Diagnostic performance of thyroid imaging reporting and data system (TI-RADS) alone and in combination with contrast-enhanced ultrasonography for the characterization of thyroid nodules

Huaqun, Zhao; Li, Xueling; Liu, Bei; Peng, Cheng; Li, Jian; Wu, Yedong; Ma, Zhen; Fang, Wei; Hongyue, Su

doi:10.3233/ch-180457

Cited by 29 publications

(25 citation statements)

References 28 publications

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“…Our study also confirmed the good diagnostic efficacy of a combination for diagnosing non-hypovascular thyroid nodules, with an AUC, sensitivity, and specificity of 0.921, 87.0%, and 86.2% in the derivation cohort and 0.900, 85.7%, and 88.5% in the external validation cohort, respectively. The AUC of the combined method in the derivation cohort in this study was significantly higher than the conventional US ( Z = 2.255, P = 0.0242) and CEUS ( Z = 2.671, P = 0.0076) alone ( Figure 5 ) , which was in line with published articles ( 14 , 15 ).…”

Section: Discussionsupporting

confidence: 87%

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Contrast-Enhanced Ultrasound in the Differential Diagnosis and Risk Stratification of ACR TI-RADS Category 4 and 5 Thyroid Nodules With Non-Hypovascular

et al. 2021

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ObjectiveThis 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.MethodsFrom 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.ResultsMicro-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.ConclusionsCEUS 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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Section: Discussionsupporting

confidence: 87%

“…Previous studies have shown the good performance of CEUS in differentiating benign and malignant thyroid nodules and screening appropriate nodules for FNA, as an effective supplement technique of conventional US (11)(12)(13). And the diagnostic accuracy of thyroid nodules can be increased by combining conventional US and CEUS (14,15).…”

Section: Introductionmentioning

confidence: 99%

Contrast-Enhanced Ultrasound in the Differential Diagnosis and Risk Stratification of ACR TI-RADS Category 4 and 5 Thyroid Nodules With Non-Hypovascular

et al. 2021

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“…In a recent study by Zhao et al in 2018 the highest accuracy of 94.02%, sensitivity of 94.74% and specificity of 93.33% was achieved using TI-RADS in combination with CEUS for differentiation of malignant vs. benign nodules. The most prominent features of nodules pointing to malignancy on CEUS were low enhancement and rim-like enhancement [58]. In contrast, other authors reported rim-enhancement as a pattern for benign nodules [30].…”

Section: Qualitative Analysis Of Ceus Enhancement Patternsmentioning

confidence: 87%

Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives

Radziņa

Ratniece

Putriņš

et al. 2021

Cancers

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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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“…As US is the dominant imaging modality used in thyroid evaluation, contrastenhanced US could be used to extend TI-RADS. Various studies showed a significant increase in diagnostic accuracy when morphologic analysis was augmented with contrastenhanced US (44,45).…”

Section: Inclusion Of Contrast-enhanced Us and Elastographymentioning

confidence: 99%

ACR TI-RADS: Pitfalls, Solutions, and Future Directions

et al. 2019

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The high prevalence of thyroid nodules combined with the generally indolent growth of thyroid cancer present a challenge for optimal patient care. Risk classification models based on US features have been created by multiple professional societies, including the American College of Radiology (ACR), which published the Thyroid Imaging Reporting and Data System (TI-RADS) in 2017. ACR TI-RADS uses a standardized lexicon for assessment of thyroid nodules to generate a numeric scoring of features, designate categories of relative probability of benignity or malignancy, and provide management recommendations, with the aim of reducing unnecessary biopsies and excessive surveillance. Adopting ACR TI-RADS may require practice-level changes involving image acquisition and workflow, interpretation, and reporting. Significant resources should be devoted to educating sonographers and radiologists to accurately recognize features that contribute to the scoring of a nodule. Following a system that uses approved terminology generates reproducible and relevant reports while providing clarity of language and preventing misinterpretation. Comprehensive documentation facilitates quality improvement efforts. It also creates opportunities for outcome data and other performance metrics to be integrated with research. The authors review ACR TI-RADS, describe challenges and potential solutions related to its implementation based on their experiences, and highlight possible future directions in its evolution. ©

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Diagnostic performance of thyroid imaging reporting and data system (TI-RADS) alone and in combination with contrast-enhanced ultrasonography for the characterization of thyroid nodules

Cited by 29 publications

References 28 publications

Contrast-Enhanced Ultrasound in the Differential Diagnosis and Risk Stratification of ACR TI-RADS Category 4 and 5 Thyroid Nodules With Non-Hypovascular

Contrast-Enhanced Ultrasound in the Differential Diagnosis and Risk Stratification of ACR TI-RADS Category 4 and 5 Thyroid Nodules With Non-Hypovascular

Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives

ACR TI-RADS: Pitfalls, Solutions, and Future Directions

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