao Zeng
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiao-Hong Xu
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Brandenstein MK, Zhang L, Scharf G, Thurn S, Hornung M, Menhart K, Meiler S, Stroszczynski C, Jung EM. The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging. ROFO-FORTSCHR RONTG 2024. [PMID: 39038458 DOI: 10.1055/a-2350-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
V-flow is a dynamic ultrasound technique that visualizes perfusion patterns by displaying dynamic arrows that change in response to the flow of erythrocytes. Furthermore, it provides quantitative values for the maximum and mean velocity of blood flow as well as a percentage value for turbulence. The aim was to enhance the preoperative diagnostic accuracy of thyroid lesions by combining V-flow with established ultrasound modes.B-mode, CCDS, elastography, CEUS, and V-flow were performed on 101 patients. After the ultrasound examination, every nodule was confirmed as benign or malignant via histopathology. The Kruskal-Wallis test, ROC curve, and binary logistic regression were used for the statistical analysis.93 benign regressive thyroid nodules and 8 carcinomas were included in this study. The average mean velocity value for benign lesions was measured at 19.5 cm/s and at 10.7 cm/s for malignant lesions (p = 0.039). The average turbulence percentage was 26.1% for benign nodules and 46.7% for carcinomas (p = 0.016). Carcinomas exhibited a slower and more turbulent perfusion pattern compared to benign tumors. A V-flow-centered system achieves a sensitivity of 100.0% and a specificity of 84.9% in predicting malignancy. This system could have reduced the number of unnecessary thyroid surgeries for benign lesions in our patient group by 70%.The capillary perfusion of thyroid nodules represents a significant indicator of its status. By analyzing the velocity and turbulence level of microvascular blood flow, V-flow offers promising prospects for accurately distinguishing between benign and malignant thyroid lesions. When integrated into a comprehensive multimodal sonographic imaging approach, V-flow further enhances diagnostic accuracy. · V-flow allows for qualitative and quantitative analysis of microvascular perfusion. · Malignant tumors are associated with slower and more turbulent microvascular hemodynamics. · Combining V-flow with other ultrasound modes eases the diagnosis of thyroid carcinomas. · Brandenstein MK, Zhang L, Scharf G et al. The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2350-0107.
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Affiliation(s)
| | - Liang Zhang
- Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Gregor Scharf
- Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Sylvia Thurn
- Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Karin Menhart
- Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Stefanie Meiler
- Radiology, University Hospital Regensburg, Regensburg, Germany
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Żyłka A, Dobruch-Sobczak K, Piotrzkowska-Wróblewska H, Jędrzejczyk M, Bakuła-Zalewska E, Góralski P, Gałczyński J, Dedecjus M. The Utility of Contrast-Enhanced Ultrasound (CEUS) in Assessing the Risk of Malignancy in Thyroid Nodules. Cancers (Basel) 2024; 16:1911. [PMID: 38791990 PMCID: PMC11119249 DOI: 10.3390/cancers16101911] [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: 03/21/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Ultrasonography is a primary method used in the evaluation of thyroid nodules, but no single feature of this method predicts malignancy with high accuracy. Therefore, this paper aims to assess the utility of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of thyroid nodules. METHODS The study group comprised 188 adult patients (155 women and 33 men) who preoperatively underwent CEUS of a thyroid nodule classified as Bethesda categories II-VI after fine-needle aspiration biopsy. During the CEUS examination, 1.5 mL of SonoVue contrast was injected intravenously, after which 15 qualitative CEUS enhancement patterns were analysed. RESULTS The histopathologic results comprised 65 benign thyroid nodules and 123 thyroid carcinomas. The dominant malignant CEUS features, such as hypo- and heterogeneous enhancement and slow wash-in phase, were evaluated, whereas high enhancement, ring enhancement, and a slow wash-out phase were assessed as predictors of benign lesions. Two significant combinations of B-mode and CEUS patterns were noted, namely, hypoechogenicity with heterogeneous enhancement and non-smooth margins with hypo- or iso-enhancement. CONCLUSIONS The preliminary results indicate that CEUS is a useful tool in assessing the risk of malignancy of thyroid lesions. The combination of the qualitative enhancement parameters and B-mode sonographic features significantly increases the method's usefulness.
