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Angelopoulos N, Goulis DG, Chrisogonidis I, Livadas S, Iakovou I. Color Doppler ultrasound and real-time elastography in patients with hypothyroidism for the prediction of levothyroxine replacement: a cross-sectional study of 338 patients. J Ultrasound 2024:10.1007/s40477-024-00876-x. [PMID: 38393451 DOI: 10.1007/s40477-024-00876-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
AIMS While hormonal assays are commonly used for thyroid function assessment, Doppler sonography provides valuable information on vascularization and blood flow. This study aimed to examine the potential associations between Doppler parameters and clinical characteristics of hypothyroid patients, such as the autoimmune nature of the disease and adequacy of LT4 replacement. METHODS A total of 338 patients with hypothyroidism, primarily caused by autoimmune thyroiditis (AT), were enrolled in this study. Exclusion criteria comprised specific medical conditions, medication history, and nodular abnormalities of the thyroid gland. Patient demographics (age, sex, BMI), treatment parameters (LT4 daily dose), and thyroid hormone levels (TSH, fT4) were recorded. RESULTS Among the enrolled patients, 85.2% had autoimmune thyroiditis. Suboptimal levothyroxine (LT4) replacement was observed in 20.1% of patients at the time of enrollment. Patients with autoimmune thyroiditis had increased elastography ratios compared to those without autoimmune disease and present a positive association of elastography ratios with vascularity. In patients without autoimmune thyroiditis, those with suboptimal LT4 replacement had lower total thyroid volume. Patients with suboptimal LT4 replacement had higher peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the inferior thyroid artery and lower resistive index (RI). The severity of hypothyroidism, as indicated by LT4 dose/body mass index (BMI), was negatively correlated with thyroid volume and EDV values of superior and inferior thyroid arteries. PSV of the inferior thyroid artery can predict suboptimal LT4 replacement (sensitivity 81.8%, specificity 42%). CONCLUSIONS In situations where obtaining blood tests may be challenging, utilizing color Doppler ultrasound can serve as an alternative method to assess treatment responses and identify patients who require further hormonal examinations.
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Affiliation(s)
- Nikolaos Angelopoulos
- 2nd Academic Department of Nuclear Medicine, Faculty of Medicine, School of Health Sciences, AHEPA University Hospital, Venizelou 26, Kavala, 65403, Thessaloniki, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Chrisogonidis
- Department of Radiology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ioannis Iakovou
- 2nd Academic Department of Nuclear Medicine, Faculty of Medicine, School of Health Sciences, AHEPA University Hospital, Venizelou 26, Kavala, 65403, Thessaloniki, Greece
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Okasha HH, Mansor M, Sheriba N, Abdelfattah Y, Abdelfatah D, Orabi HE, Elebrashy IN, Saif A, Meligi AAE, Elshazli M, Elhadidy KE, Abushady MM, Islam EE, Yosef TM, Salama ASED, Ouf TI, Said SM, Eid YM, Mohsen AA, Rizk MN, Yousief E, Elrawi H, Ahmed TM, Roshdy E, Sedrak HK, Din HGE, Aboulsoud S, El-Sawy SS, El-Feki MA, Alzamzamy A, Elenin SA, Tag-Adeen M, Abdelhameed H, Awad A. Value of TI-RADS and elastography strain ratio in predicting malignant thyroid nodules: experience from a single center in Egypt. Egypt J Intern Med 2023; 35:45. [DOI: https:/doi.org/10.1186/s43162-023-00227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/04/2023] [Indexed: 11/04/2023] Open
Abstract
Abstract
Introduction
Thyroid nodules are highly prevalent in the general population; therefore, it is crucial to discriminate benign from malignant nodules. A practical thyroid imaging reporting and data system (TI-RADS) for thyroid nodules and ultrasound elastography are valuable tools not only for characterization of nodules but also for the selection of tumors for fine-needle aspiration cytology (FNAC).
Objective
This study aimed to evaluate the diagnostic accuracy of US evaluation in the prediction of malignant thyroid nodules and evaluate the role of the elastography score, strain ratio (SR), and the TI-RADS scoring system as non-invasive tools in differentiation between malignant and benign thyroid nodules.
Material and methods
A total of 1269 patients were evaluated between February 2017 and April 2020 by a single expert thyroid ultrasound operator. The final diagnosis was achieved from cytological and/or histological evaluation and follow-up for at least 1 year.
