Diagnostic Value of AngioPLUS Microvascular Imaging in Thyroid Nodule Diagnosis Using Quantitative and Qualitative Vascularity Grading

Using ultrafast angio planewave ultrasensitive and conventional doppler imaging techniques to assess intramuscular blood perfusion in older adults

BACKGROUND

Microvascular ultrasound imaging techniques such as Angio PLanewave UltraSensitive (Angio-PL.U.S.) have been used to detect microvascular blood flow in various organs and tissues. However, the advantage of Angio-PL.U.S. for assessing muscle microvascularity over other non-invasive imaging modalities has not been investigated. This cross-sectional study compared ultrafast Angio-PL.U.S. and conventional color Doppler flow imaging (CDFI) techniques for assessing intramuscular blood perfusion.

METHODS

Forty-five older adults participated (age = 59.1 ± 7.6). The vascularity index (VI) was used to quantify intramuscular blood flow of the bilateral biceps brachii (BB) and medial gastrocnemius (MG). Intra-limb (difference in VI between CDFI and Angio-PL.U.S. techniques) and inter-limb differences [percent side-to-side differences (%SSD) in VI between dominant and non-dominant sides] were compared using Wilcoxon Signed Ranks and Mann-Whitney U tests, respectively. Associations between techniques were assessed using Spearman's rho (ρ).

RESULTS

No significant differences were observed between dominant and non-dominant BB (p ≥ 0.053) and MG (p ≥ 0.756) for both CDFI-VI and Angio-PL.U.S.-VI. Only VI measures for the non-dominant BB demonstrated significant intra-limb difference between techniques (p = 0.002). A significant %SSD between techniques was observed for BB (p = 0.022) but not MG (p = 0.225). Strong to very strong correlations were observed between CDFI-VI and Angio-PL.U.S.-VI across all muscles (ρ = 0.616-0.814, p ≤ 0.001).

CONCLUSION

Ultrafast Angio-PL.U.S. and conventional ultrasound imaging techniques were comparable when used in conjunction with the VI for quantifying resting intramuscular blood flow. Angio-PL.U.S. appeared to be more sensitive in detecting bilateral disparities in upper extremity muscles. However, further research is needed to validate these findings and investigate the potential clinical utility of this technique for characterizing disease progression in populations with global or unilateral musculoskeletal tissue alterations.

Comparison of Angio PLanewave UltraSensitive and Power Doppler Ultrasound in Detecting Synovial Blood Flow in Wrist and Finger Joints of Rheumatoid Arthritis Patients

RATIONALE AND OBJECTIVES

The purpose of this study is to conduct a comparison between the newly introduced Angio PLanewave UltraSensitive (AngioPLUS) method and the power Doppler ultrasound (PDUS) technique, evaluating the efficacy of these two methods in detecting synovial blood flow in wrist and finger joints of rheumatoid arthritis (RA) patients. Furthermore, the study aimed to investigate the potential associations between the observed blood flow patterns and various symptoms and indicators associated with RA.

MATERIALS AND METHODS

A cohort of 101 patients diagnosed with RA was included and subsequently categorized into two groups: 20 male participants (19.80%) and 81 female participants (80.20%). Their grayscale ultrasound, PDUS, and AngioPLUS were utilized to acquire data, and subsequent scoring was conducted. Serological tests of the patients were also performed, and DAS28 scores were calculated. The McNemar and Wilcoxon tests were used to compare the blood flow display rate and grading of PDUS as well as AngioPLUS, respectively.

RESULTS

AngioPLUS blood was significantly improved compared to PDUS. In all joints, the proportion of slight and significant improvement in wrist joints was the highest (14.11% and 1.98%, respectively). AngioPLUS was moderately correlated with C-reactive Protein (CRP), Disease Activity Score that includes 28-joint counts, and swollen joint counts and weakly correlated with platelet, hemoglobin, tender joint counts, and CRP before and after treatment.

CONCLUSION

Compared to PDUS, AngioPLUS has a better auxiliary diagnostic role in evaluating disease activity and can provide a reference to improve the management of RA further.

Diagnostic performance of ACR-TIRADS combined with superb microvascular imaging for differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas

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.

Ultrasound microflow patterns help in distinguishing malignant from benign thyroid nodules

BACKGROUND

Vascular features are not commonly used to evaluate thyroid nodules by conventional ultrasound due to the low sensitivity. Superb Microvascular Imaging (SMI) is a new ultrasonic Doppler technology that specializes in depicting microvessels and low-speed flow. The objective of this study was to explore the value of microflow features on SMI in differentiating malignant from benign thyroid nodules.

METHODS

One hundred and seventy-seven adult patients with thyroid nodules in our center from October 2021 to June 2022 with available histopathological results were recruited, including 125 malignant nodules and 123 benign nodules. Preoperative ultrasound was performed using greyscale, Color Doppler Flow Imaging (CDFI), monochrome SMI (mSMI) and color SMI (cSMI). Vascular features such as flow richness, microflow distribution and microflow patterns of malignant thyroid nodules were compared with those of benign nodules.

