Sonografie von Schilddrüsenknoten

Zusammenfassung

Die Sonografie gehört zu den Standardverfahren bei der Evaluation von Schilddrüsenknoten. Verschiedene sonografische Veränderungen sind mit einem erhöhten Malignitätsrisiko assoziiert. Basierend hierauf wurden in den letzten Jahren Klassifizierungssysteme entwickelt, um leichter diejenigen Knoten zu selektieren, welche einer weiteren Abklärung bedürfen (TI-RADS: thyroid imaging and reporting systems). Bis jetzt werden in diesen Systemen nur morphologische Kriterien eingeschlossen. Resultate einer Farbdoppler-Sonografie als ergänzendem Verfahren werden in diesen Klassifizierungen nicht berücksichtigt, obwohl eine erhöhte intranoduläre Vaskularisation bei follikulären Neoplasien mit einem erhöhten Malignitätsrisiko assoziiert ist. Aktuell werden die neuen Systeme evaluiert und müssen ggf. für die klinische Praxis optimiert werden. Außerdem gibt es erste Ansätze, die Dokumentation der Ultraschallergebnisse weiter zu standardisieren, um die diagnostischen Möglichkeiten der Ultraschalluntersuchung im Sinne der Verbesserung der Patientenversorgung zu optimieren.

Abstract

Thyroid ultrasound is used as a first-line diagnostic procedure to evaluate thyroid nodules. Several ultrasound characteristics have been associated with an increased risk of malignancy. Based on these criteria, classification systems are being developed to categorize thyroid nodules and stratify their malignant risk to decide about further evaluation. Up to now only morphological features are taken into account. The results of Doppler ultrasonography have not yet been included in these thyroid imaging and reporting systems (TI-RADS) although predominantly internal flow is associated with malignancy of thyroid follicular neoplasia. Currently, the new systems will be evaluated and may be optimized for clinical practice. Furthermore there are first attempts to standardize the reporting of ultrasound features of thyroid nodules to enhance patient care by optimizing the diagnostic capabilities of an ultrasound examination.

Schlüsselwörter

Sonografie - TI-RADS - Doppler-Sonografie

Key words

sonography - TI-RADS - duplex sonography

• Literatur

• 1 American College of Radiology, BI-RADS Committee . ACR-BI-RADS^®-ultrasound. In ACR BI-RADS breast imaging and reporting data system: breast imaging atlas. 4^th ed. Reston, VA: American College of Radiology; 2003: 1-86
• 2 Brito JP, Gionfriddo MR, Al Nofal A et al. The Accuracy of Thyroid Nodule Ultrasound to Predict Thyroid Cancer: Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2014; 99: 1253-1263
• 3 Cooper DS, Doherty GM, Haugen BR et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19: 1167-1214
• 4 Frates MC, Benson CB, Charboneau JW et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology 2005; 237: 794-800
• 5 Frates MC, Benson CB, Doubilet PM et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography. J Clin Endocrinol Metab 2006; 91: 3411-3417
• 6 Haugen BR, Alexander EK, Bible KC et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 1: 1-134
• 7 Horvath E, Majlis S, Rossi R et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009; 94: 1748-1751
• 8 Iared W, Shigueoka DC, Cristófoli JC et al. Use of color Doppler ultrasonography for the prediction of malignancy in follicular thyroid neoplasms. J Ultrasound Med 2010; 29: 419-425
• 9 Karger S, Tötsch M, Krause K et al. Der Schilddrüsenknoten – Differentialdiagnostik und Therapiekonzepte. Medizinische Klinik 2008; 103: 575-588
• 10 Kim GR, Kim MH, Moon HJ et al. Sonographic characteristics suggesting papillary thyroid carcinoma according to nodule size. Ann Surg Oncol 2013; 20: 906-913
• 11 Kwak JY, Han KH, Yoon JH et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260: 892-899
• 12 Lacout A, Chevenet C, Salas J et al. Thyroid Doppler US: Tips and tricks. J Med Imaging and Rad Oncol 2015; 1-6
• 13 Maia FF, Matos PS, Pavin EJ et al. Thyroid imaging reporting and data system score combined with Bethesda system for malignancy risk stratification in thyroid nodules with indeterminate results on cytology. Clin Endocrinol (Oxf) 2015; 82: 439-444
• 14 Moon HJ, Kwak JY, Kim MJ et al. Can vascularity at power Doppler US help predict thyroid malignancy?. Radiology 2010; 255: 260-269
• 15 Moon HJ, Sung JM, Kim EK et al. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology 2012; 262: 1002-1013
• 16 Moon HJ, Kim EK, Kwak JY. Malignancy risk stratification in thyroid nodules with benign results on cytology: Combination of Thyroid Imaging Reporting and Data System and Bethesda System. Ann Surg Oncol 2014; 21: 1898-1903
• 17 Pacini F, Schlumberger M, Dralle H et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006; 154: 787-803
• 18 Papini E, Guglielmi R, Bianchini A et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002; 87: 1941-1946
• 19 Park JY, Lee HJ, Jang HW et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid 2009; 19: 1257-1264
• 20 Perros P, Boelaert K, Colley S et al. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 (Suppl. 01) 1-122
• 21 Rago T, Vitti P. Role of thyroid ultrasound in the diagnostic evaluation of thyroid nodules. Best Pract Res Clin Endocrinol Metab 2008; 22: 913-928
• 22 Razavi SA, Hadduck TA, Sadigh G et al Comparative effectiveness of elastographic and B-mode ultrasound criteria for diagnostic discrimination of thyroid nodules: a meta-analysis. AJR Am J Roentgenol 2013; 200: 1317-1326
• 23 Remonti LR, Kramer CK, Leitão CB et al. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid 2015; 25: 538-550
• 24 Russ G, Leboulleux S, Leenhardt L et al. Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. Eur Thyroid J 2014; 3: 154-163
• 25 Xie C, Cox P, Taylor N et al. Ultrasonography of thyroid nodules: a pictoral review. Insights Imaging 2016; 7: 77-86
• 26 Yeung MJ, Serpell JW. Management of the solitary thyroid nodule. Oncologist 2008; 13: 105-112
• 27 Yoon JH, Lee HS, Kim EK. Malignancy risk stratification of thyroid nodules: Comparison between the thyroid imaging reporting and data system and the 2014 American Thyroid Association management guidelines. Radiology 2016; [epub ahead of print]
• 28 Zhang J, Bo-Ji L, Xu H-X et al. Prospective validation of an ultrasound-based thyroid imaging reporting and data system (TI-RADS) on 3980 thyroid nodules. Int J Clin Exp Med 2015; 8: 5911-5917