Results
There were 1088 females and 181 males with a mean age of 44 ± 10 SD. The final diagnosis was 1197 benign nodules and 72 malignant nodules. Most malignant nodules were scored elastography score 4 (83.3%) and TI-RADS category 5 (86.11%). We found that nodules with antero-posterior to transverse (A-P/T) diameter > 1, have 21 times more risk to be malignant than those with A-P/T diameter < 1, patients with solitary thyroid nodules have 4.5 times to develop malignancy compared to those with multinodular goiter (MNG), nodules with absent halo have 4 times more risk of malignancy. Furthermore, microcalcifications in thyroid nodules increase the risk of malignancy 9 times compared to those without calcifications. SR was found to be an excellent discriminator to differentiate between benign and malignant nodules with P < 0.001. Also, we found that for every unit increase in SR, the risk of malignancy increased by 20%. We reported that the accuracy of ultrasonography in the detection of malignant thyroid nodules had a sensitivity of 89%, specificity of 98%, 70% PPV, and 99.3% NPV, with an overall accuracy of 97.2%.
Conclusion
The application of ultrasonographic non-invasive criteria for thyroid nodules in clinical practice might significantly reduce the number of unnecessary FNAC. Elastography, SR, and TI-RADS classification could be good predictors for malignant thyroid nodules.
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Okasha HH, Mansor M, Sheriba N, Assem M, Abdelfattah Y, Ashoush OA, Rakha M, Abdelfattah D, El-Sawy SS, Elshenoufy M, Mohsen AA, Sedrak HK, Abdellatif AA. Role of elastography strain ratio and TIRADS score in predicting malignant thyroid nodule. Arch Endocrinol Metab 2021; 64:735-742. [PMID: 34033283 PMCID: PMC10528627 DOI: 10.20945/2359-3997000000283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/12/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. METHODS From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC. RESULTS Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. CONCLUSION Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.
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Affiliation(s)
| | - Mona Mansor
- Kasr Al-Aini Hospitals, Cairo University, Cairo, Egypt
| | | | - Maha Assem
- Kasr Al-Aini Hospitals, Cairo University, Cairo, Egypt
| | | | - Omar A Ashoush
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Rakha
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Abdelfattah
- Biostatistic and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Sun L, Goh HJ, Wang NX, Verma SK, Velan SS, Leow MKS. Diffusely increased 18F-FDG thyroid radionuclide uptake is not always hyperthyroidism. Postgrad Med J 2021; 98:e27. [PMID: 37063015 PMCID: PMC9691811 DOI: 10.1136/postgradmedj-2020-139643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/18/2021] [Accepted: 04/01/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Lijuan Sun
- Human Development, Singapore Institute for Clinical Sciences, Singapore
| | - Hui Jen Goh
- Human Development, Singapore Institute for Clinical Sciences, Singapore
| | - Nan Xin Wang
- Clinical Nutrition Research Centre, Agency for Science, Technology and Research (A*STAR), Singapore.,Department of Human Nutrition, University of Otago, Otago, New Zealand
| | - Sanjay K Verma
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, Agency for Science Technology and Research (A*STAR), Singapore
| | - S Sendhil Velan
- Laboratory of Molecular Imaging, Singapore Bioimaging Consortium, Agency for Science Technology and Research (A*STAR), Singapore
| | - Melvin Khee Shing Leow
- Human Development, Singapore Institute for Clinical Sciences, Singapore .,Endocrinology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Bhatia N, Dhingra VK, Kumari S, Dhawan DK, Chadha VD. Efficacy of dual use of Tc-99m-pertechnetate and Tc-99m-tetrofosmin scintigraphy for the assessment of thyroid nodules. J Med Imaging Radiat Oncol 2020; 64:189-196. [PMID: 32103595 DOI: 10.1111/1754-9485.13006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/06/2019] [Accepted: 12/24/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Radioisotope methods have shown to be useful in the non-invasive diagnosis of thyroid nodules over the past years. The present prospective study aims to evaluate the efficacy of gamma imaging using single and dual tracer using Tc-99m pertechnetate and Tc-99m tetrofosmin for evaluation and management of thyroid nodules. METHODS Dynamic (perfusion) imaging was performed after injecting 148-185 MBq (4-5 mCi) of Tc-99m pertechnetate followed by static imaging. A second, dynamic (perfusion) imaging study within same week was performed with 296-370MBq (8-10mCi) of Tc-99m tetrofosmin on same group of patients followed by early and delayed images. Results of radionuclide perfusion scan from both studies were compared qualitatively with postsurgical histopathology or fine needle aspiration cytology (FNAC). RESULTS Total 65 nodules in 50 patients were included in the study. With single tracer, the specificity and accuracy of Tc-99m pertechnetate was 23% and 45% and for Tc-99m tetrofosmin scan was 40% and 49%. When dual tracers were evaluated for the same group of patients, the specificity was 56% and accuracy was 55%. CONCLUSION Dual Tracer technique with Tc-99m pertechnetate and Tc-99m tetrofosmin could be helpful in selecting nodules need surgical intervention. This technique can be used for convenient and rapid diagnostic evaluation of thyroid nodules non-invasively. We suggest a combination of fine needle aspiration biopsy and dual use of Tc-99m-pertechnetate and Tc-99m-tetrofosmin as a routine diagnostic approach to thyroid nodules.