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Affiliation(s)
- Agnieszka Żyłka
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.G.); (J.G.); (M.D.)
| | - Katarzyna Dobruch-Sobczak
- Radiology Department II, Maria Sklodowska-Curie National Research Institute of Oncology, 02-034 Warsaw, Poland;
| | - Hanna Piotrzkowska-Wróblewska
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, 02-106 Warsaw, Poland;
| | - Maciej Jędrzejczyk
- Department of Ultrasound and Mammography Diagnostics, Mazovian Brodnowski Hospital, 03-242 Warsaw, Poland;
| | - Elwira Bakuła-Zalewska
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Piotr Góralski
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.G.); (J.G.); (M.D.)
| | - Jacek Gałczyński
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.G.); (J.G.); (M.D.)
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.G.); (J.G.); (M.D.)
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Chen JH, Zhang YQ, Zhu TT, Zhang Q, Zhao AX, Huang Y. Applying machine-learning models to differentiate benign and malignant thyroid nodules classified as C-TIRADS 4 based on 2D-ultrasound combined with five contrast-enhanced ultrasound key frames. Front Endocrinol (Lausanne) 2024; 15:1299686. [PMID: 38633756 PMCID: PMC11021584 DOI: 10.3389/fendo.2024.1299686] [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: 09/22/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives To apply machine learning to extract radiomics features from thyroid two-dimensional ultrasound (2D-US) combined with contrast-enhanced ultrasound (CEUS) images to classify and predict benign and malignant thyroid nodules, classified according to the Chinese version of the thyroid imaging reporting and data system (C-TIRADS) as category 4. Materials and methods This retrospective study included 313 pathologically diagnosed thyroid nodules (203 malignant and 110 benign). Two 2D-US images and five CEUS key frames ("2nd second after the arrival time" frame, "time to peak" frame, "2nd second after peak" frame, "first-flash" frame, and "second-flash" frame) were selected to manually label the region of interest using the "Labelme" tool. A total of 7 images of each nodule and their annotates were imported into the Darwin Research Platform for radiomics analysis. The datasets were randomly split into training and test cohorts in a 9:1 ratio. Six classifiers, namely, support vector machine, logistic regression, decision tree, random forest (RF), gradient boosting decision tree and extreme gradient boosting, were used to construct and test the models. Performance was evaluated using a receiver operating characteristic curve analysis. The area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy (ACC), and F1-score were calculated. One junior radiologist and one senior radiologist reviewed the 2D-US image and CEUS videos of each nodule and made a diagnosis. We then compared their AUC and ACC with those of our best model. Results The AUC of the diagnosis of US, CEUS and US combined CEUS by junior radiologist and senior radiologist were 0.755, 0.750, 0.784, 0.800, 0.873, 0.890, respectively. The RF classifier performed better than the other five, with an AUC of 1 for the training cohort and 0.94 (95% confidence interval 0.88-1) for the test cohort. The sensitivity, specificity, accuracy, PPV, NPV, and F1-score of the RF model in the test cohort were 0.82, 0.93, 0.90, 0.85, 0.92, and 0.84, respectively. The RF model with 2D-US combined with CEUS key frames achieved equivalent performance as the senior radiologist (AUC: 0.94 vs. 0.92, P = 0.798; ACC: 0.90 vs. 0.92) and outperformed the junior radiologist (AUC: 0.94 vs. 0.80, P = 0.039, ACC: 0.90 vs. 0.81) in the test cohort. Conclusions Our model, based on 2D-US and CEUS key frames radiomics features, had good diagnostic efficacy for thyroid nodules, which are classified as C-TIRADS 4. It shows promising potential in assisting less experienced junior radiologists.
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Affiliation(s)
| | | | | | | | | | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Gong ZJ, Xin J, Yin J, Wang B, Li X, Yang HX, Zhu YW, Shen J, Gu J. Diagnostic Value of Artificial Intelligence-Assistant Diagnostic System Combined With Contrast-Enhanced Ultrasound in Thyroid TI-RADS 4 Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1527-1535. [PMID: 36723397 DOI: 10.1002/jum.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study evaluated the diagnostic value of artificial intelligence-assistant diagnostic system combined with contrast-enhanced ultrasound in The American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS) 4 category thyroid nodules. METHODS Thyroid nodules that were evaluated as ACR TI-RADS 4 by conventional ultrasound were selected, all of which had pathological or fine needle aspiration (FNA) results. All nodules were examined by contrast-enhanced ultrasound (CEUS) and artificial intelligence (AI) analysis. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of AI, CEUS and their combined diagnosis were compared; Analyzed and compared the diagnostic efficiency of AI, CEUS and their combined diagnosis. RESULTS A total of 148 thyroid nodules were included in 140 patients, including 58 malignant nodules and 89 benign nodules. The sensitivity of combined diagnosis was significantly higher than that of AI or CEUS alone (P < .05). The NPV of AI, CEUS and combined diagnosis were statistically significant (P < .05). There was no significant difference in the diagnostic efficacy between AI and CEUS (P > .05), but there was a significant difference in NPV between AI and combined diagnosis (P < .05). The AUC of the combined diagnosis was 0.859, which was higher than that of AI, CEUS alone. CONCLUSIONS AI has a high diagnostic efficiency, which was helpful for radiologists to make rapid assessment. AI combined CEUS can significantly improve the diagnostic sensitivity and NPV, which was beneficial for the early detection of malignant nodules.
