Contrast-enhanced ultrasonography and time-intensity curve analysis for differential diagnosis of benign and malignant thyroid nodules

Abstract

Objective To investigate the clinical value of contrast-enhanced ultrasonography (CEUS) combined with time-intensity curve (TIC) analysis in differential diagnosis of benign and malignant thyroid nodules. Methods We conducted a retrospective study of 114 patients with 175 thyroid nodules detected by CEUS in our hospital between August, 2016 and September, 2017 and compared the enhancement patterns and TIC of CEUS between benign and malignant thyroid nodules. All the patients underwent surgical resection of the nodules and the findings of CEUS were compared with the results of surgical pathology. Results CEUS identified 93 benign nodules and 82 malignant nodules, while the pathological results confirmed 98 benign nodules (29 adenomas and 69 nodular goiters) and 77 malignant nodules (papillary carcinoma). CEUS had a diagnostic sensitivity of 85.7% for malignant thyroid nodules with a specificity of 83.6% and an accuracy of 84.5%. CEUS showed homogeneous hyperenhancement or isoenhancement in 58.1% (57/98) of thyroid adenomas and nodular goiters, and heterogeneous hypoenhancement in 71.4% (55/77) of malignant thyroid nodules. TIC analysis showed that compared with the surrounding thyroid tissue, thyroid adenomas showed a rapid entry in CEUS with a steep ascending branch and a higher peak intensity (P 0.05). Conclusion Benign and malignant thyroid nodules commonly present with different characteristics in CEUS. Thyroid carcinomas (papillary carcinomas) are typically characterized by slow and heterogeneous hypoenhancement in CEUS, while benign thyroid nodules feature a rapid hyper- or isoenhancement. CEUS combined with quantitative analysis can improve the diagnostic accuracy for malignant thyroid nodules

Keywords

• contrast-enhanced ultrasonography
• differential diagnosis
• thyroid nodules
• quantitative analysis