1
|
Li S, Ding Z, Li X, Fu M, Sang L, Yang M, Tang R, Gu T, Sang L. A meta-analysis: elucidating diagnostic thresholds of peak systolic flow velocities in thyroid arteries for the discrimination of Graves' disease and destructive thyrotoxicosis. Front Endocrinol (Lausanne) 2024; 15:1393126. [PMID: 38911037 PMCID: PMC11190173 DOI: 10.3389/fendo.2024.1393126] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Objective This meta-analysis examines peak systolic velocities (PSVs) in thyroid arteries as potential biomarkers for thyroid disorders, which includes treated and untreated Graves' disease(GD) and destructive thyrotoxicosis(DT). Methods A search across databases including PubMed, Google Scholar, Embase, and Web of Science identified studies assessing peak systolic flow velocity in the inferior thyroid artery (ITA-PSV) and superior thyroid artery (STA-PSV) diagnostic efficacy in GD and DT.And the search was restricted to publications in the English language.The analysis compared STA-PSV and ITA-PSV across patient groups, evaluating intra-group variances and synthesizing sensitivity and specificity data. Results The analysis covered 18 studies with 1276 GD, 564 DT patients, and 544 controls. The difference of STA-PSV between GD group, DT group and normal group and the difference of ITA-PSV were analyzed in subgroups, and there was no statistical significance between subgroups when comparing any two groups. Normal subjects displayed intra-group ITA-PSV and STA-PSV differences with established cut-off values of 20.33 cm/s (95% CI, 17.48-23.18) for ITA-PSV and 25.61 cm/s (95% CI, 20.37-30.85) for STA-PSV. However, no significant intra-group differences were observed in the STA-PSV and ITA-PSV cut-off values among groups with GD or DT. The combined cut-off values for these patient groups and normal subjects were 68.63 cm/s (95% CI, 59.12-78.13), 32.08 cm/s (95% CI, 25.90-38.27), and 23.18 cm/s (95% CI, 20.09-26.28), respectively. The diagnostic odds ratio(DOR) for these values was 35.86 (95% CI, 18.21-70.60), and the area under the summary receiver operating characteristic (SROC) curve was 0.91, with a sensitivity estimate of 0.842 (95% CI, 0.772-0.866). Conclusion PSVs in thyroid arteries are useful diagnostic tools in distinguishing DT from GD. A PSV above 68.63 cm/s significantly improves GD diagnosis with up to 91% efficacy. No notable differences were found between superior and inferior thyroid arteries in these conditions.
Collapse
Affiliation(s)
- Sinong Li
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zheng Ding
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiang Li
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Miao Fu
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Li Sang
- Department of Acupuncture and Massage, Shouguang Hospital of Traditional Chinese Medicine, Shouguang, China
| | - Mingxia Yang
- Department of Ultrasound, Shouguang People’s Hospital, Shouguang, China
| | - Rubo Tang
- Department of Cardiology, Shouguang People’s Hospital, Shouguang, China
| | - Tianxiang Gu
- Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liang Sang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
2
|
Huang J, Zhao J. Quantitative Diagnosis Progress of Ultrasound Imaging Technology in Thyroid Diffuse Diseases. Diagnostics (Basel) 2023; 13:diagnostics13040700. [PMID: 36832188 PMCID: PMC9954877 DOI: 10.3390/diagnostics13040700] [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] [Received: 12/03/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
High-frequency ultrasound (HFUS), the imaging modality of choice for thyroid screening, is most commonly used in the study of diffuse thyroid disease (DTD) with Hashimoto's thyroiditis (HT) and Graves' disease (GD). DTD can involve thyroid function and severely affect life quality, so early diagnosis is important for the development of timely clinical intervention strategies. Previously, the diagnosis of DTD relied on qualitative ultrasound imaging and related laboratory tests. In recent years, with the development of multimodal imaging and intelligent medicine, ultrasound and other diagnostic imaging techniques have gradually become more widely used for quantitative assessment of the structure and function of DTD. In this paper, we review the current status and progress of quantitative diagnostic ultrasound imaging techniques for DTD.
