Abstract
Background Contrast-enhanced ultrasound (CEUS) scanning can detect differences between thyroid tumors and surrounding tissues. However, enhancement patterns within nodules are insufficient for the diagnosis of thyroid carcinomas. The peripheral enhancement patterns of nodules may provide useful diagnostic information. The objective of this study was to investigate the diagnostic accuracy of the peripheral enhancement patterns during CEUS scanning of thyroid nodules. Material and Methods 120 nodules with peripheral rings during CEUS and definite pathology confirmed by surgery were included in this study. The internal and peripheral CEUS enhancement patterns of these nodules were assessed, and the diagnostic value of CEUS was compared with the conventional ultrasound. The relationship of types of peripheral rings and sizes of nodules was analyzed, respectively. Results There were 78 benign and 42 malignant nodules. Peripheral irregular ring performs well in detecting malignancy. It improves the diagnostic performance of CEUS by combining with internal enhancement patterns (diagnostic sensitivity of 97.6%, specificity of 98.7%, and accuracy of 98.3%) and adds value to conventional ultrasound (95.2%, 70.5%, and 79.2%). The sizes of the nodules with regular high-enhanced rings (2.34 ± 1.33 cm) were larger than the other three types of peripheral rings (P < 0.05). Conclusions Features of peripheral ring on CEUS are important for the diagnosis of thyroid cancer; they can further contribute to the accuracy combining with the internal enhancement pattern, which could avoid the unnecessary biopsy.
Highlights
Since mid-1990s, the incidence of detected thyroid cancer has been increased worldwide, and it appears to be the fastest-growing cancer nowadays [1, 2]
Four types of rings around thyroid nodules were found, so we specially analyzed the nodules with peripheral ring signs on Contrast-enhanced ultrasound (CEUS), and the results showed that peripheral rings contributed greatly to the diagnosis of thyroid cancer
Regular high-enhancement rings were found mainly in benign nodules, except for one case with medullary carcinoma. This medullary carcinoma was a large heterogeneous mass (5.0 × 3.9 × 4.5 cm) which showed regular shape, defined margin, and rich blood flow signal on conventional US, and internal heterogeneous isoenhancement pattern and peripheral regular high-enhancement ring were displayed on CEUS
Summary
Since mid-1990s, the incidence of detected thyroid cancer has been increased worldwide, and it appears to be the fastest-growing cancer nowadays [1, 2]. The objective of this study was to investigate the diagnostic accuracy of the peripheral enhancement patterns during CEUS scanning of thyroid nodules. The internal and peripheral CEUS enhancement patterns of these nodules were assessed, and the diagnostic value of CEUS was compared with the conventional ultrasound. Peripheral irregular ring performs well in detecting malignancy It improves the diagnostic performance of CEUS by combining with internal enhancement patterns (diagnostic sensitivity of 97.6%, specificity of 98.7%, and accuracy of 98.3%) and adds value to conventional ultrasound (95.2%, 70.5%, and 79.2%). Features of peripheral ring on CEUS are important for the diagnosis of thyroid cancer; they can further contribute to the accuracy combining with the internal enhancement pattern, which could avoid the unnecessary biopsy
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