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Affiliation(s)
- Nisha Bhatia
- Centre of Nuclear Medicine, Panjab University, Chandigarh, India.,Department of Nuclear Medicine, Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India
| | - Vandana K Dhingra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Saumya Kumari
- Department of Nuclear Medicine, Cancer Research Institute, Swami Rama Himalayan University, Dehradun, India
| | | | - Vijayta D Chadha
- Centre of Nuclear Medicine, Panjab University, Chandigarh, India
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Ardakani AA, Mohammadzadeh A, Yaghoubi N, Ghaemmaghami Z, Reiazi R, Jafari AH, Hekmat S, Shiran MB, Bitarafan-Rajabi A. Predictive quantitative sonographic features on classification of hot and cold thyroid nodules. Eur J Radiol 2018; 101:170-177. [PMID: 29571793 DOI: 10.1016/j.ejrad.2018.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/04/2018] [Accepted: 02/09/2018] [Indexed: 02/01/2023]
Abstract
PURPOSE This study investigated the potentiality of ultrasound imaging to classify hot and cold thyroid nodules on the basis of textural and morphological analysis. METHODS In this research, 42 hypo (hot) and 42 hyper-function (cold) thyroid nodules were evaluated through the proposed method of computer aided diagnosis (CAD) system. To discover the difference between hot and cold nodules, 49 sonographic features (9 morphological, 40 textural) were extracted. A support vector machine classifier was utilized for the classification of LNs based on their extracted features. RESULTS In the training set data, a combination of morphological and textural features represented the best performance with area under the receiver operating characteristic curve (AUC) of 0.992. Upon testing the data set, the proposed model could classify the hot and cold thyroid nodules with an AUC of 0.948. CONCLUSIONS CAD method based on textural and morphological features is capable of distinguishing between hot from cold nodules via 2-Dimensional sonography. Therefore, it can be used as a supplementary technique in daily clinical practices to improve the radiologists' understanding of conventional ultrasound imaging for nodules characterization.
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Affiliation(s)
- Ali Abbasian Ardakani
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammadzadeh
- Department of Radiology, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Yaghoubi
- Department of Nuclear Medicine, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghaemmaghami
- Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Reiazi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Medical Image and Signal Processing Research Core, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Homayoun Jafari
- Department of Medical Physics & Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Hekmat
- Department of Nuclear Medicine, School of Medicine, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Bagher Shiran
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Ahmad Bitarafan-Rajabi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Department of Nuclear Medicine, Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Abstract
Context: Ultrasonography of thyroid gland is a frequently performed investigation. Many of the diffuse thyroid pathologies are associated with altered vascularity. In view of potential applications and scant available data, there is a need to find normal values of Doppler indices of superior thyroid artery (STA). Aims: To find the normal range of Doppler indices like mean peak systolic velocity (PSV), resistivity index (RI), and pulsatility index (PI) of STA in clinically euthyroid adult individuals. Settings and Design: Prospective cross-sectional observational study. Materials and Methods: A study was done in the Department of Radiodiagnosis of a tertiary care hospital, involving clinically euthyroid adult volunteers. Ultrasonography of the thyroid gland with Doppler of bilateral STAs was performed and mean values of PSV, RI, and PI were calculated. Results: A total of 208 subjects, with a mean age of 37.7 years, underwent Doppler evaluation of STA; 148 of them were women and 60 were men. The mean PSV obtained was 16.94 ± 5.3 cm/s. Mean PI and RI were 0.93 ± 0.31 and 0.5 ± 0.13, respectively. There was no significant difference in the values obtained among both the genders. Conclusion: Mean values of Doppler indices of STA in euthyroid individuals have been found in this study.