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Affiliation(s)
- Zhong-Jing Gong
- Department of Ultrasound, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Xin
- Department of Ultrasound, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jun Yin
- Department of Ultrasound, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bo Wang
- Department of Ultrasound, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xin Li
- Department of Ultrasound, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui-Xian Yang
- Department of Ultrasound, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan-Wen Zhu
- Department of Pathology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Junkang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiying Gu
- Department of Ultrasound, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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Dolidze DD, Bagatelia ZA, Lukin AY, Сovantsev SD, Shevyakova TV, Pichugina NV, Skripnichenko DM, Mulaeva KA. The possibilities of ultrasound imaging in the diagnosis of follicular neoplasia of the thyroid gland. HEAD AND NECK TUMORS (HNT) 2023; 13:81-90. [DOI: 10.17650/2222-1468-2023-13-1-81-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
Thyroid cancer is the most common cancer of the endocrine system. The diagnosis of thyroid cancer has taken a step forward due to the introduction of fine-needle biopsy of the thyroid gland with subsequent evaluation of cytological material using the Bethesda system. One category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the neoplasia as benign or malignant and requires surgical intervention. The traditional informative and widely used method for diagnosing thyroid tumors is ultrasound. However, the sensitivity and specificity of the method varies over a wide range. This review analyzes the literature on the possibilities of ultrasound diagnostics in assessing the malignant potential of follicular tumors of the thyroid gland.
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Affiliation(s)
- D. D. Dolidze
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - Z. A. Bagatelia
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - A. Yu. Lukin
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | - S. D. Сovantsev
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - T. V. Shevyakova
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | - N. V. Pichugina
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
| | | | - K. A. Mulaeva
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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Sultan SR. B-mode Ultrasound Characteristics of Thyroid Nodules With High-Benign Probability and Nodules With Risk of Malignancy. Cureus 2023; 15:e39281. [PMID: 37346196 PMCID: PMC10280039 DOI: 10.7759/cureus.39281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Thyroid nodules are commonly found on clinical examination or diagnostic imaging of the neck. Malignant thyroid nodules are increasing worldwide, making thyroid cancer one of the most common endocrine malignancies worldwide. The aim of this study was to determine B-mode ultrasound characteristics of benign thyroid nodules and nodules with risk of malignancy. Material and methods: This retrospective study was conducted on subjects (n=99) who underwent thyroid ultrasound. Data were retrieved from the Thyroid Digital Image Database of Universidad Nacional de Colombia, a published open-access dataset, in which B-mode ultrasound images were interpreted by expert radiologists providing a complete diagnostic description of thyroid lesions using the Thyroid Imaging Reporting and Data System. RESULTS Sponge-like appearance (Pearson Chi-Square 4.6, p=0.02), cystic (Pearson Chi-Square 27.3, p<0.001), isoechoic (Pearson Chi-Square 26, p<0.001), and well-defined (Pearson Chi-Square 13.7, p<0.001) thyroid nodules were more likely to be observed in benign nodules (risk of malignancy <5%). On the other hand, predominately solid (Pearson Chi-Square 5.9, p=0.01), microcalcifications (Pearson Chi-Square 50.7, p<0.001), hypoechoic (Pearson Chi-Square 27.7, p<0.001), irregular shape (Pearson Chi-Square 6.6, p=0.01), and ill-defined (Pearson Chi-Square 8.8, p=0.003) thyroid nodules were more likely to be observed in nodules with risk of malignancy (>5%). CONCLUSION Ultrasound characteristics could be used to determine thyroid nodules with risk of malignancy and avoid over-diagnosing nodules with benign features. Further research evaluating the use of multiparametric ultrasound to distinguish between benign thyroid nodules and thyroid nodules with risk of malignancy is required.
