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Suh PS, Baek JH, Lee JH, Chung SR, Choi YJ, Chung KW, Kim TY, Lee JH. Effectiveness of microvascular flow imaging for radiofrequency ablation in recurrent thyroid cancer: comparison with power Doppler imaging. Eur Radiol 2024:10.1007/s00330-024-10977-0. [PMID: 39042304 DOI: 10.1007/s00330-024-10977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/13/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES To compare microvascular flow imaging (MVFI) and power Doppler ultrasonography imaging (PDUS) for detecting intratumoral vascularity in recurrent thyroid cancer both before and after radiofrequency ablation (RFA). METHODS This retrospective study included 80 patients (age, 57 ± 12 years; 54 women) with 110 recurrent tumors who underwent RFA between January 2021 and June 2023. A total of 151 PDUS and MVFI image sets were analyzed (85 pre-RFA, 66 post-RFA). Two readers assessed vascularity on the images using a four-point scale with a 2-week interval between PDUS and MVFI to estimate inter-reader agreement. Intra-reader agreement was determined by reinterpreting images in reverse order (MVFI-PDUS) after a 1-month gap. Additionally, diagnostic performance for identifying viable tumors after RFA was assessed in 44 lesions using thyroid-protocol CT as a reference standard. RESULTS MVFI demonstrated higher vascular grades than PDUS, both before (reader 1: 3.04 ± 1.15 vs. 1.93 ± 1.07, p < 0.001; reader 2: 3.20 ± 0.96 vs. 2.12 ± 1.07, p < 0.001) and after RFA (reader 1: 2.44 ± 1.28 vs. 1.67 ± 1.06, p < 0.001; reader 2: 2.62 ± 1.23 vs. 1.83 ± 0.99, p < 0.001). Inter-reader agreement was substantial (κ = 0.743) and intra-reader agreement was almost perfect (κ = 0.840). MVFI showed higher sensitivity (81.5%-88.9%) and accuracy (84.1%-86.4%) than PDUS (sensitivity: 51.9%, p < 0.01; accuracy: 63.6-70.5%, p < 0.04), without sacrificing specificity. CONCLUSION MVFI was superior to PDUS for assessing intratumoral vascularity and showed good inter- and intra-reader agreement, highlighting its clinical value for assessing pre-RFA vascularity and accurately identifying post-RFA viable tumors in recurrent thyroid cancer. CLINICAL RELEVANCE STATEMENT Microvascular flow imaging (MVFI) is superior to power-Doppler US for assessing intratumoral vascularity; therefore, MVFI can be a valuable tool for assessing vascularity before radiofrequency ablation (RFA) and for identifying viable tumors after RFA in patients with recurrent thyroid cancer. KEY POINTS The value of microvascular flow imaging (MVFI) for evaluating intratumoral vascularity is unexplored. MVFI demonstrated higher vascular grades than power Doppler US before and after ablation. Microvascular flow imaging showed higher sensitivity and accuracy than power Doppler US without sacrificing specificity.
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Affiliation(s)
- Pae Sun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jae Ho Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Yong Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Matsui M, Jikuzono T, Kure S, Ishibashi O, Akasu H, Sugitani I. Usefulness of Ultrasonographic Detective Flow Imaging for Detecting Parathyroid Tumors: A Report of Two Cases. J NIPPON MED SCH 2024; 90:460-464. [PMID: 36273907 DOI: 10.1272/jnms.jnms.2023_90-604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Parathyroid tumors (PTs) are sometimes difficult to diagnose because they are small and have low-velocity blood flow, which can be missed by current imaging modalities. PTs consist of parathyroid adenoma (PA), parathyroid cyst, and parathyroid carcinoma (PC). Detective flow imaging (DFI) is a new imaging technology that displays low-velocity blood flow. Herein, we report two cases in which DFI was useful for diagnosis of PTs. One patient had a PA and a parathyroid cyst in close proximity, and the other had a PC. To our knowledge, this is the first report to demonstrate the usefulness of DFI in the diagnosis of PTs.
