Abstract
BackgroundSuperb microvascular imaging (SMI) for depiction of microvascular flow in thyroid nodules was compared with color/power Doppler imaging (CDI/PDI) and contrast-enhanced ultrasonography (CEUS). In addition, the diagnostic performance of conventional ultrasound combined with SMI for differentiating benign and malignant thyroid nodules was evaluated.MethodsPreoperative conventional ultrasound consisting of gray-scale ultrasonography and CDI/PDI, followed by SMI and CEUS, was used to record 52 thyroid nodules. Two radiologists analyzed the gray-scale ultrasound signs and nodules’ microvascular flow patterns to differentiate between benign (n = 13) and malignant nodules (n = 39).ResultsSMI was significantly more effective in the detection of microvascular flow signals than CDI/PDI. In malignant nodules, SMI depicted the presence of incomplete surrounding periphery microvasculature and of disordered heterogeneous internal microvasculature. Benign nodules showed complete surrounding periphery microvasculature (ring sign) and homogeneity internal branching. The accuracies of conventional ultrasound combined with CDI/ PDI, SMI, or CEUS for predicting malignancy were 67.31, 86.54, and 92.31%, respectively. The accuracy of SMI differed significantly from CDI/PDI (P = 0.012), but not from CEUS (P = 0.339).ConclusionsMicrovascular flow and vessel branching in the peripheral and internal microvasculature of thyroid nodules is depicted with greater detail and clarity with SMI compared with conventional ultrasound. SMI offers a safe and low-cost alternative to CEUS for differentiating between benign and malignant thyroid nodules.
Highlights
Superb microvascular imaging (SMI) for depiction of microvascular flow in thyroid nodules was compared with color/power Doppler imaging (CDI/PDI) and contrast-enhanced ultrasonography (CEUS)
The details of microvasculature within the nodules were recorded semi-quantitatively (Fig. 1). Both color and monochrome SMI delivered clearer and more cohesive vessel branching detail in the nodules compared with Color/Power Doppler imaging (CDI/PDI)
The characteristics of the nodules according to microvascular flow of CDI/ PDI, SMI, and CEUS were evaluated and the accuracy of the 3 imaging microvascular flow patterns was assessed
Summary
Superb microvascular imaging (SMI) for depiction of microvascular flow in thyroid nodules was compared with color/power Doppler imaging (CDI/PDI) and contrast-enhanced ultrasonography (CEUS). It is well known that blood vessels are important to the growth of a nodule, but conventional color or power Doppler imaging (CDI and PDI, respectively) are not very sensitive to microvascularity patterns and low blood flow velocity [5]. Vessel extraction methods, such as minimal path techniques to effectively locate tiny vessels, might be of help to extract vessel-related information for further diagnosis [6], they are limited by some inherent problems like endpoint, shortcut and accumulation issues [7]. A recent improved means of visualizing low flow in microvessels is superb microvascular imaging (SMI) ultrasound technology, implemented with the Aplio 500 US
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