High-performance sonographical multimodal imaging of non cystic thyroid lesions: Chances of the preoperative diagnostics in relation to histopathology

Abstract

AIM: To improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance ultrasound techniques: optimized B-mode morphology, elastography, Color-Coded Doppler-Sonography (CCDS) and contrast enhanced ultrasound (CEUS) MATERIALS AND METHODS: In 33 cases solid, non-cystic thyroid lesions were rated as TIRADS 3 and up from conventional B-mode examinations. Additional high resolution Power Doppler including HR- and Glazing-Flow as optimized macrovascularization techniques, shear wave elastography and CEUS were performed on these patients by one experienced examiner. For CEUS a bolus of 1–2.4 ml Sulfurhexafluorid microbubbles (SonoVue®, Bracco, Milan, Italy) was injected into a cubital vein and then the distribution kinetics of the contrast agent were documented from the early arterial phase (10 to 15 seconds after injection) to the late venous phase (5 minutes after injection). Postoperative histopathology was the diagnostic gold standard as it provides the most reliable proof. RESULTS: 33 patients (13 males, 20 females; age 29 –77 years; mean 55 years; SD 13 years) were included in this study. 28 of them had benign regressive thyroid nodules, 3 had adenomas and 4 were diagnosed with carcinomas (3 were histologically identified as papillary thyroid carcinomas, one as a medullary thyroid carcinoma). The volume of the thyroid gland ranged from 6.6 to 401.3 cm2 (mean 72.6±92.0 cm2). The adenomas diameters ranged from 9 to 40 mm (mean 22±16 mm) and the carcinoma diameters ranged from 19 to 33 mm (mean 26±6 mm). The 3 adenomas had different echogenicities: One was completely echofree, one was hypoechoic and one isoechoic. The 4 carcinomas however were equally characterized as hypoechoic and echofree. Two of three adenomas and all of the carcinomas showed an incomplete or diffuse margin. Micro-calcifications were found in one adenoma and in every carcinoma. However, no micro-calcifications were observed in cases of benign regressive nodules. Performing shear-wave elastography the adenomas showed lower values than the carcinomas: The tissue velocity of the adenomas ranged from 2.86 m/s to 3.85 m/s (mean 3.32±0.5 m/s) and in carcinomas from 3.89 m/s to 5.66 m/s (mean 4.18±0.3 m/s). Marginal hypervascularization was detected in two adenomas after applying CCDS. One adenoma was hypovascularized. The four carcinomas showed an irregular extreme hypervascularization along their margins as well as an irregular central normo- or hypervascularization in CCDS. The additional HR-Flow helped reducing artefacts. In CEUS the dynamic capillary microvascularization of all carcinomas was very irregular with early enhancement and followed by partial or complete wash-out. In CEUS two adenomas had no wash-out and the other one showed a partial wash-out. CONCLUSION: Using modern multimodal imaging offers new possibilities for the differentiation between benign and malignant thyroid lesions. It is a very important diagnostic tool in addition to the B-Mode TIRADS classification and eases the decision between TIRADS 3, 4 and 5. However, additional multicenter studies are required for more detailed evaluations.

Advanced multimodal imaging of solid thyroid lesions with artificial intelligence-optimized B-mode, elastography, and contrast-enhanced ultrasonography parametric and with perfusion imaging: Initial results

“…Another approach of the new multimodal ultrasound diagnostics is the parallel examination with strain and shear wave elastography. This not only increases the comparability in TI-RADS III lesions, but also the assessment of malignancy-suspicious foci with increased tissue compaction with measured values > 2.5 cm/s or > 30 kPA [ 4, 11–13 ].…”

“…Or irregular hypervascularization with early onset wash out may occur. With the new integrated perfusion software, wash in and wash out kinetics of CEUS can be mapped parametrically within less than 1 min for the different perfusion parameters, such as time to peak (TTP), peak, mean transit time (mTT), wash in area under the curve (AUC) [ 4 ]. In addition, based on the TIC analysis in curve form, the values are also presented finally in table form.…”

Anwendung der Kontrastmittelsonografie im Kopf-Hals-Bereich: Update

“…Die Forschung zum CEUS in der Schilddrüsendiagnostik beschäftigt sich hauptsächlich mit der Differenzierung von Schilddrüsenknoten (▶ Tab. 3) [24,25,26,27,28]. Der Diagnostik mit CEUS geht immer ein konventioneller Ultraschall voraus, bei dem die Knoten meist anhand einer TI-RADS-Klassifikation eingeteilt werden.…”

“…Weitere malignitätssuspekte Befunde einer Schilddrüsenläsion sind eine schnelle, unregelmäßige Hypervaskularisation beginnend in der Peripherie sowie ein unregelmäßiges, frühes Wash-out insbesondere der hypervaskularisierten Tumorränder (▶ Abb. 4) [24,27,28,31].…”

“…heterogen mit schnellem Wash-in und Wash-out, vor allem in hypervaskularisierten Randbereichen [24,26,31] Peak Intensity (PI) höher im Vergleich zum umliegenden Gewebe [28] geringer im Vergleich zum umliegenden Gewebe [28] Area under the Curve (AUC) höher im Vergleich zum umliegenden Gewebe [28] geringer im Vergleich zum umliegenden Gewebe [28] Time to Peak (TTP) höher im Vergleich zu malignen Befunden [31] geringer im Vergleich zu benignen Befunden [31] out-Phänomens [31]. Eine auch in späteren Phasen homogen vorhandene, klar abgrenzbare, ringförmige Aufnahme des Kontrastmittels im Randbereich der Läsion scheint dagegen typisch für einen benignen Befund zu sein [26,30].…”