Collapse
Affiliation(s)
- Jing Huang
- Department of Ultrasound, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai 200003, China
| | - Jiaqi Zhao
- Department of Ultrasound, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China
- Correspondence: ; Tel.: +86-21-5560-3999
| |
Collapse
|
3
|
Bayramoglu Z, Kandemirli SG, Akyol Sarı ZN, Kardelen AD, Poyrazoglu S, Bas F, Darendeliler F, Adaletli I. Superb Microvascular Imaging in the Evaluation of Pediatric Graves Disease and Hashimoto Thyroiditis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:901-909. [PMID: 31705696 DOI: 10.1002/jum.15171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/07/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We aimed to investigate the differences between spectral Doppler and Superb Microvascular Imaging (SMI; Canon Medical Systems, Tokyo, Japan) findings in children with Hashimoto thyroiditis (HT) and Graves disease (GD) compared to healthy control participants. METHODS The study included 34 patients with GD, 37 patients with HT, and 22 healthy volunteers. All patients with HT and 11 patients with GD were euthyroid; 23 patients with GD had symptoms of hyperthyroidism and had thyrotropin values of less than 0.5 mIU/L. Thyroid volumes, mean resistive indices, and peak systolic velocities along with vascularity indices (VIs) on Superb Microvascular Imaging were measured. RESULTS Patients with GD had a significantly higher mean thyroid volume (P < .001; right lobe, 11.80 mL; left lobe, 9.10 mL) and peak systolic velocity (right, 32.5 cm/s; left, 30 cm/s) with a lower resistive index (right, 0.48%; left, 0.48%) compared to patients with HT (right, 8.78 mL, 20 cm/s, 0.55%; left, 7.41 mL, 20 cm/s, 0.55%, respectively) and also control participants (right, 4.59 mL, 15 cm/s, 0.56%; left, 3.52 mL, 15 cm/s, 0.54%). Patients with GD had a significantly higher median VI (right, 25%; left, 26%) compared to patients with HT (right, 11%; left, 13%) and control participants (right, 8%; left, 8%). When patients with GD were categorized as euthyroid and hyperthyroid based on thyrotropin levels and clinical symptoms, both euthyroid and hyperthyroid patients with GD had significantly higher thyroid volumes compared to patients with HT (P < .001). Hyperthyroid patients with GD had higher thyroid volumes compared to euthyroid patients with GD; however, the difference failed to reach statistical significance. A significant strong positive correlation with the VI and thyrotropin receptor autoantibody levels (r = 0.696) was found. The highest area under the curve was obtained for the right lobe VI (0.885), followed by the left lobe VI (0.872), right lobe volume (0.828), and peak systolic velocity (0.810). The optimal cutoff VI value for distinguishing between HT and GD was 17.35% with sensitivity, specificity, and diagnostic accuracy of 85.3%, 78.4%, and 81.7%, respectively. CONCLUSIONS Superb Microvascular Imaging is a new method that can detect subtle vascularity changes with higher accuracy compared to spectral Doppler parameters in distinguishing between HT and GD.
Collapse
Affiliation(s)
- Zuhal Bayramoglu
- Departments of Radiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | | | - Zeynep Nur Akyol Sarı
- Departments of Radiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Aslı Derya Kardelen
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Firdevs Bas
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Feyza Darendeliler
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| |
Collapse
|
4
|
Yuksekkaya R, Celikyay F, Gul SS, Yuksekkaya M, Kutluturk F, Ozmen C. Quantitative Color Doppler Ultrasonography Measurement of Thyroid Blood Flow in Patients with Graves' Disease. Curr Med Imaging 2020; 16:1111-1124. [PMID: 32107993 DOI: 10.2174/1573405616666200124121546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Graves' Disease is an autoimmune disorder characterized by increased levels of thyroid hormones correlated with increased thyroid blood flow. Thyroid scintigraphy is an important and conventional method. However, it has limited accessibility, has ionizing radiation, and is expensive. OBJECTIVES To investigate the thyroid blood flow in patients with Graves' Disease by color Doppler Ultrasonography and a newly developed software Color Quantification. METHODS Forty-one consecutive subjects with GD and 41 healthy controls were enrolled. Color Doppler ultrasonography parameters of the thyroid arteries and Color Quantification values of the gland were measured by a radiologist. The correlations between thyroid blood flow parameters, levels of 99mTechnetium pertechnetate uptake, thyrotropin, and free thyroxine were evaluated. The diagnostic performances of these parameters were investigated. RESULTS The peak systolic-end diastolic velocities of thyroid arteries and Color Quantification values were increased in the study group (p < 0.05 for all). We observed negative correlations between thyrotropin levels and peak-systolic and end-diastolic velocities of superior thyroid arteries and Color Quantification values. There were positive correlations between 99mTechnetium uptake levels and thyroid blood flow parameters (p < 0.05 for all). In the diagnostic performance of thyroid blood flow parameters, we observed utilities significantly in peak-systolic and end-diastolic velocities of thyroid arteries and Color Quantification values (p < 0.05 for all). CONCLUSION The increased peak-systolic and end-diastolic velocities of thyroid arteries, and increased Color Quantification values might be helpful in the diagnosis of Graves' Disease.