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Affiliation(s)
- Mami Matsui
- Department of Endocrine Surgery, Nippon Medical School
| | - Tomoo Jikuzono
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Osamu Ishibashi
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Haruki Akasu
- Department of Endocrine Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
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Xia Q, Cheng W, Bi J, Ren AP, Chen X, Li T. Value of biplane transrectal ultrasonography plus micro-flow imaging in preoperative T staging and rectal cancer diagnosis in combination with CEA/CA199 and MRI. BMC Cancer 2023; 23:860. [PMID: 37700269 PMCID: PMC10496222 DOI: 10.1186/s12885-023-11370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Rectal cancer is one of the most common malignant tumors and has a high incidence rate and fatality rate. Accurate preoperative T staging of rectal cancer is critical for the selection of appropriate rectal cancer treatment. Various pre-operative imaging methods are available, and the identification of the most accurate method for clinical use is essential for patient care. We investigated the value of biplane transrectal ultrasonography (TRUS) combined with MFI in preoperative staging of rectal cancer and explored the value of combining TRUS plus MFI with CEA/CA199 and MRI. METHODS A total of 87 patients from Daping Hospital with rectal cancer who underwent TRUS examination plus MFI were included. Grades of MFI were determined by Alder classification. Among the total patients, 64 underwent MRI and serum CEA/CA199 tests additionally within one week of TRUS. Pathological results were used as the gold standard for cancer staging. Concordance rates between TRUS, MRI, and CEA/CA199 for tumors at different stages were compared. RESULTS There were no significant differences between the Alder classification and pathological T staging. The concordance rate of TRUS and MFI for rectal cancer T staging was 72.4% (K = 0.615, p < 0.001). Serum CEA and CA199 levels were significantly different in tumors at different stages and increased progressively by pathological stage (p < 0.001); the accuracy rate was 71.88% (K = 0.599, p < 0.001), while that of MRI was 51.56% (K = 0.303, p < 0.001), indicating that TRUS had higher consistency in the preoperative T staging of rectal cancer. The combination of TRUS, MRI, and CEA/CA199 yielded an accuracy rate of 90.6%, which was higher than that of any method alone. CONCLUSIONS Preoperative T staging of rectal cancer from biplane TRUS plus MFI was highly consistent with postoperative pathological T staging. TRUS combined with MRI and serum CEA/CA199 had a greater value in the diagnosis of rectal cancer and a higher diagnostic rate than any examination alone.
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Affiliation(s)
- Qin Xia
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Wei Cheng
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Jie Bi
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - An-Ping Ren
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Xiao Chen
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China
| | - Tao Li
- Department of Ultrasound, Daping Hospital, Army Medical University, Chongqing, 400000, China.
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Jiang L, Zhang D, Chen YN, Yu XJ, Pan MF, Lian L. The value of conventional ultrasound combined with superb microvascular imaging and color Doppler flow imaging in the diagnosis of thyroid malignant nodules: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1182259. [PMID: 37415660 PMCID: PMC10321595 DOI: 10.3389/fendo.2023.1182259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To evaluate and compare the value of conventional ultrasound-based superb microvascular imaging (SMI) and color Doppler flow imaging (CDFI) in the diagnosis of malignant thyroid nodule by meta-analysis. Methods The literature included in the Cochrane Library, PubMed, and Embase were searched by using " superb microvascular imaging (SMI), color Doppler flow imaging (CDFI), ultrasound, thyroid nodules" as the keywords from inception through February 1, 2023. According to the inclusion and exclusion criteria, the clinical studies using SMI and CDFI to diagnose thyroid nodules were selected, and histopathology of thyroid nodules was used as reference standard. The diagnostic accuracy research quality assessment tool (QUADAS-2) was used to evaluate the quality of included literature, and the Review Manager 5.4 was used to make the quality evaluation chart. The heterogeneity test was performed on the literature that met the requirements, the combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were pooled, and a comprehensive ROC curve analysis was performed. Meta-DiSc version 1.4, StataSE 12, and Review Manager 5.4 software were used. Results Finally, 13 studies were included in this meta-analysis. A total of 815 thyroid malignant nodules were assessed. All thyroid nodules were histologically confirmed after SMI or CDFI. The combined sensitivity, specificity, PLR, NLR, DOR, and area under the SROC curve of SMI for the diagnosis of malignant thyroid nodules were 0.80(95%CI: 0.77-0.83), 0.79(95%CI: 0.77-0.82), 4.37(95%CI: 3.0-6.36), 0.23(95%CI: 0.15-0.35), 22.29(95%CI: 12.18-40.78), and 0.8944, respectively; the corresponding values of CDFI were 0.62(95%CI: 0.57-0.67), 0.81(95%CI: 0.78-0.85), 3.33(95%CI: 2.18-5.07), 0.41(95%CI: 0.27-0.64), 8.93(95%CI: 3.96-20.16), and 0.8498. Deek funnel pattern showed no significant publication bias. Conclusion The diagnostic efficiency of SMI for malignant thyroid nodules is better than CDFI, and SMI technology can provide significantly more information on vascularity, make up for the deficiency of CDFI, and has better clinical application value. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023402064.
