Elastography for the diagnosis of high-suspicion thyroid nodules based on the 2015 American Thyroid Association guidelines: a multicenter study.

BACKGROUND: An accurate diagnosis for high-suspicion nodules based on the 2015 American Thyroid Association (ATA) guidelines would reduce unnecessary invasive examinations. Elastography is a useful tool for discriminating benign and malignant thyroid nodules. The aim of this study is to investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 ATA guidelines in the Chinese population. METHODS: Thyroid nodules with high-suspicion characteristics based on the 2015 ATA guidelines were subjected to conventional ultrasound (US) and ultrasound strain elastography (USE) examinations at 12 hospitals from 4 geographic regions across China. Cytology/histology of thyroid nodules was used as a reference method. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of the elasticity score (ES) and strain ratio (SR). Logistic regression analysis was used to determine the predictors of malignancy. RESULTS: Overall, a total of 1445 thyroid nodules (834 malignant, 611 benign) from 12 centers were included in the final analysis. The areas under the curve of the ES and SR were 0.828 and 0.732, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the ES were 92.4, 60.7, 79.0, 76.3 and 85.5%, respectively, and those of the SR were 81.1, 50.1, 68.9, 65.9 and 67.9%, respectively. The combination of the Thyroid Imaging Reporting and Data System (TI-RADS) and ES led to a significant increase in the sensitivity and NPV (97.1 and 91.9%, respectively) compared with the TI-RADS alone. Logistic regression analysis showed that microcalcifications (OR = 5.290), taller than wide (OR = 12.710), irregular margins (OR = 10.117), extrathyroidal extension (ETE; OR = 6.412), the ES (OR = 3.741) and the SR (OR = 1.083) were independent predictors of malignant thyroid nodules. The sensitivity, specificity, accuracy, PPV and NPV of the ES were all superior in nodules ≥1 cm than in those < 1 cm (95.0% vs 90.4, 68.8% vs 56.8, 85.9% vs 74.4, 85.2% vs 69.9, and 87.8% vs 84.2%, respectively). CONCLUSIONS: Elastography combined with the ES is a valuable tool for the assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.

Interpreted American College of Radiology TI-RADS classification system of ultrasonography for thyroid nodules in 2017 edition and the experiences in clinical application / 中华耳鼻咽喉头颈外科杂志

Thyroid nodules are extremely common. Ultrasonography is the most effective imaging modality to diagnose and differentiate thyroid nodules. There are many versions of thyroid image reporting and data system(TI-RADS) evaluated by ultrasound, but some classification system indexes are complicated and clinical application is chaotic. In 2017, the American College of Radiology (ACR) published white papers that introduced a TI-RADS classification system based on conventional ultrasound to reduce the dependence on operators and facilitate communication with physicians. The purpose of the ACR TI-RADS is to establish the risk classification system for managing thyroid nodules and guide the physicians to make professional judgments. The ACR TI-RADS risk classification system is interpreted in this article, including the development, overview and feature categories of ACR TI-RADS, and authors′ experiences in clinical application.

Evaluation of fetal thymus size with thymic-thoracic ratio and clinical significance / 中国医学影像技术

Objective To explore value of detecting fetal thymus size with the thymic-thoracic ratio (TT-ratio).Methods Prenatal ultrasonography examinations were performed on totally 317 normal singleton healthy pregnancies from 18 to 39 gestational weeks.The normal thymus of fetus were observed on the three-vessel-trachea (3VT) view.The anteroposterior diameter of the thymus (T1) was measured between the anterior border of the aortic arch and posterior border of sternum.The intrathoracic mediastinal diameter (T2) was measured between the anterior border of thoracic vertebral body and posterior border of sternum.The TT-ratio was then calculated as the ratio of T1 to T2.Scatter plot between TT-ratio and gestational age was drawn.And the Spearman regression analysis was performed.Results The thymus of fetus was shown as an irregular homogenous structure in the anterior mediastinum on the 3VT view.The mean TT-ratio was 0.45± 0.03.There was no correlation between TT-ratio and gestation (rs =0.06,P=0.29).Conclusion Prenatal ultrasound can display the thymus obviously.TT-ratio could be applied to assess the fetal thymus size,which can provides clinical basis for the detection of absent or hypoplastic thymus in fetus.

Value of sonographic diagnosis of benign and malignant thyroid nodules with rimlike peripheral calcification / 中国医学影像技术