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Affiliation(s)
- Salahaden R Sultan
- Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, SAU
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Chen XJ, Huang LJ, Mao F, Yuan HX, Wang X, Lu Q, Dong CH. Value of CEUS features in diagnosing thyroid nodules with halo sign on B-mode ultrasound. BMC Med Imaging 2023; 23:11. [PMID: 36681788 PMCID: PMC9867848 DOI: 10.1186/s12880-023-00966-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The results of halo sign in the differential diagnosis of thyroid nodules were conflicting, and the value of contrast-enhanced ultrasound (CEUS) in characterization of thyroid nodules with halo has not been fully evaluated. This study was therefore designed to investigate the value of contrast-enhanced ultrasound features in the differential diagnosis of thyroid nodules with halo sign on B-mode ultrasound. MATERIAL AND METHODS Seventy-four consecutive thyroid nodules with halo sign on B-mode ultrasound were pathologically confirmed by surgery or fine needle aspiration, including 43 benign and 31 malignant lesions. All these lesions underwent pre-operative CEUS examination. The CEUS features, including enhanced time, enhanced intensity and homogeneity, and presence of enhancing ring, were compared between benign and malignant ones. RESULTS Enhanced intensity was significant different between benign and malignant lesions with halo. Hypo-enhancement was more frequently detected in malignant nodules than that in benign ones, compared with iso-enhancement and hyper-enhancement (p = 0.013, and = 0.014, respectively). Detection rate of high-enhancing ring was significantly higher in benign nodules than that in malignant group (p = 0.001). While in nodules > 10 mm, only high-enhancing ring was the distinguishing feature between benign and malignant nodules. CONCLUSIONS Enhanced intensity and high-enhancing ring may be helpful in the differential diagnosis of thyroid nodules with halo sign on B-mode ultrasound.
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Affiliation(s)
- Xue-Jun Chen
- Department of Ultrasound, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, Fujian Province, China
| | - Lin-Jin Huang
- Department of Ultrasound, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, 361015, Fujian Province, China
| | - Feng Mao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Hai-Xia Yuan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Xi Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China
| | - Qing Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China.
| | - Cai-Hong Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200030, China.
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Boers T, Braak SJ, Rikken NET, Versluis M, Manohar S. Ultrasound imaging in thyroid nodule diagnosis, therapy, and follow-up: Current status and future trends. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023. [PMID: 36655705 DOI: 10.1002/jcu.23430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Ultrasound, the primary imaging modality in thyroid nodule management, suffers from drawbacks including: high inter- and intra-observer variability, limited field-of-view and limited functional imaging. Developments in ultrasound technologies are taking place to overcome these limitations, including three-dimensional-Doppler, -elastography, -nodule characteristics-extraction, and novel machine-learning algorithms. For thyroid ablative treatments and biopsies, perioperative use of three-dimensional ultrasound opens a new field of research. This review provides an overview of the current and future applications of ultrasound, and discusses the potential of new developments and trends that may improve the diagnosis, therapy, and follow-up of thyroid nodules.
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Affiliation(s)
- Tim Boers
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Sicco J Braak
- Department of Radiology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Nicole E T Rikken
- Department of Endocrinology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Michel Versluis
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Srirang Manohar
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
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Zhang G, Yu J, Lei YM, Hu JR, Hu HM, Harput S, Guo ZZ, Cui XW, Ye HR. Ultrasound super-resolution imaging for the differential diagnosis of thyroid nodules: A pilot study. Front Oncol 2022; 12:978164. [PMID: 36387122 PMCID: PMC9647016 DOI: 10.3389/fonc.2022.978164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/12/2022] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Ultrasound imaging provides a fast and safe examination of thyroid nodules. Recently, the introduction of super-resolution imaging technique shows the capability of breaking the Ultrasound diffraction limit in imaging the micro-vessels. The aim of this study was to evaluate its feasibility and value for the differentiation of thyroid nodules. METHODS In this study, B-mode, contrast-enhanced ultrasound, and color Doppler flow imaging examinations were performed on thyroid nodules in 24 patients. Super-resolution imaging was performed to visualize the microvasculature with finer details. Microvascular flow rate (MFR) and micro-vessel density (MVD) within thyroid nodules were computed. The MFR and MVD were used to differentiate the benign and malignant thyroid nodules with pathological results as a gold standard. RESULTS Super-resolution imaging (SRI) technique can be successfully applied on human thyroid nodules to visualize the microvasculature with finer details and obtain the useful clinical information MVD and MFR to help differential diagnosis. The results suggested that the mean value of the MFR within benign thyroid nodule was 16.76 ± 6.82 mm/s whereas that within malignant thyroid was 9.86 ± 4.54 mm/s. The mean value of the MVD within benign thyroid was 0.78 while the value for malignant thyroid region was 0.59. MFR and MVD within the benign thyroid nodules were significantly higher than those within the malignant thyroid nodules respectively (p < 0.01). CONCLUSIONS This study demonstrates the feasibility of ultrasound super-resolution imaging to show micro-vessels of human thyroid nodules via a clinical ultrasound platform. The important imaging markers, such as MVD and MFR, can be derived from SRI to provide more useful clinical information. It has the potential to be a new tool for aiding differential diagnosis of thyroid nodules.