Collapse
Affiliation(s)
- Ruken Yuksekkaya
- Department of Radiology, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Fatih Celikyay
- Department of Radiology, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Serdar S Gul
- Department of Nuclear Medicine, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Mehmet Yuksekkaya
- Department of Biomedical Engineering, Faculty of Engineering, Baskent University, Ankara, Turkey
| | - Faruk Kutluturk
- Department of Endocrinology and Metabolism, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Cansel Ozmen
- Department of Biochemistry, Gaziosmanpasa University School of Medicine, Gaziosmanpasa University, Tokat, Turkey
| |
Collapse
|
5
|
Bayramoglu Z, Kandemirli SG, Caliskan E, Yilmaz R, Kardelen AD, Poyrazoglu S, Bas F, Adaletli I, Darendeliler F. Assessment of paediatric Hashimoto's thyroiditis using superb microvascular imaging. Clin Radiol 2018; 73:1059.e9-1059.e15. [PMID: 30139503 DOI: 10.1016/j.crad.2018.07.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/09/2018] [Indexed: 01/21/2023]
Abstract
AIM To evaluate the role of superb microvascular imaging along with greyscale and Doppler imaging for thyroid gland evaluation in Hashimoto's thyroiditis (HT) versus control subjects. MATERIALS AND METHODS The study included 33 healthy volunteers with normal ultrasound and laboratory findings and 70 patients with HT based on laboratory and sonographic findings who were undergoing follow-up and receiving medical treatment. HT patients were classified based on the modification of the scheme proposed by Sostre and Reyes that incorporates the extent of hypoechoic foci or patchy infiltration as grade A (foci involving <50% of the gland) and B (foci involving >50% of the gland). Thyroid volume, mean resistive indices, peak-systolic and end-diastolic velocities based on Doppler imaging, and vascularity index via superb microvascular imaging were obtained using a Canon Aplio 500 ultrasound device using a linear 10-14 MHz transducer. RESULTS Patients with HT had significantly higher median thyroid volume and peak-systolic velocities (7.32 ml and 19 cm/s, respectively) compared to control subjects (4.62 ml and 16 cm/s, respectively). HT patients had significantly higher median vascularity index (VI; 13.5%) compared to control subjects (7.95%). A significant fair positive correlation with VI and anti-thyroglobulin antibody levels (r=0.356, p<0.05) and significant moderate positive correlation with VI and anti-thyroid peroxidase antibody levels (r=0.503, p<0.05) were found. In HT diagnosis, the optimal VI cut-off value was 10.58% with a sensitivity and specificity of 67.1% and 90%, respectively. CONCLUSION Superb microvascular imaging appears to allow assessment of subtle vascularity changes in early HT stages that cannot be detected by Doppler parameters. This technique demonstrates excellent visualization of the microvascular structures and quantitative assessment based on a novel parameter such as VI.
Collapse
Affiliation(s)
- Z Bayramoglu
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey.
| | - S G Kandemirli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - E Caliskan
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - R Yilmaz
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - A D Kardelen
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - S Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - F Bas
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - I Adaletli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - F Darendeliler
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| |
Collapse
|
6
|
The End-Diastolic Velocity of Thyroid Arteries Is Strongly Correlated with the Peak Systolic Velocity and Gland Volume in Patients with Autoimmune Thyroiditis. J Thyroid Res 2017; 2017:1924974. [PMID: 29062583 PMCID: PMC5618767 DOI: 10.1155/2017/1924974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/01/2017] [Indexed: 11/29/2022] Open
Abstract
Background The end-diastolic velocity (EDV) of thyroid arteries reflects peripheral blood flow resistance. Objective The aim was to evaluate EDV correlations with other Doppler sonography parameters and with clinical and biochemical variables in a sample of patients with hypothyroidism caused by chronic autoimmune thyroiditis (CAT). Methods A sample of 48 CAT hypothyroid patients receiving treatment with stable doses of levothyroxine was selected. The participants underwent clinical evaluation and measurement of serum thyrotropin (TSH), total triiodothyronine (T3), total thyroxine (T4), free T4, thyroid peroxidase antibodies (anti-TPO), and antithyroglobulin antibodies (anti-Tg) and Doppler sonography. Results The EDV of the inferior thyroid arteries (ITA-EDV) was strongly and positively correlated with the peak systolic velocity of the inferior thyroid arteries (ITA-PSV, r = 0.919), thyroid volume (r = 0.711), and thyroid visual vascularization pattern (TVP, r = 0.687). There was no correlation between ITA-EDV and the clinical variables, hormones, anti-TPO, or anti-Tg. Conclusion The strong correlation of ITA-EDV with ITA-PSV, TVP, and volume suggests that increased vascularization in CAT may be associated with a reduction in thyroid blood flow resistance, possibly due to an angiogenesis-induced increase in the total vascular cross-sectional area of the parenchyma.