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Affiliation(s)
- Upendra Kumar Joish
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
| | - Y Kavitha
- Department of ENT, JJM Medical College, Davangere, Karnataka, India
| | - R Harikiran Reddy
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
| | - Anitha S Prabhu
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
| | - M Chetan Kumar
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
| | - M C Siddharth
- Department of Radiodiagnosis, JJM Medical College, Davangere, Karnataka, India
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Abstract
RATIONALE Primary hyperparathyroidism (PHPT) during pregnancy is rare. Nevertheless, hypercalcemia secondary to gestational PHPT may be masked by physiological changes in calcium homeostasis during pregnancy. Gestational PHPT constitutes a serious danger to mother and fetus. Surgery is the only curative treatment when conservative treatment could not control the condition. Due to the lack of guidelines concerning PHPT during pregnancy, the optimal anesthetic management of PHPT during pregnancy needs to be individualized. Patient concerns: We report a case of PHPT with successful surgical treatment under combined cervical plexus block and general anesthesia. DIAGNOSIS She was diagnosed with hypercalcemia, PHPT, a possible parathyroid adenoma, and a 19-week intrauterine pregnancy. INTERVENTIONS The patient underwent heparin-free hemodialysis before the surgery in the nephrology department in the presence of a cardiologist. She then received a successful parathyroidectomy under combined bilateral superficial cervical plexus block and general anesthesia in her 19th week of pregnancy. OUTCOMES She was released from the hospital with no maternal or fetal complications on postoperative day 9. A healthy baby boy was uneventfully born at 37 weeks of gestation. LESSONS We suggest that surgical removal of the lesion after lowering the blood calcium concentration in mid-pregnancy is currently the optimal treatment option for pregnant patients with PHPT. Furthermore, multidisciplinary perioperative management is particularly important.
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Gonzalo-Domínguez M, Hernández-Rodríguez MC, Martín-Pérez MA, Marín-Balbín JM, Blanco-Hernández R, Martín-García I. Resonancia magnética de tiroides y paratiroides. Rev ORL 2017. [DOI: 10.14201/orl201784.14846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Xia J, Chen H, Li Q, Zhou M, Chen L, Cai Z, Fang Y, Zhou H. Ultrasound-based differentiation of malignant and benign thyroid Nodules: An extreme learning machine approach. Comput Methods Programs Biomed 2017; 147:37-49. [PMID: 28734529 DOI: 10.1016/j.cmpb.2017.06.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 04/23/2017] [Accepted: 06/20/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES It is important to be able to accurately distinguish between benign and malignant thyroid nodules in order to make appropriate clinical decisions. The purpose of this study was to improve the effectiveness and efficiency for discriminating the malignant from benign thyroid cancers based on the Ultrasonography (US) features. METHODS There were 114 benign nodules in 106 patients (82 women and 24 men) and 89 malignant nodules in 81 patients (69 women and 12 men) included in this study. The potential of extreme learning machine (ELM) has been explored for the first time to discriminate malignant and benign thyroid nodules based on the sonographic features in ultrasound images. The influence of two key parameters (the number of hidden neurons and type of activation function) on the performance of ELM was investigated. The relationship between feature subsets obtained by the feature selection method and the classification performance of ELM was also examined. A real-life dataset was used to evaluate the effectiveness of the proposed method in terms of classification accuracy, sensitivity, specificity, and area under the ROC (receiver operating characteristic) curve (AUC). RESULTS The results demonstrate that there are significant differences between the malignant and benign thyroid nodules (p-value<0.01), the most discriminative features are echogenicity, calcification, margin, composition and shape. Compared with other methods, the proposed method not only has achieved very promising classification accuracy via 10-fold cross-validation (CV) scheme, but also greatly reduced the computational cost compared to other counterparts. The proposed ELM-based approach achieves 87.72% ACC, 0.8672 AUC, 78.89% sensitivity, and 94.55% specificity. CONCLUSIONS Based on the empirical analysis, the proposed ELM-based approach for thyroid cancer detection has promising potential in clinical use, and it can be of assistance as an optional tool for the clinicians.