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Affiliation(s)
- Ge Zhang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of science and technology, Wuhan, China
| | - Jing Yu
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Yu-Meng Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Jun-Rui Hu
- Department of Chemistry and Chemical Engineering, Queen’s University Belfast, Belfast, United Kingdom
| | - Hai-Man Hu
- Department of Electrical and Electronic Engineering, Hubei University of Technology, Wuhan, China
| | - Sevan Harput
- Department of Electrical and Electronic Engineering, London South Bank University, London, United Kingdom
| | - Zhen-Zhong Guo
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of science and technology, Wuhan, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Rong Ye
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
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11
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Brandenstein M, Wiesinger I, Künzel J, Hornung M, Stroszczynski C, Jung EM. Multiparametric Sonographic Imaging of Thyroid Lesions: Chances of B-Mode, Elastography and CEUS in Relation to Preoperative Histopathology. Cancers (Basel) 2022; 14:cancers14194745. [PMID: 36230668 PMCID: PMC9564296 DOI: 10.3390/cancers14194745] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary As the incidence of thyroid lesions in Europe is rising, more and more people affected by thyroid pathologies seek treatment in a clinic. Every suspicious thyroid nodule needs to be confirmed as benign or malignant in order to be treated correctly. Unnecessary invasive diagnostics and thyroid surgery should be avoided. The aim of this retrospective study was to improve the distinction between benign and malignant nodules by using new high-performance multiparametric ultrasound examination techniques. By analyzing 122 thyroid nodules we created a score-based system combining B-mode, shear-wave elastography and contrast-enhanced ultrasound malignancy criteria. This system allows for a quite accurate detection of thyroid carcinomas with a sensitivity of 95% and specificity of 75.49%. Shear-wave elastography and contrast-enhanced ultrasound can detect unique malignancy features, which cannot be found in B-mode. Therefore, these criteria would present a relevant addition to the B-mode TI-RADS classification. Abstract Background: The aim was to improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance multiparametric ultrasound examination techniques. Methods: Multiparametric ultrasound consists of B-mode, shear-wave elastography and contrast enhanced ultrasound (CEUS) including Time-Intensity-Curve (TIC) analysis. A bolus of 1–2.4 mL Sulfur Hexafluorid microbubbles was injected for CEUS. Postoperative histopathology was the diagnostic gold standard. Results: 116 patients were included in this study. 102 benign thyroid nodules were diagnosed as well as 20 carcinomas. Suspicious B-mode findings like microcalcifications, a blurry edge and no homogeneous sonomorphological structure were detected in 60, 75 and 80% of all carcinomas but only in 13.7, 36.3 and 46.1% of all benign lesions. The average shear-wave elastography measurements of malignant lesions (4.6 m/s or 69.8 kPa centrally and 4.2 m/s or 60.1 kPa marginally) exceed the values of benign nodules. Suspicious CEUS findings like a not-homogeneous wash-in and a wash-out were detected almost twice as often in carcinomas. Conclusion: Multiparametric ultrasound offers new possibilities for the preoperative distinction between benign and malignant thyroid nodules. A score based system of B-mode, shear-wave and CEUS malignancy criteria shows promising results in the detection of thyroid carcinomas. It reaches a sensitivity of 95% and specificity of 75.49%.
