Contrast-enhanced ultrasound and shear wave elastography in the diagnosis of ACR TI-RADS 4 and 5 category thyroid nodules coexisting with Hashimoto’s thyroiditis

Abstract

ObjectiveThis study aims to evaluate the value of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), and their combined use in the differentiation of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) 4 and 5 category thyroid nodules coexisting with Hashimoto’s thyroiditis (HT).Materials and methodsA total of 133 pathologically confirmed ACR TI-RADS 4 and 5 category nodules coexisting with HT in 113 patients were included; CEUS and SWE were performed for all nodules. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and the area under the receiver operating characteristic curve (AUC) of the SWE, CEUS, and the combined use of both for the differentiation of benign and malignant nodules were compared, respectively.ResultsUsing CEUS alone, the sensitivity, specificity, PPV, NPV, and accuracy were 89.2%, 66.0%, 81.3%, 78.6%, and 80.5%, respectively. Using SWE alone, Emax was superior to Emin, Emean, and Eratio for the differentiation of benign and malignant nodules with the best cutoff Emax >46.8 kPa, which had sensitivity of 65.1%, specificity of 90.0%, PPV of 91.5%, NPV of 60.8%, and accuracy of 74.4%, respectively. Compared with the diagnostic performance of qualitative CEUS or/and quantitative SWE, the combination of CEUS and SWE had the best sensitivity, accuracy, and AUC; the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 94.0%, 66.0%, 82.1%, 86.8%, 83.5%, and 0.80 (95% confidence interval: 0.713, 0.886), respectively.ConclusionIn conclusion, CEUS and SWE were useful for the differentiation of benign and malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT. The combination of CEUS and SWE could improve the sensitivity and accuracy compared with using CEUS or SWE alone. It could be a non-invasive, reliable, and useful method to differentiate benign from malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT.

Incorporation of CEUS and SWE Parameters into a Multivariate Logistic Regression Model for the Differential Diagnosis of Benign and Malignant TI-RADS4 Thyroid Nodules

“…Therefore, it is of more clinical signi cance to improve the diagnostic e cacy for ACR TI-RADS4 nodules. CEUS and SWE can enhance the diagnostic e cacy for thyroid nodules, and the combination of the two has even better diagnostic e cacy [15]. At present, no research on the construction of diagnostic models using CEUS and SWE quantitative parameters has been reported.…”

“…Chen et al [28] found that the diagnostic sensitivity and speci city of contrast-enhanced ultrasound plus shear-wave elastography were 93.38% and 92.89%, respectively. Wang et al [15] found that the AUC, sensitivity, speci city, and accuracy of contrast-enhanced ultrasound plus shear-wave elastography are 0.800, 94%, 66%, and 83.5%, respectively. Huang [29] found that the AUC, sensitivity, and speci city of contrast-enhanced ultrasound plus shear-wave elastography were 0.937, 91.67%, and 95.65%, respectively.…”

Incorporation of CEUS and SWE parameters into a multivariate logistic regression model for the differential diagnosis of benign and malignant TI-RADS 4 thyroid nodules

“…Therefore, it is of more clinical significance to improve the diagnostic efficacy for ACR TI-RADS 4 nodules. CEUS and SWE can enhance the diagnostic efficacy for thyroid nodules, and the combination of the two has even better diagnostic efficacy [ 19 ]. In this study, we intend to try to apply the quantitative analysis parameters of ultrasonography and the quantitative analysis parameters of shear wave elastography to construct a predictive model for category 4 nodules, in order to ware to improve the malignancy detection rate of suspicious nodules among the category 4 nodules.…”

“…Chen et al [ 32 ] found that the diagnostic sensitivity and specificity of contrast-enhanced ultrasound plus SWE were 93.38 and 92.89%, respectively. Wang et al [ 19 ] found that the AUC, sensitivity, specificity, and accuracy of contrast-enhanced ultrasound plus SWE were 0.800, 94, 66, and 83.5%, respectively. Huang [ 33 ] found that the AUC, sensitivity, and specificity of contrast-enhanced ultrasound plus SWE were 0.937, 91.67, and 95.65%, respectively.…”

Association of autoimmune thyroid disease with type 1 diabetes mellitus and its ultrasonic diagnosis and management

“…However, whether HT increases thyroid cancer risk in individuals with TNs is controversial and remains to be defined[ 111 , 112 ]. Therefore, to avoid overtreatment with surgery in HT patients with TNs without any other evidence of malignancy as well as to predict the malignancy risk of these TNs accurately, various ultrasound-based diagnostic classification systems, which have been developed for differentiating benign and malignant TNs, may represent a critical role in detecting malignant TNs in HT individuals[ 113 - 116 ]. Moreover, in some cases with difficult diagnoses, ultrasound-guided FNAB can be used as an effective, less-invasive approach to confirm the nature of the lesion and propose the most beneficial/optimal treatment[ 117 , 118 ].…”