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Affiliation(s)
- Li Jiang
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Dian Zhang
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Yue-Nan Chen
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Xue-Juan Yu
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Mei-Fang Pan
- Department of Ultrasound, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
| | - Lian Lian
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China
- Department of Oncology, Suzhou Xiangcheng People’s Hospital, Jiangsu, China
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Wilson A, Lim A. Microvascular imaging: new Doppler technology for assessing focal liver lesions. Is it useful? Clin Radiol 2022; 77:e807-e820. [DOI: 10.1016/j.crad.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022]
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Diagnostic Value of AngioPLUS Microvascular Imaging in Thyroid Nodule Diagnosis Using Quantitative and Qualitative Vascularity Grading. Biomedicines 2022; 10:biomedicines10071554. [PMID: 35884858 PMCID: PMC9313421 DOI: 10.3390/biomedicines10071554] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
This study investigated the diagnostic value of the Angio Planewave Ultrasensitive (AngioPLUS) Doppler ultrasound in improving the efficacy of grey scale ultrasound in thyroid nodule diagnosis. The EU TIRADS was used for the grey scale ultrasound assessment of 94 thyroid nodules. conventional Doppler and AngioPLUS Doppler ultrasound images were evaluated using qualitative vascularity grading, where predominant central vascularity indicated malignancy-suspicion, and quantitative regional vascularity assessment, where predominant peripheral vascularity using a ratio vascularity index (RVI) of > 1 indicated benign disease. Diagnostic performance outcomes of sole and combination approaches were calculated based on final pathologic results. Using sole EU TIRADS and AngioPLUS + power Doppler imaging (APDI) based on qualitative vascularity and RVI, the results were a sensitivity of 83.3% vs. 83.3 vs. 66.7% and a specificity of 50% vs. 81.3% vs. 73.4, respectively. EU TIRADS combined with APDI significantly improved the specificity using both qualitative vascularity and RVI assessment approaches (84.4% and 81%, respectively, p < 0.05); and slightly reduced the sensitivity (76.7% and 58.1%). For cytologically-equivocal thyroid nodules, the combination approach using qualitative vascularity assessment outperformed the EU TIRADS (sensitivity: both were 88.9%; specificity: 77.4% vs. 38.7%, p < 0.05; and AUROC: 0.83 vs. 0.62, p < 0.05). APDI combined with EU TIRADS is diagnostically efficient in stratifying thyroid nodules, particularly cytologically-equivocal nodules.