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Affiliation(s)
- Jianfu Xia
- Department of General Surgery, The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China
| | - Huiling Chen
- College of Physics and Electronic Information, Wenzhou University, Wenzhou, Zhejiang, 325035, China.
| | - Qiang Li
- College of Physics and Electronic Information, Wenzhou University, Wenzhou, Zhejiang, 325035, China
| | - Minda Zhou
- Department of Ultrasound, The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China
| | - Limin Chen
- Department of Ultrasound, The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China
| | - Zhennao Cai
- College of Physics and Electronic Information, Wenzhou University, Wenzhou, Zhejiang, 325035, China
| | - Yang Fang
- Department of General Surgery, The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China
| | - Hong Zhou
- Department of General Surgery, The Dingli Clinical Institute of Wenzhou Medical University(Wenzhou Central Hospital), Wenzhou, Zhejiang, 325000, China
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Díaz-soto G, Torres B, López Gómez JJ, Gómez Hoyos E, Villar A, Romero E, de Luis DA. Impacto económico y satisfacción de la implantación de una consulta de alta resolución de patología nodular tiroidea en Endocrinología. ACTA ACUST UNITED AC 2016; 63:414-20. [DOI: 10.1016/j.endonu.2016.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/11/2016] [Accepted: 04/04/2016] [Indexed: 11/20/2022]
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Abstract
Thyroid gland disorders include benign and malignant thyroid nodules and diffuse thyroid disorders. The incidence of malignant thyroid nodules is low and the prognosis is good. The diagnosis of thyroid cancer and diffuse parenchymal disorders is generally based on clinical manifestations and histopathological evaluation. Ultrasonography has its place in the diagnostics and follow-up of thyroid disorders. Ultrasonographic elastography is a new, developing method that shows increase in clinical practice. In this study, we aimed to review the data on thyroid ultrasound elastography.
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Affiliation(s)
| | - Mahmut Duymus
- Department of Radiology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Serhat Avcu
- Department of Radiology, Gazi University, Faculty of Medicine, Ankara, Turkey
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Song G, Xue F, Zhang C. A Model Using Texture Features to Differentiate the Nature of Thyroid Nodules on Sonography. J Ultrasound Med 2015; 34:1753-1760. [PMID: 26307120 DOI: 10.7863/ultra.15.14.10045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/28/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the use of texture-based gray-level co-occurrence matrix (GLCM) features extracted from thyroid sonograms in building prediction models to determine the nature of thyroid nodules. METHODS A GLCM was used to extract the texture features of 155 sonograms of thyroid nodules (76 benign and 79 malignant). The GLCM features included energy, contrast, correlation, sum of squares, inverse difference moment, sum average, sum variance, sum entropy, entropy, difference variance, difference entropy, information measures of correlation, and maximal correlation coefficient. The texture features extracted by the GLCM were used to build 6 different statistical models, including support vector machine, random tree, random forest, boost, logistic, and artificial neural network models. The models' performances were evaluated by 10-fold cross-validation combining a receiver operating characteristic curve, indices of accuracy, true-positive rate, false-positive rate, sensitivity, specificity, precision, recall, F-measure, and area under the receiver operating characteristic curve. External validation was used to examine the stability of the model that showed the best performance. RESULTS The logistic model showed the best performance, according to 10-fold cross-validation, among the 6 models, with the highest area under the curve (0.84), accuracy (78.5%), true-positive rate (0.785), sensitivity (0.789), specificity (0.785), precision (0.789), recall (0.785), and F-measure (0.784), as well as the lowest false-positive rate (0.215). The external validation results showed that the logistic model was stable. CONCLUSIONS Gray-level co-occurrence matrix texture features extracted from sonograms of thyroid nodules coupled with a logistic model are useful for differentiating between benign and malignant thyroid nodules.
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Affiliation(s)
- Gesheng Song
- School of Medicine (G.S.), and Department of Epidemiology and Biostatistics, School of Public Health (F.X.), Shandong University, Jinan, China; and Health Management Center, Shandong Provincial Qianfoshan Hospital, Jinan, China (C.Z.)
| | - Fuzhong Xue
- School of Medicine (G.S.), and Department of Epidemiology and Biostatistics, School of Public Health (F.X.), Shandong University, Jinan, China; and Health Management Center, Shandong Provincial Qianfoshan Hospital, Jinan, China (C.Z.)
| | - Chengqi Zhang
- School of Medicine (G.S.), and Department of Epidemiology and Biostatistics, School of Public Health (F.X.), Shandong University, Jinan, China; and Health Management Center, Shandong Provincial Qianfoshan Hospital, Jinan, China (C.Z.).