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Affiliation(s)
- Moritz Brandenstein
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-17-647-793-303
| | - Isabel Wiesinger
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Matthias Hornung
- Department of Surgery, University Hospital, 93053 Regensburg, Germany
| | - Christian Stroszczynski
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
| | - Ernst-Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital, 93053 Regensburg, Germany
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12
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Abstract
In multimodal radiologic imaging, contrast-enhanced ultrasound (CEUS) is increasingly used. One of the advantages of CEUS is the possibility of repeated application of contrast media without decreasing renal function or affecting the thyroid gland. Small solid liver lesions can be diagnosed and detected with high accuracy. Moreover, solid lesions in other abdominal organs can also be characterized. Frequent applications for solid lesions in the near field concern thyroid tumors and lymph nodes. For prostate diagnostics, CEUS can be used with an endorectal probe and perfusion imaging. This review explains how the additional (semi-)quantitative perfusion analysis, especially time-intensity curve (TIC) analyses, and wash-in/wash-out kinetics of integrated or external perfusion software programs facilitate new options in dynamic assessment of microvascularization during tumor follow-up care and even minimally invasive tumor therapy.
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Affiliation(s)
- Ernst-Michael Jung
- Institute of Radiology, Interdisciplinary Department for Ultrasound, University Medical Center, Regensburg, Germany.
- Institut für Röntgendiagnostik/Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Isabel Wiesinger
- Institute of Neuroradiology, Bezirksklinikum Regensburg, Regensburg, Germany
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13
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Radzina M, Ratniece M, Putrins DS, Saule L, Cantisani V. Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives. Cancers (Basel) 2021; 13:5469. [PMID: 34771632 PMCID: PMC8582579 DOI: 10.3390/cancers13215469] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Ultrasound has been established as a baseline imaging technique for thyroid nodules. The main advantage of adding CEUS is the ability to assess the sequence and intensity of vascular perfusion and hemodynamics in the thyroid nodule, thus providing real-time characterization of nodule features, considered a valuable new approach in the determination of benign vs. malignant nodules. Original studies, reviews and six meta-analyses were included in this article. A total of 624 studies were retrieved, and 107 were included in the study. As recognized for thyroid nodule malignancy risk stratification by US, for acceptable accuracy in malignancy a combination of several CEUS parameters should be applied: hypo-enhancement, heterogeneous, peripheral irregular enhancement in combination with internal enhancement patterns, and slow wash-in and wash-out curve lower than in normal thyroid tissue. In contrast, homogeneous, intense enhancement with smooth rim enhancement and "fast-in and slow-out" are indicative of the benignity of the thyroid nodule. Even though overlapping features require standardization, with further research, CEUS may achieve reliable performance in detecting or excluding thyroid cancer. It can also play an operative role in guiding ablation procedures of benign and malignant thyroid nodules and metastatic lymph nodes, and providing accurate follow-up imaging to assess treatment efficacy.
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Affiliation(s)
- Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Madara Ratniece
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
| | - Davis Simanis Putrins
- Medical Faculty, University of Latvia, LV-1004 Riga, Latvia;
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Laura Saule
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia; (M.R.); (L.S.)
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1002 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Anatomopathological and Oncological Sciences, Sapienza University of Rome, 00100 Rome, Italy;
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14
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Sorrenti S, Dolcetti V, Fresilli D, Del Gaudio G, Pacini P, Huang P, Camponovo C, Leoncini A, D’Andrea V, Pironi D, Frattaroli F, Trimboli P, Radzina M, Cantisani V. The Role of CEUS in the Evaluation of Thyroid Cancer: From Diagnosis to Local Staging. J Clin Med 2021; 10:jcm10194559. [PMID: 34640574 PMCID: PMC8509399 DOI: 10.3390/jcm10194559] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/25/2022] Open
Abstract
Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate thyroid parenchyma as recommended by EFSUMB guidelines, for use in clinical research field, although its role is not yet clear. Several papers show the potential utility of CEUS in the differential diagnosis of benign and malignant thyroid nodules and in the analysis of lymph node involvement in neoplastic pathology. Therefore, we carried out an evaluation of the literature concerning the role of CEUS in three specific areas: the characterization of the thyroid nodule, the evaluation of minimally invasive treatment and loco-regional staging of the lymph node in proven thyroid cancer. According to evidence reported, CEUS can also play an operative role in nodular thyroid pathology as it is able to guide ablation procedures on thyroid nodule and metastatic lymph nodes, to assess the radicality of surgery, to evaluate disease relapse at the level of the margins of ablated regions and to monitor the clinical evolution of necrotic areas in immediate post-treatment setting.