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Baek HS, Park JY, Jeong CH, Ha J, Kang MI, Lim DJ. Usefulness of Real-Time Quantitative Microvascular Ultrasonography for Differentiation of Graves' Disease from Destructive Thyroiditis in Thyrotoxic Patients. Endocrinol Metab (Seoul) 2022; 37:323-332. [PMID: 35413779 PMCID: PMC9081314 DOI: 10.3803/enm.2022.1413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Microvascular ultrasonography (MVUS) is a third-generation Doppler technique that was developed to increase sensitivity compared to conventional Doppler. The purpose of this study was to compare MVUS with conventional color Doppler (CD) and power Doppler (PD) imaging to distinguish Graves' disease (GD) from destructive thyroiditis (DT). METHODS This prospective study included 101 subjects (46 GDs, 47 DTs, and eight normal controls) from October 2020 to November 2021. All ultrasonography examinations were performed using microvascular flow technology (MV-Flow). The CD, PD, and MVUS images were semi-quantitatively graded according to blood flow patterns. On the MVUS images, vascularity indices (VIs), which were the ratio (%) of color pixels in the total grayscale pixels in a defined region of interest, were obtained automatically. Receiver operating characteristic curve analysis was performed to verify the diagnostic performance of MVUS. The interclass correlation coefficient and Cohen's kappa analysis were used to analyze the reliability of MVUS (ClinicalTrials.gov:NCT04879173). RESULTS The area under the curve (AUC) for CD, PD, MVUS, and MVUS-VI was 0.822, 0.844, 0.808, and 0.852 respectively. The optimal cutoff value of the MVUS-VI was 24.95% for distinguishing GD and DT with 87% sensitivity and 80.9% specificity. We found a significant positive correlation of MVUS-VI with thyrotropin receptor antibody (r=0.554) and with thyroid stimulating immunoglobulin bioassay (r=0.841). MVUS showed high intra- and inter-observer reliability from various statistical method. CONCLUSION In a real time and quantitative manner, MVUS-VI could be helpful to differentiate GD from thyroiditis in thyrotoxic patients, with less inter-observer variability.
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Affiliation(s)
- Han-Sang Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Yeon Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chai-Ho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moo Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hong MJ, Ahn HS, Ha SM, Park HJ, Oh J. Quantitative analysis of vascularity for thyroid nodules on ultrasound using superb microvascular imaging: Can nodular vascularity differentiate between malignant and benign thyroid nodules? Medicine (Baltimore) 2022; 101:e28725. [PMID: 35119020 PMCID: PMC8812680 DOI: 10.1097/md.0000000000028725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/11/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to investigate the utility of adding superb microvascular imaging (SMI) to B-mode ultrasound (US) for distinguishing between benign and malignant thyroid nodules and evaluate the usefulness of SMI quantification of nodular vascularity for diagnosing thyroid cancer.The malignancy likelihood was scored for 3 datasets before versus after additional color Doppler imaging or SMI using 4-scale visual analysis (i.e., B-mode US alone, B-mode US + color Doppler image, and B-mode US + SMI). Further, the SMI pixel count was measured in the region of interest, including the whole nodule, on the longitudinal view. It was compared between benign and malignant nodules and analyzed according to the US patterns of thyroid nodules based on the Korean thyroid imaging reporting and data system. We calculated the area under the receiver operating characteristic curve values, sensitivities, and specificities.There was no significant difference in the area under the receiver operating characteristic curve values among B-mode, B-mode + color Doppler, and B-mode + SMI. However, the SMI pixel count was significantly higher in malignant thyroid nodules than in benign ones. The optimal cut-off value for the SMI pixel count for predicting malignant thyroid nodules obtained using a receiver operating characteristic curve was 17 (40.54% in sensitivity, 91.3% in specificity). Analysis based on the US pattern of thyroid nodules revealed significant differences in the nodules with low-to-intermediate suspicious US features between malignant and benign nodules.Quantification analysis of vascularity using SMI can differentiate malignant thyroid nodules from benign ones.