RESULTS

Penetrating vessel ≥ 1 (82.4% in the malignant group vs. 30.9% in the benign group, P < 0.001), the crab claw-like pattern (64.0% vs. 10.6%, P < 0.001) and the root hair-like pattern (8.0% vs. 2.4%, P = 0.049) were common in malignant thyroid nodules, among which the crab claw-like pattern was an independent risk factor for malignant thyroid nodules. The wheel-like pattern (1.6% in the malignant group vs. 33.3% in the benign group, P < 0.001) and the arborescent pattern (0 vs. 19.5%, P < 0.001) were more likely to appear in benign nodules. The diagnostic specificities of the crab claw-like pattern and the root hair-like pattern for malignant thyroid nodules were 0.894, 0.976, and the positive predictive values were 0.860, 0.769. The diagnostic specificities of the wheel-like pattern and the arborescent pattern for benign thyroid nodules were 0.984, 1.000, and the positive predictive values were 0.953, 1.000.

CONCLUSIONS

The crab claw-like pattern and the root hair-like pattern were microflow characteristics of malignant thyroid nodules. The wheel-like pattern and the arborescent pattern could help exclude the diagnosis of thyroid cancer.

Diagnostic efficiency among Eu-/C-/ACR-TIRADS and S-Detect for thyroid nodules: a systematic review and network meta-analysis

Background

The performance in evaluating thyroid nodules on ultrasound varies across different risk stratification systems, leading to inconsistency and uncertainty regarding diagnostic sensitivity, specificity, and accuracy.

Objective

Comparing diagnostic performance of detecting thyroid cancer among distinct ultrasound risk stratification systems proposed in the last five years.

Evidence acquisition

Systematic search was conducted on PubMed, EMBASE, and Web of Science databases to find relevant research up to December 8, 2022, whose study contents contained elucidation of diagnostic performance of any one of the above ultrasound risk stratification systems (European Thyroid Imaging Reporting and Data System[Eu-TIRADS]; American College of Radiology TIRADS [ACR TIRADS]; Chinese version of TIRADS [C-TIRADS]; Computer-aided diagnosis system based on deep learning [S-Detect]). Based on golden diagnostic standard in histopathology and cytology, single meta-analysis was performed to obtain the optimal cut-off value for each system, and then network meta-analysis was conducted on the best risk stratification category in each system.

Evidence synthesis

This network meta-analysis included 88 studies with a total of 59,304 nodules. The most accurate risk category thresholds were TR5 for Eu-TIRADS, TR5 for ACR TIRADS, TR4b and above for C-TIRADS, and possible malignancy for S-Detect. At the best thresholds, sensitivity of these systems ranged from 68% to 82% and specificity ranged from 71% to 81%. It identified the highest sensitivity for C-TIRADS TR4b and the highest specificity for ACR TIRADS TR5. However, sensitivity for ACR TIRADS TR5 was the lowest. The diagnostic odds ratio (DOR) and area under curve (AUC) were ranked first in C-TIRADS.

Conclusion

Among four ultrasound risk stratification options, this systemic review preliminarily proved that C-TIRADS possessed favorable diagnostic performance for thyroid nodules.

Systematic review registration

https://www.crd.york.ac.uk/prospero, CRD42022382818.

Quantitative Biomarkers Derived from a Novel Contrast-Free Ultrasound High-Definition Microvessel Imaging for Distinguishing Thyroid Nodules

Low specificity in current ultrasound modalities for thyroid cancer detection necessitates the development of new imaging modalities for optimal characterization of thyroid nodules. Herein, the quantitative biomarkers of a new high-definition microvessel imaging (HDMI) were evaluated for discrimination of benign from malignant thyroid nodules. Without the help of contrast agents, this new ultrasound-based quantitative technique utilizes processing methods including clutter filtering, denoising, vessel enhancement filtering, morphological filtering, and vessel segmentation to resolve tumor microvessels at size scales of a few hundred microns and enables the extraction of vessel morphological features as new tumor biomarkers. We evaluated quantitative HDMI on 92 patients with 92 thyroid nodules identified in ultrasound. A total of 12 biomarkers derived from vessel morphological parameters were associated with pathology results. Using the Wilcoxon rank-sum test, six of the twelve biomarkers were significantly different in distribution between the malignant and benign nodules (all p < 0.01). A support vector machine (SVM)-based classification model was trained on these six biomarkers, and the receiver operating characteristic curve (ROC) showed an area under the curve (AUC) of 0.9005 (95% CI: [0.8279,0.9732]) with sensitivity, specificity, and accuracy of 0.7778, 0.9474, and 0.8929, respectively. When additional clinical data, namely TI-RADS, age, and nodule size were added to the features, model performance reached an AUC of 0.9044 (95% CI: [0.8331,0.9757]) with sensitivity, specificity, and accuracy of 0.8750, 0.8235, and 0.8400, respectively. Our findings suggest that tumor vessel morphological features may improve the characterization of thyroid nodules.