Keywords:
Image manipulation / Reconstruction, Ultrasound-Colour Doppler, Ultrasound, Contrast agents, Thyroid / Parathyroids, Head and neck, Outcomes analysis, Contrast agent-intravenous, Screening, Endocrine disorders
Authors:
A. BOCCUZZI1, S. Mazzeo1, R. Cervelli2, P. Rossi1, P. Papini1, G. Materazzi1, R. Cioni1, D. Caramella1; 1PISA/IT, 2Pisa, It/IT
DOI:
10.26044/ecr2019/C-2837
Aims and objectives
Thyroid nodules are a common finding in the general population,
and their detection rate is increasing with the widespread use of ultrasound (US).
Most thyroid nodules are benign,
and fewer than 5% are malignant [1]
Conventional thyroid US has been widely used to stratify the malignant risk of thyroid nodules.
Microcalcifications,
irregular margins,
and tall shape are the features with high specificities for thyroid cancer,
but none of them are independently and fully predictive of malignancy [2] (an example of suspicious nodule characteristic is shown in (Fig.1)).
Thyroid imaging,
reporting and data system (TI-RADS) classification was created and published in 2009 [3],
as an attempt to solve the problem of nodule selection for FNAB,
according to the rate of the nodule risk of malignancy.
The TI-RADS designates a score for both general thyroid pathology (TI-RADS 1–6) and for US-assessed thyroid nodules (TI-RADS 2–6),
with an increasing probability of a cancer diagnosis (e.g.
TI-RADS 1 is a normal exam,
TIRADS 6 is a certified malignancy - Table 1). The European thyroid association also proposed a simplify TI-RADS classification,
called EU-TIRADS,
in order to make easier the nodule management [4] (Fig.2). However,
the sensitivity and specificity of TI-RADS classification were 75% and 69%,
respectively.
Contrast-enhanced ultrasound (CEUS) is considered to be an effective technique to evaluate microvascularization,
which is important because angiogenesis is the basis for neoplastic growth [5].
In the last decade,
the applicability of CEUS to thyroid-related disease greatly improved due to the development of dedicated US equipment.
A step forward was made by the introduction of software applications for quantifying tissue perfusion by using dynamic contrast-enhanced ultrasound.
The aim of this study was to assess the accuracy of the TI-RADS classification combined with time-intensity curve (TIC) analysis of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant thyroid nodules.