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Affiliation(s)
- Min Ji Hong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jiyun Oh
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Zehui FMD, Siqi WMD, Jian ZMD, Yejun LMD, Xiaomin MMD, Ye HMD, Chong WMD, Hui CMD. Diagnostic Performance of Superb Microvascular Imaging for Breast Masses: A Systematic Review and Meta-analysis. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Studeny T, Kratzer W, Schmidberger J, Graeter T, Barth TFE, Hillenbrand A. Analysis of vascularization in thyroid gland nodes with superb microvascular imaging (SMI) and CD34 expression histology: a pilot study. BMC Med Imaging 2021; 21:159. [PMID: 34717558 PMCID: PMC8557585 DOI: 10.1186/s12880-021-00690-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background The Doppler sonography technique known as "superb microvascular imaging" (SMI) is advancing sonographic micro vascularization imaging in various disciplines. In this study, we aimed to determine whether SMI could reliably reproduce the blood flow in thyroid nodes and whether malignancy could be diagnosed, based on vascularization properties. Immunhistochemical staining by CD34 and SMI where used to determine the vascularization of nodes in terms of quantified vascularization parameters gained by computational evaluation. Methods We used image analysis programs to investigate whether the quantitative value for vascularization strength in the thyroid node, measured with SMI, was correlated with the actual degree of vascularization, determined microscopically. We included 16 patients that underwent thyroid resections. We prepared thyroid gland tissue slices for immunohistochemistry and labelled endothelial cells with CD34 to visualize blood vessels microscopically. We used image analysis programs, ImageJ, to quantify SMI Doppler sonographic measurements and CellProfiler to quantify CD34 expression in histological sections. We evaluated the numeric values for diagnostic value in node differentiation. Furthermore, we compared these values to check for correlations. Results Among the 16 nodes studied, three harboured malignant tumours (18.75%): two papillary and one follicular carcinoma. Among the 13 benign lesions (81.25%), four harboured follicular adenomas. Malignant and benign nodes were not significantly different in sonographic (0.88 ± 0.89 vs. 1.13 ± 0.19; p = 0.2790) or immunohistochemical measurements of vascularization strength (0.05 ± 0.05 vs. 0.08 ± 0.06; p = 0.2260). Conclusion We found a positive, significant correlation (r = 0.55588; p = 0.0254) between SMI (quantitative values for vascularization strength) and immunohistochemistry (CD34 staining) evaluations of thyroid nodes.
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Affiliation(s)
- Thomas Studeny
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Julian Schmidberger
- Department of Internal Medicine I, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Tilmann Graeter
- Department of Diagnostic and Interventional Radiology, Ulm University Hospital, Albert-Einstein-Alee 23, 89081, Ulm, Germany
| | - Thomas F E Barth
- Institute of Pathology, Ulm University Hospital, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Andreas Hillenbrand
- Department of General and Visceral Surgery, Ulm University Hospital, Albert-Einstein-Alee 23, 89081, Ulm, Germany
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Cappelli C, Pirola I, Gandossi E, Rotondi M, Casella C, Lombardi D, Agosti B, Ferlin A, Castellano M. Ultrasound of benign thyroid nodules: A 120 months follow-up study. Clin Endocrinol (Oxf) 2021; 94:866-871. [PMID: 33394535 DOI: 10.1111/cen.14408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Some evidence suggests that most benign nodules exhibit no significant size increase during 5 years of follow-up, although conflicting results have emerged. The aim of the present study is to evaluate the frequency and the magnitude of growth in benign nodules during 120 months of follow-up. DESIGN We reviewed the medical and imaging records of patients who were submitted to ultrasound-guided FNA of thyroid nodules at our hospital from January 2007 to March 2009. We selected only patients with benign nodules who underwent annual ultrasound evaluation in our Department. RESULTS Among 966 selected patients, 289 were lost during follow-up, meaning that the total number of patients analysed was 677 (474 women and 203 men), with a mean age of 45.6 (16-71) years. In 559/677 patients (82.7%), the size of the nodule remained stable during follow-up; 42 (6.2%) patients experienced spontaneous nodule shrinkage, and 75 (11.1%) patients showed nodule growth. Patients with or without nodule growth during follow-up were superimposable at baseline for age, gender, TSH values, number of patients on levothyroxine treatment and nodule characteristics. All baseline variables in predicting nodular growth were entered to an adjusted multivariate logistic regression model. None of the parameters taken into account was associated with nodular growth. CONCLUSIONS In conclusion, the majority of benign nodules remained stable over the period of monitoring. On the basis of our experience, we recommend ultrasound examination at a distance of 2 and 5 years following cytological evaluation, then every 4-5 years from then on.