Objective To investigate the value of ultrasound in differential diagnosis of benign and malignant thyroid lesions with rimlike peripheral calcification.Methods Seventy-three patients of thyroid nodules with rimlike peripheral calcification were analyzed retrospectively.All cases were confirmed by surgery and pathology.The efficacy of sonographic features on diagnosis of thyroid nodules was analyzed.Results Among 73 patients,58 (58/73,79.45％) were benign and 15 (15/73,20.55％) were malignant.Among the sonographic features mentioned,the mean size,margin,internal echo and presence of halo showed no significant differences between malignant and benign nodules (all P＞0.05).Proportion of thyroid nodules coexisting with nodular goiter,irregular thickness and interruption of rimlike peripheral calcification had significant differences between malignant and benign nodules (all P＜0.05).The sensitivity,specificity,positive predictive value and negative predictive value of coexisting with nodular goiter for diagnosing benign nodules were 77.59％ (45/58),60.00％ (9/15),88.24 ％ (45/51),40.91％ (9/22),respectively.The sensitivity,specificity,positive predictive value and negative predictive value of irregular thickness for diagnosing malignant nodules were 53.33 ％ (8/15),87.93％ (51/58),53.33％ (8/15),87.93％ (51/58),respectively.The sensitivity,specificity,positive predictive value and negative predictive value of interruption of rimlike peripheral calcification for diagnosing malignant nodules were 73.33％ (11/15),68.97％ (40/58),37.93％ (11/29),90.91％ (40/44),respectively.Conclusion Ultrasonography is helpful to diagnosis of thyroid nodules with rimlike peripheral calcification.Irregular thickness and interruption of calcification are associated with malignancy.

Inlfuence of High Density Lipoprotein Cholesterol Upon Carotid Artery Structure and Elasticity：Assessed with Ultrasound Radio Frequency-data Technique / 中国医学影像学杂志

PurposeTo explore the value of ultrasound radio frequency technique in the quantitative evaluation of common carotid artery intima-media thickness (IMT) and elasticity change in patients with dyslipidemia, and to discuss the influence of high density lipoprotein cholesterol (HDL-C) upon carotid artery structure and elasticity function. Materials and Methods A hundred and fifty patients with abnormal serum lipid were selected as case group and further divided into three groups: group A--50 patients with hyperlipidemia and high HDL-C, group B--50 patients with hyperlipidemia and normal HDL-C, group C--50 patients with hyperlipidemia and low HDL-C. Meanwhile, 50 healthy people were enrolled in the study as control group (group D). The ultrasound radio frequency-data technique was employed to analyze the influence of hyperlipidemia and HDL-C upon IMT, CC,β, PWV and AIx.Results The IMT,β, PWV and AIx in group B were higher than those in group D, but group B had lower CC (the differences with statistic significance,t=5.141, 4.219, 4.898, 4.142 and-3.758,P0.05). In patients with hyperlipidemia, the increase of HDL-C led to the reduction of the common carotid artery IMT and wall stiffness and the increase of elasticity and vice versa.Conclusion The ultrasound radio frequency technique could measure the real-time common carotid artery IMT and elasticity automatically and accurately, thus provides reliable quantitative index for the evaluation of early artery structure and change of function in lipid lowering therapy.

Value of strain means of quantitative parameters in diagnosis of liver fibrosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the value of the strain means of the quantitative parameters of organization diffusion in determining the degree of liver fibrosis.</p><p><b>METHODS</b>A total of 130 patients with chronic hepatitis B were examined for quantitative analysis of organization diffusion before liver biopsy to analyze the performance of the strain means in liver fibrosis of different degrees. All the cases were confirmed by pathology.</p><p><b>RESULTS</b>The strain means differed significantly between different stages of liver fibrosis. Using the best cut-off values of 116.2, 111.4, 101.6 and 97.5 for diagnosis of S≥1, S≥2, S≥3 and S=4, the diagnostic sensitivities were 91.2%, 90.8%, 95.8% and 89.7%, with specificities of 90.4%, 98.6%, 93.8% and 95.6% and accuracies of 90.6%, 94.7%, 95.5% and 91.8%, respectively.</p><p><b>CONCLUSION</b>The strain mean can provide specific numerical indicators to determine the degree of liver fibrosis.</p>

Value of ROI A value in strain ratio and elasticity scores in differential diagnosis of thyroid nodules using ultrasonic elastography / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the value of ROI A value in the strain ratio and the elasticity scores by the 4-score system in ultrasonic elastography in differential diagnosis of benign and malignant thyroid nodules.</p><p><b>METHODS</b>A total of 124 patients with 166 thyroid nodules underwent examinations with real-time ultrasonic elastography to obtain the elasticity score and the ROI A value in strain ratio. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of ROI A value, and the best cutoff point was determined. The results of diagnosis based on ROI A value, elasticity scores, and their combination were compared with the results of pathological diagnosis.</p><p><b>RESULTS</b>The area under the ROC curve (Az) of ROI A value for differentiating benign and malignant thyroid nodules was 0.825. The best diagnostic cut-off point of ROI A value was 0.00165. In differentiating benign and malignant thyroid nodules, the sensitivity, specificity, accuracy and odds ratio were 82.93%, 72.80%, 75.30%, and 13.0 for ROI A value, 87.80%, 80.00%, 81.93%, and 28.8 for the elasticity scores, and 73.17%, 91.20%, 86.75%, and 32.1 for their combination, respectively. The odds ratio of the combined diagnosis was the highest, and the accuracy of the combined diagnosis was significantly higher than that of ROI A value (χ(2)=19.31, P<0.05) and the elasticity scores (χ(2)=12.03, P<0.05).</p><p><b>CONCLUSION</b>ROI A value has moderate diagnostic value and clinical practicability in differentiating thyroid nodules. The diagnostic accuracy of ROI A value can be improved by combining with the elasticity scores.</p>

Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules.

