Usefulness of combined use of contrast-enhanced ultrasound and TI-RADS classification for the differentiation of benign from malignant lesions of thyroid nodules

Abstract

PurposeTo study the thyroid image reporting and data system (TI-RADS) classification and the contrast-enhanced ultrasound (CEUS) enhancement pattern of thyroid nodules, and to determine whether combined use of both methods is helpful in the diagnosis of thyroid nodules.MethodsA total of 319 thyroid nodules in 246 patients were assessed with TI-RADS, CEUS and a combination of both methods. The diagnostic performance of TI-RADS, CEUS and a combination of both methods was compared.ResultsThe accuracy in the diagnosis of thyroid nodules was 90.3 % for TI-RADS, 90.0 % for CEUS and 96.0 % for a combination of both methods respectively. A statistically significant difference was not observed in the diagnostic accuracy of CEUS and TI-RADS (P > 0.05). However, a significant difference was observed between a combination of both methods and either alone (P < 0.01). A combination of both methods showed high sensitivity, specificity and accuracy for TI-RADS classifications of 4a and 4b thyroid nodules compared with TI-RADS alone (P < 0.01) and a statistically significant difference was not observed for thyroid nodules classified as 2, 3, and 5 (P > 0.05).ConclusionsThe improved TI-RADS, when combined with CEUS, could significantly improve the diagnostic accuracy for thyroid nodules, especially for TI-RADS class-4 thyroid nodules.Key Points• TI-RADS can be used as the primary diagnostic standard for thyroid nodules • CEUS can be used as an important complement to TI-RADS • The improved TI-RADS can significantly improve the qualitative diagnostic accuracy

Mummified Thyroid Nodules: Conventional and Contrast‐Enhanced Ultrasound Features

“…Contrast‐enhanced ultrasound (CEUS), as one of the novel US modalities, could provide much better characterization of dynamic microvessel perfusion in the differential diagnosis of focal thyroid nodules than conventional US . However, to our knowledge, no studies have reported the CEUS features of mummified thyroid nodules and their differences from papillary thyroid carcinomas (PTCs).…”

“…Contrast-enhanced ultrasound (CEUS), as one of the novel US modalities, could provide much better characterization of dynamic microvessel perfusion in the differential diagnosis of focal thyroid nodules than conventional US. 8,9 However, to our knowledge, no studies have reported the CEUS features of mummified thyroid nodules and their differences from papillary thyroid carcinomas (PTCs). The purpose of our study was to highlight the grayscale, color Doppler, and contrastenhanced US features of mummified thyroid nodules, which should help differentiate them from histologically proven PTCs.…”

Advantages of the Korean Thyroid Imaging Reporting and Data System Combined with Contrast-Enhanced Ultrasound in Diagnosing Papillary Thyroid Microcarcinoma

“…When CEUS was initiated, the imaging section was maintained unchanged for each patient (13). Dynamic contrast images underwent successive or frame-by-frame playback and the CEUS diagnostic criteria were divided into peak enhancement (hypo-enhancement, iso-enhancement and hyper-enhancement), homogeneity of enhancement (interior solid portion of target nodules, classified as homogeneous or heterogeneous) and rim-like enhancement (14). For obtaining degrees of echo and enhancement of nodules, CEUS findings were compared with adjacent muscles or normal thyroid parenchyma.…”

“…The malignant thyroid nodules were diagnosed based on inhomogeneous low enhancement in nodule tissues. The diagnostic criteria for benign thyroid nodules were the opposite of malignancy, including high enhancement or equal enhancement, and presence of rim-like enhancement in nodule tissues (14).…”

Differential diagnosis of thyroid nodules through a combination of multiple ultrasonography techniques: A decision‑tree model

“…Although the diagnostic accuracy of ES alone is not optimal, the information it supplies is useful when combined with that obtained via other US techniques (16). These advanced integrative techniques reportedly improved the diagnostic accuracy of the thyroid image reporting and data Differential diagnosis of thyroid nodules through a combination of multiple ultrasonography techniques: A decision-tree model system (TI-RADS) (17). However, to the best of our knowledge, no previous study has provided a systematic method for integrating US parameters from multiple techniques; physicians and sonographers are sometimes overwhelmed by the large amount of information acquired (18).…”