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Affiliation(s)
- Carlo Cappelli
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Ilenia Pirola
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Elena Gandossi
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Claudio Casella
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Barbara Agosti
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
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Fu Z, Zhang J, Lu Y, Wang S, Mo X, He Y, Wang C, Chen H. Clinical Applications of Superb Microvascular Imaging in the Superficial Tissues and Organs: A Systematic Review. Acad Radiol 2021; 28:694-703. [PMID: 32418782 DOI: 10.1016/j.acra.2020.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 12/12/2022]
Abstract
Superb microvascular imaging (SMI) is an innovative Doppler technique for vascular examination. It uses an intelligent algorithm that efficiently separates low-speed flow signals from motion artifacts so that it can assess microvessels and the vessel distribution in detail. This article reviews the clinical applications of SMI in the disorders of superficial tissues and organs including thyroid nodules, breast tumors and lymph node diseases etc. More information of diseases that are closely associated with angiogenesis can be shown by SMI than other noninvasive examinations. Although some limitations exist, this safe and convenient technique is becoming acceptable and would play a more important role in disease diagnosis and therapeutic responses evaluation.
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Ihezagire I, Bayramoglu Z, Akpinar Y, Adaletli I. The Role of Superb Microvascular Imaging and Shear Wave Elastography in Differentiation of Thyroid Nodules from Intrathyroidal Ectopic Thymus in Children. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2021; 17:33-41. [PMID: 34539908 PMCID: PMC8417492 DOI: 10.4183/aeb.2021.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Ectopic thymus could be located intrathyroidal, therefore fine ultrasound details are useful for this differentiation. AIM To investigate differences in stiffness and vascularity properties among thyroid nodules and intrathyroidal ectopic thymus (IET) by obtaining quantitative data in children. PATIENTS AND METHODS Twenty-seven thyroid nodules and 20 IET in children were evaluated in terms of vascularity index (VI) via superb microvascular imaging (SMI) and stiffness by shear wave elastography (SWE). Differences in the volume, VI, and SWE parameters of the lesions were assessed by using the Mann-Whitney U test. Association of the age, lesion volume, SWE, and VI parameters was investigated by using Spearman's correlation analysis. The optimal cut-off values for stiffness and vascularity in the differentiation of nodules from IET were calculated with ROC analysis. RESULTS The median (range) age of the participants with thyroid nodules and IET were 15.6 (10-18) years and 8.8 (3-14) years, respectively. The medians (range) VI of the IET and thyroid nodules were 4.7 (0.2-16) % and 23.8 (7.5-40)%, respectively. The median SWE values were 7.6 (4.4-9.5) kPa and 15.58 (8.5-23.4) kPa for IET and nodules, respectively. There have been highly significant differences among medians of volume, SWE, and VI values of the lesions. Significant positive correlations were found between VI and SWE parameters (p=0.001, r=0.64), and volume with VI (p=0.018, r=0.34) and SWE (p:0.001, r= 0.5). The diagnostic accuracies were 93%, 91% with the cut-off values as 9.2 kPa, 13% for the SWE and SMI, respectively. IETs were found to be less vascular and less stiff than thyroid nodules. CONCLUSIONS IETs could be easily and confidently differentiated from nodules using SWE and SMI quantifications. This discrimination prompts the reduction of unnecessary interventional procedures.
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Affiliation(s)
- I. Ihezagire
- Istanbul University, Istanbul Medical Faculty, Radiology Department, Istanbul, Turkey
| | - Z. Bayramoglu
- Istanbul University, Istanbul Medical Faculty, Radiology Department, Istanbul, Turkey
| | - Y.E. Akpinar
- Istanbul University, Istanbul Medical Faculty, Radiology Department, Istanbul, Turkey
| | - I. Adaletli
- Istanbul University, Istanbul Medical Faculty, Radiology Department, Istanbul, Turkey
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Ultrasonographic Findings in Common Thyroid and Parathyroid Disorders—Advantages of Real Time Observation by the Endocrinologist with their Own Ultrasound Machine. REPORTS 2021. [DOI: 10.3390/reports4010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this review we discuss the significance of the main ultrasonographic features of common thyroid and parathyroid conditions, with a focus on the advantages of real time observation. The thyroid specialist, defined as an endocrinologist with a major interest in thyroid disorders and access to a portable ultrasound machine, can correlate what they see with the thyroid blood test results and clinical findings in a way that is not available to the general endocrinologist who relies on the interpretation by the consultant radiologist of ultrasound images prepared by a technician. We also discuss the significance of the small, very bright, intra nodular microcalcifications found in benign colloid nodules, which we call “colloid spots” and the difference between these and the 3–4 mm soft microcalcifications that are 90% specific for papillary thyroid cancer and provide a new system for staging the inflammatory changes in Hashimoto thyroiditis, as observed on ultrasonography.
