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

Abstract

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.

Systematic review and meta-analysis: diagnostic value of different ultrasound for benign and malignant thyroid nodules

“…The area under the curve of conventional ultrasound was more than 0.9, indicating that it had very high diagnostic value. This was not consistent with the study by Radzina et al (2021) (43), and the reasons for this may be as follows: there were few cases of multi-source nodules in the included studies; and thyroid nodules were typical.…”

Clinical Application Value of High-Frequency Ultrasound Combined with Detection of Serum High Mobility Group Box 1, Soluble IL-2 Receptor, and Thyroglobulin Antibody in Diagnosing Thyroid Cancer

“…As the disease progresses, the enlarged lesion tissue can further compress and invade surrounding organs, which makes the patients present dyspnea, dysphagia, jugular varicosity, etc., and some patients also have lung, liver, and bone metastasis, triggering more severe symptoms such as hemoptysis and bone pain [ 3 , 4 ]. The globally age-standardized incidence of thyroid cancer increased by 20.0% between 1990 and 2013, while in China, it was increased by more than 33.3%, and 143,900 cases of thyroid cancer have been reported in China until 2013 [ 5 , 6 ]. Some scholars believe that the increasing incidence of thyroid cancer is related to the upgrading of diagnostic techniques in addition to oncogenes, ionizing radiation, iodine intake, and other factors [ 7 ].…”

Contrast-enhanced ultrasound improves the potency of fine-needle aspiration in thyroid nodules with high inadequate risk

“…This result suggests that FNA is not recommended in completely non-enhancing nodules under CEUS because viable tissues are rare. However, PTC with severe fibrosis and calcifications occasionally show US pattern of heavily calcified nodule or entirely calcified nodule may also show non-enhancement of CEUS [ 24 ]. For those thyroid nodules with high clinical suspicion or patient with extremely anxious, core-needle biopsy is more effective than FNA.…”