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14
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Chang TC. The Roles of Ultrasonography and Ultrasonography-guided Fine-needle Aspiration Cytology in the Planning of Management of Thyroid Cancers. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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15
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Abstract
OBJECTIVE Thyroid cancer is the most common endocrine cancer. This review evaluates the established use of (18)F-FDG PET/CT in papillary, follicular, Hürthle cell, anaplastic, and medullary thyroid cancers. The significance of incidental diffuse and focal thyroid FDG uptake is discussed. The evolving value of non-FDG radiotracers, including (124)I, (18)F-dihydroxyphenylalanine, and (68)Ga somatostatin analogs, is summarized. CONCLUSION PET/CT is a valuable imaging test, in the appropriate clinical context, for the management of thyroid cancers.
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Abstract
Primary hyperparathyroidism (PHPT) is rarely diagnosed during pregnancy but is associated with significant maternal and fetal morbidity and mortality. Information on appropriate management is limited. We reviewed the medical literature through December 2012 for key articles on PHPT during pregnancy, focusing on large series. Clinical knowledge in this area is restricted to isolated case reports and a few retrospective studies. Diagnosis can be difficult, owing to the non-specific nature of signs and symptoms of hypercalcemia during pregnancy. Pregnant women with a calcium level over 2.85 mmol/L (11.4 mg/dL) and prior pregnancy loss are at a particularly high risk of maternal complications (hypercalcemic crisis, nephrolithiasis, pancreatitis, etc.) and fetal loss. Around one-half of neonates born to mothers with untreated PHPT have hypocalcemia and tetany. Algorithms proposed for the management of the pregnant woman with PHPT are not evidence based, reflecting the paucity of data. Treatment should thus be individually tailored. Gestational age and the severity of hypercalcemia should be taken into account when assessing the risk-benefit balance of a conservative approach (hyperhydration and vitamin D supplementation) versus parathyroid surgery. Current evidence supports parathyroidectomy as the main treatment, performed preferably during the second trimester, when the serum calcium is above 2.75 mmol/L (11 mg/dL). In the patients with mild forms of PHPT, which are nowadays the most frequent, a conservative management is generally preferred.
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Affiliation(s)
- Gonzalo Diaz-Soto
- Service d'Endocrinologie et des Maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, 94275, Le Kremlin Bicêtre, France
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17
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Acharya UR, Sree SV, Swapna G, Gupta S, Molinari F, Garberoglio R, Witkowska A, Suri JS. Effect of complex wavelet transform filter on thyroid tumor classification in three-dimensional ultrasound. Proc Inst Mech Eng H 2013; 227:284-92. [PMID: 23662344 DOI: 10.1177/0954411912472422] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ultrasonography has great potential in differentiating malignant thyroid nodules from the benign ones. However, visual interpretation is limited by interobserver variability, and further, the speckle distribution poses a challenge during the classification process. This article thus presents an automated system for tumor classification in three-dimensional contrast-enhanced ultrasonography data sets. The system first processes the contrast-enhanced ultrasonography images using complex wavelet transform-based filter to mitigate the effect of speckle noise. The higher order spectra features are then extracted and used as input for training and testing a fuzzy classifier. In the off-line training system, higher order spectra features are extracted from a set of images known as the training images. These higher order spectra features along with the clinically assigned ground truth are used to train the classifier and obtain an estimate of the classifier or training parameters. The ground truth tells the class label of the image (i.e. whether the image belongs to a benign or malignant nodule). During the online testing phase, the estimated classifier parameters are applied on the higher order spectra features that are extracted from the testing images to predict their class labels. The predicted class labels are compared with their corresponding original ground truth to evaluate the performance of the classifier. Without utilizing the complex wavelet transform filter, the fuzzy classifier demonstrated an accuracy of 91.6%, while utilizing the complex wavelet transform filter, the accuracy significantly boosted to 99.1%.
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Affiliation(s)
- U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, 535 Clementi Road, Singapore.
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18
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Abstract
Although thyroid scintigraphy and ultrasound continues to be the mainstay of the diagnostic imaging of the thyroid gland, there have been several recent advances that are of interest to both radiologists and endocrinologists. In this review article, the authors discuss recent progress in imaging of the thyroid by use of radionuclide imaging including single photon-emission computed tomography/positron emission tomography, ultrasonography (USG), USG elastography, computed tomography (CT), magnetic resonance imaging (MRI), and optical coherence tomography.