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Wang C, Lin M, Zhong L, Tian C. The value of TI-RADS combined with superb microvascular imaging in distinguishing thyroid nodules: A protocol for systematic review and meta-analysis. PLoS One 2021; 16:e0245035. [PMID: 33411820 PMCID: PMC7790367 DOI: 10.1371/journal.pone.0245035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As a novel ultrasonic technique, superb microvascular imaging (SMI) can quickly, simply and noninvasively observe the microvascular distribution in a tumor and evaluate the microvascular perfusion. Previous studies have shown that SMI can detect the blood flow signals of neovascularization in tumors and increase the sensitivity for detecting thyroid cancer. However, the results of these studies have been contradictory, and the sample sizes were too small. Therefore, the present meta-analysis will aim at evaluating the value of a thyroid imaging report and data system (TI-RADS) combined with SMI in distinguishing between benign and malignant thyroid nodules. METHODS We will search PubMed, Web of Science, Cochrane Library, Google Scholar, and Chinese biomedical databases from their inceptions to the June 31, 2020. Two authors will independently carry out searching literature records; scanning titles, abstracts, and full texts; collecting data; and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis. RESULTS This systematic review will evaluate the value of TI-RADS combined with SMI in distinguishing between benign and malignant thyroid nodules. SYSTEMATIC REVIEW REGISTRATION INPLASY202070113.
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Affiliation(s)
- Cong Wang
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mingxin Lin
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lin Zhong
- Pathology Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Congliang Tian
- Pediatrics Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
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Tian C, Wang Z, Hou X, Wang C. The diagnostic accuracy of superb microvascular imaging in distinguishing thyroid nodules: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e22350. [PMID: 33019411 PMCID: PMC7535557 DOI: 10.1097/md.0000000000022350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Ultrasonography is the first choice for clinical diagnosis and differentiation of thyroid cancer Currently. However, due to the complexity and overlapping nature of the thyroid nodule sonograms, it remains difficult to accurately identify nodules with atypical ultrasound characteristics. Previous studies showed that superb microvascular imaging (SMI) can detect tumor neovascularization to differentiate benign from malignant thyroid nodules. However, the results of these studies have been contradictory with low sample sizes. This meta-analysis tested the hypothesis that SMI is accurate in distinguishing benign and malignant thyroid nodules. METHODS We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the August 20, 2020, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software ((Stata Corp, College Station, TX) will be used for data analysis. RESULTS This systematic review will determine the accuracy of SMI in distinguishing thyroid nodules. CONCLUSION Its findings will provide helpful evidence for the accuracy of SMI in in distinguishing thyroid nodules.Systematic review registration: INPLASY202080084.
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Affiliation(s)
- Congliang Tian
- Pediatrics Department of the First Affiliated Hospital of Dalian Medical University
| | - Zinan Wang
- Nutrition Department of the First Affiliated Hospital of Dalian Medical University
| | - Xiukun Hou
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
| | - Cong Wang
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning Province, China
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Chung J, Lee YJ, Choi YJ, Ha EJ, Suh CH, Choi M, Baek JH, Na DG. Clinical applications of Doppler ultrasonography for thyroid disease: consensus statement by the Korean Society of Thyroid Radiology. Ultrasonography 2020; 39:315-330. [PMID: 32892523 PMCID: PMC7515666 DOI: 10.14366/usg.20072] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Doppler ultrasonography (US) is widely used for the differential diagnosis of thyroid nodules, metastatic cervical lymph nodes in patients with thyroid cancer, and diffuse parenchymal disease, as well as for guidance in various US-guided procedures, including biopsy and ablation. However, controversies remain regarding the appropriate use and interpretation of Doppler US. Therefore, the Korean Society of Thyroid Radiology organized a taskforce to develop a consensus statement on the clinical use of Doppler US for thyroid disease. The review and recommendations in this article are based on a comprehensive analysis of the current literature and the consensus of experts.
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Affiliation(s)
- Jin Chung
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, Gangneung, Korea.,Human Medical Imaging and Intervention Center, Seoul, Korea
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