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

Wang, Yanfang; Dong, Tiantian; Nie, Fang; Wang, Guojuan; Liu, Ting; Niu, Qian

doi:10.3389/fonc.2021.662273

Cited by 19 publications

(22 citation statements)

References 49 publications

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“…Prospectively, because the three investigated TIRADSs had not considered the locations of the thyroid nodules, cervical lymph nodes, epidemic factors, contrast-enhanced US features, US elastography, artificial intelligence, and so on. Some experts have suggested adding one or more of these variables to extend and augment these systems and to improve their risk stratification efficiency (14,(28)(29)(30)(31)(32). Wang, et al reported that contrast-enhanced US combining with conventional US in differentiating ACR TI-RADS category 4 and 5 nodules with non-hypovascular may improve the malignancy risk stratification of non-hypovascular thyroid nodules (28).…”

Section: Discussionmentioning

confidence: 99%

“…Some experts have suggested adding one or more of these variables to extend and augment these systems and to improve their risk stratification efficiency (14,(28)(29)(30)(31)(32). Wang, et al reported that contrast-enhanced US combining with conventional US in differentiating ACR TI-RADS category 4 and 5 nodules with non-hypovascular may improve the malignancy risk stratification of non-hypovascular thyroid nodules (28). Celletti et al found that adding strain elastosonography of Strain Ratio to K-TIRADS assessment can significantly increase its sensitivity and negative predictive value (30).…”

Section: Discussionmentioning

confidence: 99%

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Validating and Comparing C-TIRADS, K-TIRADS and ACR-TIRADS in Stratifying the Malignancy Risk of Thyroid Nodules

Chen

Lin

2022

Front. Endocrinol.

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The thyroid imaging reporting and data system (TIRADS) was proposed by experts for optimal ultrasound evaluation of malignancy risk of thyroid focal lesions. There are several versions of TIRADS, some of them have been validated sufficiently, and the others have not been well assessed. In this study, a recently launched Chinese version of TIRADS (C-TIRADS) for malignancy risk stratification of thyroid nodules was validated, and the performance was compared to that of the Korean TIRADS (K-TIRADS) and American College of Radiology(ACR) TIRADS (ACR-TIRADS). Archives of 2177 patients who had undergone thyroid ultrasound examination, coarse needle tissue biopsy and/or surgery were reviewed, and 1978 patients with 1982 thyroid nodules were assessed according to the three TIRADSs. The histopathology was taken as the golden standard. The results showed the 1982 thyroid nodules were consisted of 1306 benign nodules and 676 malignant nodules. The malignancy risk accounted for 1.09%, 2.14%, 10.34%, 49.28%, 88.19% and 85.29% of the total nodules that were categorised as C-TIRADS 2, 3, 4A, 4B, 4C and 5, respectively; 0.00%, 1.64%, 2.87%,18.71% and 82.22% of the total nodules that were categorised as ACR-TIRADS 1, 2, 3, 4 and 5, respectively; 0.85%, 3.27%, 24.27% and 80.96% of the total nodules that were categorised as K-TIRADS 2, 3, 4 and 5, respectively. The correlation between the category of TIRADS and percentile of malignancy was 0.94 in the C-TIRADS, 1.00 in the ACR-TIRADS, and 1.00 in the K-TIRADS, respectively. The highest values of accuracy(AUC) of ROC curves of C-TIRADS 4B, K-TIRADS 5 and ACR-TIRADS 5 were taken as the cut-off values for risk stratification, respectively. The sensitivity, specificity, positive and negative predictive values and AUC by C-TIRADS 4B, K-TIRADS 5 and ACR-TIRADS 5 for malignancy risk stratification of thyroid nodules were 90.83%, 84.23%, 74.88% and 94.66% and 0.88, respectively; 83.58%, 89.82%, 80.95%, 91.36% and 0.87, respectively; and 85.50%, 90.35%, 82.10%, 92.33% and 0.88, respectively (P>0.05 for all). We concluded that the C-TIRADS has excellent performance in the malignancy risk stratification of thyroid nodules by the optimized cut-off value, which is comparable to that in K-TIRADS and ACR-TIRADS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Validating and Comparing C-TIRADS, K-TIRADS and ACR-TIRADS in Stratifying the Malignancy Risk of Thyroid Nodules

Chen

Lin

2022

Front. Endocrinol.