Collapse
|
7
|
Nalbant A, Aydin A, Karacan A, Onmez A, Tamer A, Cinemre H. Association of vitamin D insufficiency/deficiency with thyroid artery Doppler ultrasonography in patients with Hashimoto thyroiditis. Pak J Med Sci 2017; 33:295-299. [PMID: 28523025 PMCID: PMC5432692 DOI: 10.12669/pjms.332.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background & Objective: During the course of the autoimmune thyroid diseases, ultrasonography change parallel to histopathology. Vitamin D is associated with autoimmune diseases and thus can affect thyroid blood flow. Our aim was to investigate the relationship between vitamin D insufficiency/deficiency and thyroid hemodynamic indices in patients with Hashimoto thyroiditis. Methods: A total of 93 patients who presented to Sakarya University Endocrinology outpatient clinic from April to September 2016 and diagnosed with Hashimoto thyroiditis were included in this study. Clinical and serologic data, thyroid antibodies and 25(OH)D3 were evaluated. Mean peak systolic velocity(mPSV), mean end-diastolic velocity (EDV), mean resistive index (RI) flows of superior and inferior thyroid arteries were measured with B-mode Doppler ultrasonography. Results: Vitamin D insufficiency/deficiency was detected in 59 (63.4%). TPO Ab and TgAb levels were found higher in patients with vitamin D insufficiency/deficiency. In the normal vitamin D group, superior thyroid artery mPSV (32.21±6.73cm/s) and EDV(13.27±2.80 cm/s) were higher than in the low vitamin D group [mPSV (28.32±8.99cm/s) and EDV(10.67±3.68 cm/s)] (P=0.034, P=0.001, respectively). Inferior thyroid artery EDV value was higher in the normal compared to the low vitamin D group (0.032). RI measured in all arteries were higher in the vitamin D insufficient/deficient group compared to the Vitamin D normal group (p=0.001). Conclusion: Vitamin-D insufficiency/deficiency has led to reduced parenchymal blood supply and increased micro-vascular resistance in Hashimoto thyroiditis patients.
Collapse
Affiliation(s)
- Ahmet Nalbant
- Dr. Ahmet Nalbant, Assistant Professor, Departments of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Ayhan Aydin
- Dr. Ayhan Aydin, Internal Medicine Consultant, Departments of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Alper Karacan
- Dr. Alper Karacan, Assistant Professor, Radiology Consultant, Departments of Radiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Attila Onmez
- Dr. Attila Onmez, Assistant Professor, Departments of Internal Medicine, Düzce University School of Medicine, Turkey
| | - Ali Tamer
- Prof. Dr. Ali Tamer, Departments of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| | - Hakan Cinemre
- Prof. Dr. Hakan Cinemre, Departments of Internal Medicine, Sakarya University School of Medicine, Sakarya, Turkey
| |
Collapse
|
8
|
Kaklamanos M, Thomas D, Pikazis D, Kaltsas G. Thyroid-specific changes following treatment with biological therapies in patients with rheumatic diseases. Endocrine 2015; 50:146-53. [PMID: 25690756 DOI: 10.1007/s12020-015-0551-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/07/2015] [Indexed: 12/18/2022]
Abstract
Biological anti-rheumatic agents (BAA) may induce autoimmune phenomena. Evidence on thyroid-specific effects of these agents is relatively limited. We studied prospectively, over 3 years, 36 rheumatic patients treated with BAA (18 Infliximab and 18 Rituximab) and no prior exposure to biological therapies (group-1), with respect to their thyroid function, thyroid antibody titers, and thyroid ultrasonographic parameters, such as left inferior thyroid artery peak systolic velocity (ITA PSV), left thyroid lobe vascularity index (TL VI), and echogenicity. Twenty-eight rheumatic patients treated with disease-modifying anti-rheumatic drugs and/or glucocorticoids (group-2), 21 rheumatic patients not receiving any treatment (group-3), and 49 healthy individuals (group-4) were used for comparison. Thyroid function and autoantibody titers were not significantly altered at any stage irrespectively of the administered BAA, previously unknown autoimmune thyroid disease (AITD) status, and/or concomitant treatment with glucocorticoids. Left ITA PSV was significantly increased in group-1 patients (mean ± SD start: 25.5 ± 14.1 cm/s vs. end: 29.8 ± 11.1 cm/s, p = 0.038 and p < 0.001, respectively). Six group-1, 7 group-2, and 3 group-3 patients developed reduced thyroid echogenicity during follow-up (start: p = 0.003 and end: p < 0.001). Left ITA PSV, left TL VI, and echogenicity changes were not related to alterations in thyroid volume, thyrotropin hormone levels, and/or underlying AITD. Infliximab and Rituximab do not cause any alterations in thyroid function and/or autoimmunity, even in patients with previously undiagnosed AITD. Elevated left ITA PSV and reduced thyroid echogenicity may be early features signaling progression to AITD in patients treated with BAA.
Collapse
Affiliation(s)
- Michail Kaklamanos
- Endocrine Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, 75 Mikras Asias St, 11527, Athens, Greece,
| | | | | | | |
Collapse
|