OBJECTIVE: To compare the effectiveness of conventional ultrasonography and ultrasound elastography in differential diagnosis of thyroid nodular diseases. METHODS: 244 patients with 291 thyroid nodules were examined by ultrasonography and ultrasound elastography respectively; the examination results were compared against pathological findings to determine the effectiveness of these two examination methods. RESULTS: The sensitivity and positive predictive value of conventional ultrasonography is higher than those of ultrasound elastography, but its specificity, accuracy, and negative predictive value is lower than those of the later. CONCLUSIONS: Ultrasound elastography is superior to conventional ultrasonography in differential diagnosis of thyroid nodules. However, ultrasonography is the basis of examination; only on this basis, an additional ultrasound elastography examination could greatly improve the diagnostic rate of thyroid nodular diseases.

Evaluation of quantitative analysis of organization diffusion application in diagnosing liver fibrosis / 中华超声影像学杂志

Objective To explore the best cutoff point of the quantitative analysis of organization diffusion for differentiating liver fibrosis and to assess its diagnostic value.Methods Sixty-five patients with chronic hepatitis B were examined with quantitative analysis of organization diffusion before liver biopsy,and made a ROC analysis of diagnostic test.All cases confirmed by pathology.Results 114.95 was the best cutoff point of the strain average value which was one parameter of the quantitative analysis of organization diffusion,the area under the curve of ROC was 0.950 (P=0.000),and the sensitivity,specificity,accuracy were 92.3%,87.2% and 89.2%,respectively.Conclusions The quantitative analysis of organization diffusion is helpful in diagnosing liver fibrosis.

Comparative study of ultrasound elastosonography with pathology on hepatic fibrosis in patients with chronic hepatitis B / 中华超声影像学杂志

Objective To investigate the value of ultrasound elastosonography in the diagnosis of liver fibrosis. Methods One hundred and twenty patients with chronic hepatitis B were examined by ultrasound elastosonography and given elasticity scores,the correlation coefficient between the elasticity scores and the histologic fibrosis stage was evaluated and its difference in the diagnosis of liver fibrosis was compared. Results The Spearman's correlation coefficient between the elasticity scores and the histologic fibrosis stage was 0. 875,which was highly significant ( P＜0. 01). There was no significantly difference between elasticity scores and fibrosis staging in the diagnosis of liver fibrosis by Marginal Homogeneity (Z=- 1. 144, P = 0. 149). The sensitivity,specificity and accuracy of ultrasonic elastography for diagnosing liver fibrosis were 92. 5%, 85.0%, 90.0%, respectively. Conclusions Elastosonography is helpful for the diagnosis of liver fibrosis.

Logistic regression analysis of ultrasonographic features in thyroid solitary nodular / 中国医学影像技术

Objective To find out the valuable ultrasonographic features for differentiating benign and malignant thyroid solitary nodular, and to apply the binary Logistic regression model in analysis of ultrasonography of thyroid solitary nodular. Methods Two-dimensional ultrasonography was performed in 194 patients with thyroid solitary nodular confirmed with surgical pathology. A Logistic model was obtained on the basis of ultrasonographic features. A receiver operator characteristic (ROC) curve was constructed to assess the performance of the Logistic model. Results Three ultrasonographic features including shape, calcification and heterogeneous texture were finally entered into the Logistic model. The percentage of correct prediction was 91.75%. The area under ROC curve was 0.916±0.035. Conclusion The binary Logistic regression can select the valuable indexes in the differential diagnosis of thyroid solitary nodular. The application of binary Logistic regression model can improve the diagnosis accuracy of thyroid solitary nodular.

Evaluation of grey scale ultrasonography combined with elastography in differentiating benign and malignant thyroid lesions using receiver operating characteristic curves / 中华超声影像学杂志

Objective To evaluate the value of grey scale ultrasonography (US) combined with elastography in the difference diagnosis of benign and malignant thyroid lesions. Methods Sixty-two patients with 81 lesions were examined by grey scale US and elastography preoperatively. All the lesions were confirmed by pathology. According to their features of grey scale ultrasonograms and elastograms, two receiver operating characteristic (ROC) curves were drawn, one for gray ultrasound and one for the combination methods. The area under curve (AUC) of them were made a comparison. Results The cut-off value of the grey scale group was equal or more than 5, the sensitivity,specificity was 60. 0% ,98. 5%. And the cut-off value of grey scale US combined with elastography group was equal or more than 6, the sensitivity, specificity was 80.0%, 89.4%. The AUC of grey scale US was 0.860 and that of the combination group was 0. 916. The difference between them was statistically significant Z = - 7. 863, P = 0. 000). Conclusions The grey scale US combined with elastography could improve sensitivity and decrease omission diagnose rate. It may be more helpful in the difference diagnosis of malignant from benign thyroid lesions.