Contrast-Enhanced Ultrasound Improves the Accuracy of the ACR TI-RADS in the Diagnosis of Thyroid Nodules Located in the Isthmus

Abstract

Objectives To evaluate the diagnostic performance of the American College of Radiology (ACR) Thyroid Image Reporting and Data System (TI-RADS), contrast-enhanced ultrasound (CEUS), and a modified TI-RADS in differentiating benign and malignant nodules located in the isthmus.

Methods This retrospective study was approved by the institutional review board. Informed consent was obtained. Grayscale ultrasound (US) and CEUS images were obtained for 203 isthmic thyroid nodules (46 benign and 157 malignant) in 198 consecutive patients (156 women, mean age: 44.7 years ± 11.3 [standard deviation]; 47 men, mean age: 40.9 years ± 11.0). The area under the receiver operating characteristic curve (AUC) of the diagnostic performance of the ACR TI-RADS, CEUS, and the modified TI-RADS were evaluated.

Results Lobulated or irregular margins (P = 0.001; odds ratio [OR] = 9.250) and punctate echogenic foci (P = 0.007; OR = 4.718) on US and hypoenhancement (P < 0.001; OR = 20.888) on CEUS displayed a significant association with malignancy located in the isthmus. The most valuable method to distinguish benign nodules from malignant nodules was the modified TI-RADS (AUC: 0.863 with modified TR5), which was significantly better than the ACR TI-RADS (AUC: 0.738 with ACR TR5) (P < 0.001) but showed no significant difference with respect to CEUS (AUC: 0.835 with hypoenhancement) (P = 0.205). The diagnostic value was significantly different between CEUS and the ACR TI-RADS (P = 0.028).

Conclusion The modified TI-RADS could significantly improve the accuracy of the diagnosis of thyroid nodules located in the isthmus.

Zusammenfassung

Ziel Bewertung der diagnostischen Leistung des Thyroid Image Reporting and Data Systems (TIRADS) des American College of Radiology (ACR), des kontrastverstärkten Ultraschalls (CEUS) und eines modifizierten TIRADS zur Differenzierung von benignen und malignen Knoten im Isthmus.

Methoden Diese retrospektive Studie wurde durch die Ethikkommission (Institutional Review Board) genehmigt. Die Einverständniserklärungen wurden eingeholt. Graustufen-Ultraschall- (US) und CEUS-Bilder wurden für 203 isthmische Schilddrüsenknoten (46 benigne und 157 maligne) bei 198 konsekutiven Patienten (156 Frauen, Durchschnittsalter: 44,7 Jahre ± 11,3 (Standardabweichung); 47 Männer, Durchschnittsalter: 40,9 Jahre ± 11,0) gewonnen. Die Fläche unter der Receiver Operating Characteristic Curve (AUC) der diagnostischen Leistung von ACR-TIRADS, CEUS und modifiziertem TIRADS wurde bewertet.

Ergebnisse Lobulierte oder unregelmäßige Ränder (p = 0,001; Odds Ratio (OR) = 9,250) und punktförmige echogene Herde (p = 0,007; OR = 4,718) im US und Hypoenhancement (p < 0,001; OR = 20,888) im CEUS zeigten eine signifikante Assoziation mit Malignität im Isthmus. Die wertvollste Methode zur Unterscheidung von benignen und malignen Knoten war das modifizierte TIRADS (AUC: 0,863 mit modifiziertem TR5), welches signifikant besser war als ACR-TIRADS (AUC: 0,738 mit ACR TR5; p < 0,001), aber keinen signifikanten Unterschied zu CEUS (AUC: 0,835 mit Hypoenhancement) zeigte (p = 0,205). Der diagnostische Wert unterschied sich signifikant zwischen CEUS und ACR-TIRADS (p = 0,028).

Schlussfolgerung Das modifizierte TIRADS konnte die Genauigkeit der Diagnose von Schilddrüsenknoten im Isthmus signifikant verbessern.

Key words

grayscale ultrasound - ACR TI-RADS - thyroid nodules - isthmus - contrast-enhanced ultrasound

Publication History

Received: 17 November 2020

Accepted: 18 June 2021

Article published online:
03 September 2021

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