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Affiliation(s)
- Salvatore Sorrenti
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Vincenzo Dolcetti
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Daniele Fresilli
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Giovanni Del Gaudio
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Patrizia Pacini
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
| | - Pintong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou 310009, China;
- Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Chiara Camponovo
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
| | - Andrea Leoncini
- Servizio di Radiologia e Radiologia Interventistica, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
| | - Vito D’Andrea
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Daniele Pironi
- Department of Surgical Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (S.S.); (V.D.); (D.P.)
| | - Fabrizio Frattaroli
- Department of Surgery “P. Stefanini”, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (C.C.); (P.T.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia;
- Medical Faculty, University of Latvia; Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1007 Riga, Latvia
| | - Vito Cantisani
- Department of Radiological, Oncological, and Pathological Sciences, Faculty of Medicine, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy; (V.D.); (D.F.); (G.D.G.); (P.P.)
- Correspondence:
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15
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Fresilli D, David E, Pacini P, Del Gaudio G, Dolcetti V, Lucarelli GT, Di Leo N, Bellini MI, D’Andrea V, Sorrenti S, Mascagni D, Biffoni M, Durante C, Grani G, De Vincentis G, Cantisani V. Thyroid Nodule Characterization: How to Assess the Malignancy Risk. Update of the Literature. Diagnostics (Basel) 2021; 11:1374. [PMID: 34441308 PMCID: PMC8391491 DOI: 10.3390/diagnostics11081374] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022] Open
Abstract
Ultrasound (US) is the first imaging modality for thyroid parenchyma evaluation. In the last decades, the role of ultrasound has been improved with the introduction of new US software, such as contrast-enhanced ultrasound (CEUS) and US-elastography (USE). USE is nowadays recognized as an essential part of the multiparametric ultrasound (MPUS) examination, in particular for the indeterminate thyroid nodule with possible fine-needle aspiration cytology (FNAC) number reduction; even if further and larger studies are needed to validate it. More controversial is the role of CEUS in thyroid evaluation, due to its high variability in sensitivity and specificity. Semi-automatic US systems based on the computer-aided diagnosis (CAD) system are producing interesting results, especially as an aid to less experienced operators. New knowledge on the molecular mechanisms involved in thyroid cancer is allowing practitioners to identify new genomic thyroid markers that could reduce the number of "diagnostic" thyroidectomies. We have therefore drawn up an updated representation of the current evidence in the literature for thyroid nodule multiparametric ultrasound (MPUS) evaluation with particular regard to USE, the US CAD system and CEUS.
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Affiliation(s)
- Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Emanuele David
- Radiological Sciences, Radiology Unit, Papardo-Hospital, 98158 Messina, Italy;
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Giovanni Del Gaudio
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Vincenzo Dolcetti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Giuseppe Tiziano Lucarelli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Nicola Di Leo
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Maria Irene Bellini
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Domenico Mascagni
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (C.D.); (G.G.)
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (C.D.); (G.G.)
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
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Wiesinger I, Jung F, Jung EM. Contrast-enhanced ultrasound (CEUS) and perfusion imaging using VueBox®. Clin Hemorheol Microcirc 2021; 78:29-40. [PMID: 33523044 DOI: 10.3233/ch-201040] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The external perfusion software (VueBox™) for contrast-enhanced ultrasound (CEUS), enables the quantitative analysis of micro-vascularization within non-cystic lesions in terms of characterization and detection. This review summarizes our work about parathyroid gland, thyroid gland, liver, prostate and other tissues as well as original studies in the use of parametric perfusion imaging. Useful perfusion parameters are introduced.