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“…When the conventional B-mode image is properly adjusted and the CEUS mode activated, a microbubble contrast agent is injected as an intravenous bolus, generally with a dose of around 1.0-2.0 mL, followed by 5-10 mL of saline; however, specific amounts of CA and saline vary between operators and institutions [30][31][32][33]. A CEUS timer is started simultaneously with the injection of the contrast agent, and cine-clips of the scanning are stored digitally as raw data for 2-3 min before being processed, but the length of examination differs between sources and institutions, with most authors choosing a time period of at least 2 min [34,35]. Only one nodule can be evaluated for each injection of contrast agent.…”

Section: The Technique Of Contrast-enhanced Ultrasound In Thyroid Imagingmentioning

confidence: 99%

“…A similar study was carried out by Xu et al in which 432 thyroid nodules were analyzed with CEUS and six suspicious features were pointed out as being specific in differentiating benign from malignant nodules: slow wash-in (p = 0.001), slow time to peak (p = 0.002), non-uniform enhancement (p = 0.023), irregular enhancement (p = 0.002), unclear enhancement boundary (p = 0.012) and no visible ring enhancement (p = 0.004) [34]. As in other studies, CEUS combined with TI-RADS showed better accuracy than any of the two alone, achieving a sensitivity of 85.66% and specificity of 83.33% [49,67].…”

Section: Quantitative Analysis Of Thyroid Nodules In Ceusmentioning

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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“…In several previous studies, the conventional US features and CEUS characteristics were taken together to be analyzed. Some suspected US and CEUS characteristics may be excluded in multivariance analysis ( 25 , 26 ). But in clinical practice, being limited by technology or acceptance of patients, CEUS has not been extensively promoted at present.…”

Section: Discussionmentioning

confidence: 99%

Differentiation of Thyroid Nodules (C-TIRADS 4) by Combining Contrast-Enhanced Ultrasound Diagnosis Model With Chinese Thyroid Imaging Reporting and Data System

et al. 2022

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ObjectivesTo establish a contrast-enhanced ultrasound (CEUS) diagnostic schedule by CEUS analysis of thyroid nodules of C-TIRADS 4. To establish a CEUS-TIRADS diagnostic model to differentiate thyroid nodules (C-TIRADS 4) by combining CEUS with Chinese thyroid imaging reporting and data system (C-TIRADS).MethodsA total of 228 thyroid nodules (C-TIRADS 4) were estimated by CEUS. The arrival time, enhancement degree, enhancement homogeneity, enhancement pattern, enhancement ring, and wash-out time were analyzed in CEUS for all of the nodules. Multivariate factors logistic analysis was performed and a CEUS diagnostic schedule was established. If the nodule had a regular hyper-enhancement ring or got a score of less than 2 in CEUS analysis, CEUS-TIRADS subtracted 1 category. If the nodule got a score of 2 in the CEUS schedule, the CEUS-TIRADS category remained the same as before. If the nodule got a score of more than 2 in the CEUS schedule, CEUS-TIRADS added 1 category. When it reflected an absent enhancement in CEUS, the nodule was judged as CEUS-TIRADS 3. All of the C-TIRADS 4 nodules were re-graded by CEUS-TIRADS. We then compare the diagnosis performance of C-TIRADS, CEUS, and CEUS-TIRADS by sensitivity, specificity, and accuracy.ResultsAmong the 228 C-TIRADS 4 nodules, 69 were determined as C-TIRADS 4a, 114 were C-TIRADS 4b, and 45 were C-TIRADS 4c. The sensitivity, specificity, and accuracy of C-TIRADS were 93.1%, 55.3%, and 74.6% respectively. The area under the curve was 0.753. Later arrival time, hypo-enhancement, heterogeneous enhancement, centripetal enhancement, and rapid washout were risk factors of malignancy in multivariate analysis. The sensitivity, specificity, and accuracy of CEUS were 78.7%, 87.5%, and 83.3% respectively. The area under the curve was 0.803. By CEUS-TIRADS diagnostic model combining CEUS with C-TIRADS, a total of 127 cases were determined as malignancy (111 were malignant and 16 were benign) and 101 were diagnosed as benign ones (5 were malignant and 96 were benign). The sensitivity, specificity, and accuracy of CEUS-TIRADS were 95.7%, 85.7%, and 92.1% respectively. The area under the curve was 0.916. The diagnostic performance of CEUS-TIRADS was significantly better than CEUS and C-TIRADS. The difference was statistically significant (P<0.05).ConclusionsThe diagnostic schedule of CEUS could get better diagnostic performance than US in the differentiation of thyroid nodules. The CEUS-TIRADS combining CEUS analysis with C-TIRADS could make up for the deficient sensibility of C-TIRADS, showing a better diagnostic performance than US and CEUS.

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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

Cited by 19 publications

References 49 publications

Validating and Comparing C-TIRADS, K-TIRADS and ACR-TIRADS in Stratifying the Malignancy Risk of Thyroid Nodules

Validating and Comparing C-TIRADS, K-TIRADS and ACR-TIRADS in Stratifying the Malignancy Risk of Thyroid Nodules

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

Differentiation of Thyroid Nodules (C-TIRADS 4) by Combining Contrast-Enhanced Ultrasound Diagnosis Model With Chinese Thyroid Imaging Reporting and Data System

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