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Affiliation(s)
- Vikas Chaudhary
- Department of Radiodiagnosis, Employees’ State Insurance Corporation (ESIC) Model Hospital, Gurgaon-122001, Haryana, India
| | - Shahina Bano
- Department of Radiodiagnosis, Lady Hardinge Medical College and Associated Smt. Sucheta Kriplani and Kalawati Hospitals, New Delhi, India
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19
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Ahn BC. Sodium iodide symporter for nuclear molecular imaging and gene therapy: from bedside to bench and back. Theranostics 2012; 2:392-402. [PMID: 22539935 PMCID: PMC3337731 DOI: 10.7150/thno.3722] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 01/23/2012] [Indexed: 12/20/2022] Open
Abstract
Molecular imaging, defined as the visual representation, characterization and quantification of biological processes at the cellular and subcellular levels within intact living organisms, can be obtained by various imaging technologies, including nuclear imaging methods. Imaging of normal thyroid tissue and differentiated thyroid cancer, and treatment of thyroid cancer with radioiodine rely on the expression of the sodium iodide symporter (NIS) in these cells. NIS is an intrinsic membrane protein with 13 transmembrane domains and it takes up iodide into the cytosol from the extracellular fluid. By transferring NIS function to various cells via gene transfer, the cells can be visualized with gamma or positron emitting radioisotopes such as Tc-99m, I-123, I-131, I-124 and F-18 tetrafluoroborate, which are accumulated by NIS. They can also be treated with beta- or alpha-emitting radionuclides, such as I-131, Re-186, Re-188 and At-211, which are also accumulated by NIS. This article demonstrates the diagnostic and therapeutic applications of NIS as a radionuclide-based reporter gene for trafficking cells and a therapeutic gene for treating cancers.
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Affiliation(s)
- Byeong-Cheol Ahn
- Department of Nuclear Medicine, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
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Acharya UR, Vinitha Sree S, Krishnan MMR, Molinari F, Garberoglio R, Suri JS. Non-invasive automated 3D thyroid lesion classification in ultrasound: a class of ThyroScan™ systems. Ultrasonics 2012; 52:508-520. [PMID: 22154208 DOI: 10.1016/j.ultras.2011.11.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 10/30/2011] [Accepted: 11/05/2011] [Indexed: 05/31/2023]
Abstract
Ultrasound-based thyroid nodule characterization into benign and malignant types is limited by subjective interpretations. This paper presents a Computer Aided Diagnostic (CAD) technique that would present more objective and accurate classification and further would offer the physician a valuable second opinion. In this paradigm, we first extracted the features that quantify the local changes in the texture characteristics of the ultrasound off-line training images from both benign and malignant nodules. These features include: Fractal Dimension (FD), Local Binary Pattern (LBP), Fourier Spectrum Descriptor (FS), and Laws Texture Energy (LTE). The resulting feature vectors were used to build seven different classifiers: Support Vector Machine (SVM), Decision Tree (DT), Sugeno Fuzzy, Gaussian Mixture Model (GMM), K-Nearest Neighbor (KNN), Radial Basis Probabilistic Neural Network (RBPNN), and Naive Bayes Classifier (NBC). Subsequently, the feature vector-classifier combination that results in the maximum classification accuracy was used to predict the class of a new on-line test thyroid ultrasound image. Two data sets with 3D Contrast-Enhanced Ultrasound (CEUS) and 3D High Resolution Ultrasound (HRUS) images of 20 nodules (10 benign and 10 malignant) were used. Fine needle aspiration biopsy and histology results were used to confirm malignancy. Our results show that a combination of texture features coupled with SVM or Fuzzy classifiers resulted in 100% accuracy for the HRUS dataset, while GMM classifier resulted in 98.1% accuracy for the CEUS dataset. Finally, for each dataset, we have proposed a novel integrated index called Thyroid Malignancy Index (TMI) using the combination of FD, LBP, LTE texture features, to diagnose benign or malignant nodules. This index can help clinicians to make a more objective differentiation of benign/malignant thyroid lesions. We have compared and benchmarked the system with existing methods.
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Affiliation(s)
- U Rajendra Acharya
- Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, 535 Clementi Road, Singapore 599489, Singapore
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