Differentiation of Thyroid Nodules Difficult to Diagnose With Contrast-Enhanced Ultrasonography and Real-Time Elastography

Xi, Xuehua; Gao, Luying; Wu, Qiong; Fang, Shibao; Xu, Jingzhu; Liu, Ruyu; Yang, Xiao; Zhu, Shenling; Zhao, Ruina; Lai, Xingjian; Zhang, Xiaoyan; Zhang, Bo; Jiang, Yuxin

doi:10.3389/fonc.2020.00112

Cited by 18 publications

(19 citation statements)

References 17 publications

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“…CEUS enhancement provides additional significant patterns for differentiating benign and malignant nodules with intermediate and low suspicion (5-20% malignancy risk). This risk can increase to 38.5% if the nodule shows heterogeneous enhancement [109]. With nodular goiter and subacute thyroiditis, a visible peripheral enhancement may be observed, as they are hyperplastic or atrophic in architecture.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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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“…Recently, some studies have also reported prediction models for differentiating benign and malignant thyroid nodules ( 22 , 42 , 48 – 50 ). However, few of them weighted for the risk factors and it was inconvenient to calculate the risk of malignancy clinically.…”

Section: Discussionmentioning

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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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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“…Graceffa et al [29] expounded the frequent coexistence of PTC and HT. Similarly, the probability of PTL in HT populations was approximately 50 times higher than the general population [1,9]. This situation highlights the importance of monitoring HT patients, particularly if they have long-lasting disease with nodules.…”

Section: Discussionmentioning

confidence: 99%

“…Elastic image was scored (1-5 points) using colors displayed in the ROI. When elastography points were > 3, hard nodules were indicated [9]. When lymph nodes were roundly enlarged, the hyperechoic structure of the lymphatic hilum disappeared, the internal echo was uneven, and irregular blood ow signals were seen inside, abnormally enlarged lymph nodes were recorded [10].…”

Section: Imaging Analysismentioning

confidence: 99%

Multi-modal Ultrasonic Diagnosis and Prognosis for Primary Thyroid Lymphoma Invasiveness

Peng¹,

Yang²,

Yao³

et al. 2021

Preprint

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Objective Sixty-nine patients with primary thyroid lymphoma (PTL) were evaluated for diagnostic value and prognosis for PTL invasiveness. Methods We retrospectively (2008–2019) analyzed multi-modal ultrasonic images and clinical characteristics from pathologically confirmed PTL patients. These patients were divided into aggressive PTL(n=46) and indolent PTL(n=23). Results Age(>70 years old) and elevated LDH (lactase dehydrogenase) were statistically different clinical features between aggressive and indolent PTL. From ultrasonic images, 34 cases were nodular, 11 diffused, and 24 mixed. Mixed types displayed high invasiveness (45.7%) while diffuse types displayed higher inertness (39.1%), and differences were statistically significant (P = 0.000). Elastography, invaded thyroid capsule and increased chaotic vascularity also showed significant differences between aggressive and indolent PTL. We observed statistical difference in OS(overall survival rates) between aggressive and indolent PTL(p=0.032). Single factor Kaplan-Meier (K-M) analysis showed that: age > 70 years old, aggressive pathology, Ki67>30%, elastography scored >3 were positively correlated with the risk of poor prognosis of PTL (P < 0.05).Conclusions Multi-modal ultrasound provides accurate ultrasonographic information, e.g., ultrasound patterns, elastography, invaded thyroid capsules, and hypervascularity, which facilitates PTL invasiveness diagnostics for improved clinical treatment. In addition, PTL patients with age > 70 years old, aggressive pathology, Ki67>30%, elastography scored >3 are more likely to have poor prognosis.

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Differentiation of Thyroid Nodules Difficult to Diagnose With Contrast-Enhanced Ultrasonography and Real-Time Elastography

Cited by 18 publications

References 17 publications

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

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

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

Multi-modal Ultrasonic Diagnosis and Prognosis for Primary Thyroid Lymphoma Invasiveness

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