Comparison of Diagnostic Efficacy of Contrast-Enhanced Ultrasound, Acoustic Radiation Force Impulse Imaging, and Their Combined Use in Differentiating Focal Solid Thyroid Nodules

Abstract

BackgroundA key limitation of conventional ultrasound (US) includes poor differentiation of benign from malignant thyroid nodules. Contrast-enhanced US (CEUS) and acoustic radiation force impulse (ARFI) could provide better characterization of focal thyroid nodules; however, no studies have compared their efficacies.ObjectiveTo evaluate the diagnostic efficacy of conventional US,CEUS, ARFI, and their combined use in differentiating focal solid thyroid nodules.MethodsOne-hundred-forty-six Chinese patients with 175 thyroid nodules (119 benign and 56 malignant) were prospectively enrolled. Each patients underwent conventional US, CEUS and ARFI, respectively. The diagnostic performance of the conventional US, CEUS, ARFI, combined use of either CEUS or ARFI and combined use of the three modalities were assessed and compared using Pathological diagnosis (histological/cytological) as the reference method.ResultsThere were no significant differences between individual groups (CEUS vs US, P = 0.279, ARFI vs US, P = 0.372, CEUS vs ARFI, P = 0.849), combined use of US and CEUS or combined use of US and ARFI yielded significant difference compared to US. (combination of US & CEUS vs US, P = 0.021; combination of US & ARFI vs US, P = 0.036). The combination of three modalities significantly improved the diagnostic accuracy compared with either combination of conventional US and CEUS or combination of conventional US and ARFI (P = 0.045 and P = 0.027, respectively).ConclusionsCEUS and ARFI can be used as an additional tool in the diagnostic work up of thyroid nodules. The combination of CEUS with ARFI can significantly improve the diagnostic accuracy.

Contrast-enhanced ultrasound and real-time elastography in the differential diagnosis of malignant and benign thyroid nodules

“…CEUS involves the use of a contrast medium that enhances the diagnostic imaging capabilities of traditional medical sonography and is a milestone for diagnostics in liver tumors, with recent studies evaluating similar application of CEUS in characterizing thyroid gland tumors (18)(19)(20)(21)(22)(23). In addition, CEUS performed with the use of a microbubble contrast agent may be a potentially useful adjunct in assessing thyroid nodules, since it has a high specificity of 84.8% and high sensitivity of 76.9% (21).…”

“…CEUS is also amenable to combination approaches, and dynamical evaluation of microcirculation with CEUS in combination with color-coded and power Doppler sonography was demonstrated to yield reliable preoperative results in the Contrast-enhanced ultrasound and real-time elastography in the differential diagnosis of malignant and benign thyroid nodules characterization of thyroid adenomas (22). Furthermore, the combination of CEUS with acoustic radiation force impulse (ARFI) has been shown to significantly improve the diagnostic accuracy of thyroid nodules (23). As a noninvasive technique for evaluating thyroid nodules, US-based elastography encompasses a variety of approaches, including RTE, acoustic radiation force impulse imaging and supersonic shear imaging (24).…”

Diagnostic Value of Contrast-Enhanced Ultrasound Evaluation of Malignant and Benign Solitary Thyroid Nodules

“…In a recent study by Yuan et al a higher value of this sign was observed, as shown by 78% sensitivity and 95% specificity (Yuan et al, 2015). Deng et al also used this feature with similar sensitivity and specificity: 82% and 85%, respectively (Deng et al, 2014).…”

“…The results are ambiguous and sometimes contradictory. The diagnostic value of CEUS has been analysed in only very few studies (Ferrari et al, 2008;Zhang et al, 2010;Nemec et al, 2012;Cantisani et al, 2013;Giusti et al, 2013;Deng et al, 2014;Ma et al, 2014), yielding variable results; the sensitivity varies between 68-100% and specificity -between 67-594%.…”

Thyroid Ultrasound: State of the Art. Part 2 – Focal Thyroid Lesions

“…Some authors reported that hypoenhancement is the most accurate US feature of malignancy on CEUS with high sensitivity, specificity and accuracy 82%, 85%, and 84%, respectively [23][24][25][26][27]. Three recent meta-analyses reported high-pooled accuracy of CEUS in diagnosing benign from malignant nodules with sensitivity, specificity, and positive and negative LR ranging 0.85-0.88, 0.87-0.90, 5.8-8.6 and 0.15-19 respectively [27][28][29].…”