Abstract
PurposeTo study the thyroid image reporting and data system (TI-RADS) classification and the contrast-enhanced ultrasound (CEUS) enhancement pattern of thyroid nodules, and to determine whether combined use of both methods is helpful in the diagnosis of thyroid nodules.MethodsA total of 319 thyroid nodules in 246 patients were assessed with TI-RADS, CEUS and a combination of both methods. The diagnostic performance of TI-RADS, CEUS and a combination of both methods was compared.ResultsThe accuracy in the diagnosis of thyroid nodules was 90.3 % for TI-RADS, 90.0 % for CEUS and 96.0 % for a combination of both methods respectively. A statistically significant difference was not observed in the diagnostic accuracy of CEUS and TI-RADS (P > 0.05). However, a significant difference was observed between a combination of both methods and either alone (P < 0.01). A combination of both methods showed high sensitivity, specificity and accuracy for TI-RADS classifications of 4a and 4b thyroid nodules compared with TI-RADS alone (P < 0.01) and a statistically significant difference was not observed for thyroid nodules classified as 2, 3, and 5 (P > 0.05).ConclusionsThe improved TI-RADS, when combined with CEUS, could significantly improve the diagnostic accuracy for thyroid nodules, especially for TI-RADS class-4 thyroid nodules.Key Points• TI-RADS can be used as the primary diagnostic standard for thyroid nodules• CEUS can be used as an important complement to TI-RADS• The improved TI-RADS can significantly improve the qualitative diagnostic accuracy
Highlights
The wide application of ultrasound (US) and other technologies in recent years has led to an increasing number of thyroid nodule diagnoses [1]
thyroid imaging reporting and data system (TI-RADS) diagnostic classification by Kwak et al A comparative study was performed between the classification criteria proposed by Kwak et al [4] and the classification criteria presented here, and the results show that there is a significant difference between the two classification methods (χ2 = 27.9, P < 0.01) (Tables 2 and 3)
The results show that a significant difference occurred between the thyroid nodule diagnoses classified as 4a (P < 0.01) and 4b (P < 0.01) by a combination of both methods and TI-RADs alone, whereas a significant difference was not observed for diagnoses classified as 2, 3 and 5 (P > 0.05) (Table 7)
Summary
The wide application of ultrasound (US) and other technologies in recent years has led to an increasing number of thyroid nodule diagnoses [1]. The pathological nature of thyroid nodules directly affects the therapeutic methodology and patient prognosis; the correct diagnosis of thyroid nodules at an early stage has important clinical significance. Conventional sonographic diagnoses for thyroid nodules presents limitations related to overlapping boundaries, morphologies, internal blood streams, and echoes between malignant and benign nodules. Subjective factors related to the diagnostician can affect the accuracy of the diagnosis. Research by Park et al [2], Horvath et al [3] and Kwak et al [4] indicates that the thyroid imaging reporting and data system (TI-RADS), which is based on the breast TIRADS. Malignancy rate % Score 1 Score 4a Score 4b
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