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Affiliation(s)
- Isabel Wiesinger
- Institute of Neuroradiology, medbo Bezirksklinikum Regensburg, Regensburg, Germany
| | - Friedrich Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, Senftenberg, Germany
| | - Ernst Michael Jung
- Institute of Radiology, Interdisciplinary Department for Ultrasound, University Medical Center, Regensburg, Germany
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17
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Wang Y, Dong T, Nie F, Wang G, Liu T, Niu Q. Contrast-Enhanced Ultrasound in the Differential Diagnosis and Risk Stratification of ACR TI-RADS Category 4 and 5 Thyroid Nodules With Non-Hypovascular. Front Oncol 2021; 11:662273. [PMID: 34123819 PMCID: PMC8189148 DOI: 10.3389/fonc.2021.662273] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
Objective This study aims to investigate the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis and risk stratification of ACR TI-RADS category 4 and 5 thyroid nodules with non-hypovascular. Methods From January 2016 to December 2019 in our hospital, 217 ACR TI-RADS category 4 and 5 nodules with non-hypovascular in 210 consecutive patients were included for a derivation cohort. With surgery and/or fine-needle aspiration (FNA) as a reference, conventional ultrasound (US) features and CEUS features were analyzed. Multivariate logistic regression analysis was used to screen the independent risk factors and establish a risk predictive model. Between January 2020 and March 2021, a second cohort of 100 consecutive patients with 101 nodules were included for an external validation cohort. The model was converted into a simplified risk score and was validated in the validation cohort. The area under the receiver operating characteristic curves (AUC) were used to assess the models’ diagnostic performance. Results Micro-calcification, irregular margin, earlier wash-out, centripetal enhancement, and absence of ring enhancement were independent risk factors and strongly discriminated malignancy in the derivation cohort (AUC = 0.921, 95% CI 0.876–0.953) and the validation cohort (0.900, 0.824–0.951). There was no significant difference (P = 0.3282) between the conventional US and CEUS in differentiating malignant non-hypovascular thyroid nodules, but a combination of them (the predictive model) had better performance than the single method (all P <0.05), with a sensitivity of 87.0%, specificity of 86.2%, and accuracy of 86.6% in the derivation cohort. The risk score based on the independent risk factors divided non-hypovascular thyroid nodules into low-suspicious (0–3 points; malignancy risk <50%) and high-suspicious (4–7 points; malignancy risk ≥ 50%), the latter with nodule ≥10mm was recommended for FNA. The risk score showed a good ability of risk stratification in the validation cohort. Comparing ACR TI-RADS in screening suitable non-hypovascular nodules for FNA, the risk score could avoid 30.8% benign nodules for FNA. Conclusions CEUS is helpful in combination with conventional US in differentiating ACR TI-RADS category 4 and 5 nodules with non-hypovascular. The risk score in this study has the potential to improve the diagnosis and risk stratification of non-hypovascular thyroid nodules.
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Affiliation(s)
- Yanfang Wang
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Tiantian Dong
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Guojuan Wang
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Ting Liu
- Medical Center of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Qian Niu
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou, China
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18
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Sun Y, Cui L, Wang S, Shi T, Hao Y, Lei Y. Comparative study of two contrast agents for intraoperative identification of sentinel lymph nodes in patients with early breast cancer. Gland Surg 2021; 10:1638-1645. [PMID: 34164308 DOI: 10.21037/gs-21-87] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The use of contrast-enhanced ultrasound (CEUS) to locate sentinel lymph nodes (SLNs) in breast cancer has been studied more and more in recent years. This prospective study aimed to compare periareolar injection of two different contrast agents, SonoVue® (SNV) and Sonazoid® (SNZ), followed by CEUS to identify SLNs in breast cancer patients with clinically negative nodes. Methods A total of 205 patients with T1-2N0M0 breast cancer were divided into the SNV group and SNZ group. All were administered a periareolar injection of SNV or SNZ and underwent US to identify contrast-enhanced SLNs. Each contrast-enhanced SLN underwent a biopsy with blue dye and examined again by CEUS in vitro. Results In all cases, contrast-enhanced lymphatic vessels were clearly visualized using US soon after the periareolar injection of SNZ, and the SLNs were easily identified. The SLN identification rates were 75.27% (210/279) for SNV and 93.58% (102/109) for SNZ. Although the accuracy of detecting SLN metastasis was slightly different between the two groups, there was no statistically significant difference between those groups (P=0.615). Moreover, it was possible to identify SLNs in vitro in the SNZ group, and these could be compared with the lymph nodes (LNs) located using SNZ during the preoperative stage and with blue dye during the procedure. This helped in determining the resection requirements. Conclusions When comparing the subdermal use of SNV and SNZ, no significant differences in the number of detected SLNs and the diagnosis of metastatic LNs were observed. Because SLNs can be detected for a longer time in living tissues with SNZ, this contrast agent may provide more intraoperative information for complete resection of all preoperative localization of SLN.
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Affiliation(s)
- Yan Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Shunmin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Tan Shi
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yunxia Hao
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yutao Lei
- Department of General Surgery, Peking University Third Hospital, Beijing, China
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