Contrast Enhancement Ultrasound Improves Diagnostic Accuracy for Thyroid Nodules: A Prospective Multicenter Study

Author:

Li Jianming1,Dou Jianping1,Li Huarong2,Xiao Fan1,Yu Jie1,Xie Mingxing3ORCID,Zhou Ping4,Liang Lei2,Zhou Guiming5,Che Ying6,Liu Cun7,Cong Zhibin8,Liu Fangyi1,Han Zhiyu1ORCID,Liang Ping1ORCID

Affiliation:

1. Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital , Beijing 100853 , China

2. Department of Ultrasound, Aero-space Center Hospital , Beijing 100049 , China

3. Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan 430022 , China

4. Department of Ultrasound, Third Xiangya Hospital, Central South University , Guangdong 410008 , China

5. Department of Ultrasound, Tianjin Medical University General Hospital , Tianjin 300052 , China

6. Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University , Dalian 116011 , China

7. Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences , Jinan 250199 , China

8. Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine , Changchun 130021 , China

Abstract

Abstract Objective To evaluate potential improvements in the diagnosis of thyroid nodules when conventional ultrasound (US) is combined with contrast-enhanced US (CEUS). Methods We recruited 515 participants with 323 malignant and 192 benign nodules, who underwent both US and CEUS examinations at 8 different medical centers in China between October 2020 and October 2021. We assessed the malignancy of thyroid nodules in US using the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS). Diagnostic criteria for US and US + CEUS were developed by investigators based on evaluations of sonographic features. Using multivariate logistic regression and receiver operating characteristic (ROC) analysis, we compared diagnostic performance between the 2 methods based on criteria identified by investigators and via statistical models. Results On the basis of diagnostic criteria identified by investigators, we measured statistically significant differences in area under the curve (AUC) values between ACR TIRADS (0.83) and CEUS TIRADS (0.87; P < .001). On the basis of diagnostic regression models, we found statistically significant differences in AUC values between US (0.76) and US + CEUS (0.84; P = .001). Models based on US + CEUS outperformed those based on US alone (Akaike information criterion of 347.7 and significant improvement in integrated discrimination). These results were confirmed by similar analyses applied to a validation cohort. Conclusion The accuracy of conventional US for differentiating between benign and malignant thyroid nodules can be improved by combining this approach with CEUS.

Funder

National Scientific Foundation Committee of China

China International Medical Foundation

Publisher

The Endocrine Society

Subject

Endocrinology, Diabetes and Metabolism

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