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

Yan Zhang, Ping Zhou, Shuang-Ming Tian, Yong-Feng Zhao, Jia-Le Li, Lan Li, Yan Zhang, Ping Zhou, Shuang-Ming Tian, Yong-Feng Zhao, Jia-Le Li, Lan Li

Abstract

Purpose: To study the thyroid image reporting and data system (TI-RADS) classification and the contrast-enhanced ultrasound (CEUS) enhancement pattern of thyroid nodules, and to determine whether combined use of both methods is helpful in the diagnosis of thyroid nodules.

Methods: A total of 319 thyroid nodules in 246 patients were assessed with TI-RADS, CEUS and a combination of both methods. The diagnostic performance of TI-RADS, CEUS and a combination of both methods was compared.

Results: The accuracy in the diagnosis of thyroid nodules was 90.3 % for TI-RADS, 90.0 % for CEUS and 96.0 % for a combination of both methods respectively. A statistically significant difference was not observed in the diagnostic accuracy of CEUS and TI-RADS (P > 0.05). However, a significant difference was observed between a combination of both methods and either alone (P < 0.01). A combination of both methods showed high sensitivity, specificity and accuracy for TI-RADS classifications of 4a and 4b thyroid nodules compared with TI-RADS alone (P < 0.01) and a statistically significant difference was not observed for thyroid nodules classified as 2, 3, and 5 (P > 0.05).

Conclusions: The improved TI-RADS, when combined with CEUS, could significantly improve the diagnostic accuracy for thyroid nodules, especially for TI-RADS class-4 thyroid nodules.

Key points: • TI-RADS can be used as the primary diagnostic standard for thyroid nodules • CEUS can be used as an important complement to TI-RADS • The improved TI-RADS can significantly improve the qualitative diagnostic accuracy.

Keywords: Combination; Contrast-enhanced ultrasound; Improved TI-RADS; TI-RADS; Thyroid nodules.

Figures

Fig. 1
Fig. 1
A 35-year-old man was found to have an 8 × 6-mm solid hypoechoic nodule in the left lobe of his thyroid. a A conventional two-dimensional image. This nodule had three malignant indicators (solid, markedly hypoechoic, and microcalcifications), and it was classified to a 4b TI-RADS score. b The ultrasound contrast status and the enhancement mode indicated high enhancement. The improved TI-RADS combined with CEUS returned a score of 4a, which indicates a benign nodule. c The pathological image of the lesion, which was of a nodular goitre
Fig. 2
Fig. 2
A 42-year-old woman was found to have a 32 × 15-mm solid nodule in the left lobe of her thyroid. a A conventional two-dimensional image. This nodule had two malignant indicators (solid and irregular margin), and it was classified to a 4a TI-RADS score. b An ultrasound contrast image, and the enhancement mode indicates low enhancement. The improved TI-RADS combined with CEUS returned a score of 4b, and the diagnosis indicated a malignant nodule. c The pathological image of the lesion, which is a thyroid papillary carcinoma
Fig. 3
Fig. 3
A 38-year-old woman was found to have a 12 × 12.5-mm solid hypoechoic nodule in the left lobe of her thyroid. a A conventional two-dimensional image. This nodule had three malignant indicators (solid, aspect ratio greater than 1 and markedly hypoechoic) and was classified to a 4b TI-RADS score. b An ultrasound contrast image; the enhancement mode was low enhancement. The improved TI-RADS combined with CEUS returned a score of 5, and the diagnosis indicates a malignant nodule. c The pathological image of the lesion, which is a thyroid papillary carcinoma
Fig. 4
Fig. 4
A 48-year-old woman was found to have a 14 × 12-mm solid hypoechoic nodule in the right lobe of her thyroid. a A conventional two-dimensional image. This nodule had four malignant indicators (solid, irregular margin, markedly hypoechoic and microcalcifications); it was classified to a TI-RADS score of 5. b An ultrasound contrast image; the enhancement mode was low enhancement. The improved TI-RADS combined with CEUS returned a score of 5, and the diagnosis indicates a malignant nodule. c The pathological image of the lesion, which is a thyroid papillary carcinoma

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