Wang Bin, Ou Xiaoyan, Yang Juan, Zhang Haibo, Cui Xin-Wu, Dietrich Christoph F, Yi Ai-Jiao
Department of Medical Ultrasound, Yueyang Central Hospital, Yueyang, China.
Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2023 Jan 11;12:1022305. doi: 10.3389/fonc.2022.1022305. eCollection 2022.
This study aims to evaluate the value of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), and their combined use in the differentiation of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) 4 and 5 category thyroid nodules coexisting with Hashimoto's thyroiditis (HT).
A total of 133 pathologically confirmed ACR TI-RADS 4 and 5 category nodules coexisting with HT in 113 patients were included; CEUS and SWE were performed for all nodules. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and the area under the receiver operating characteristic curve (AUC) of the SWE, CEUS, and the combined use of both for the differentiation of benign and malignant nodules were compared, respectively.
Using CEUS alone, the sensitivity, specificity, PPV, NPV, and accuracy were 89.2%, 66.0%, 81.3%, 78.6%, and 80.5%, respectively. Using SWE alone, Emax was superior to Emin, Emean, and Eratio for the differentiation of benign and malignant nodules with the best cutoff Emax >46.8 kPa, which had sensitivity of 65.1%, specificity of 90.0%, PPV of 91.5%, NPV of 60.8%, and accuracy of 74.4%, respectively. Compared with the diagnostic performance of qualitative CEUS or/and quantitative SWE, the combination of CEUS and SWE had the best sensitivity, accuracy, and AUC; the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 94.0%, 66.0%, 82.1%, 86.8%, 83.5%, and 0.80 (95% confidence interval: 0.713, 0.886), respectively.
In conclusion, CEUS and SWE were useful for the differentiation of benign and malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT. The combination of CEUS and SWE could improve the sensitivity and accuracy compared with using CEUS or SWE alone. It could be a non-invasive, reliable, and useful method to differentiate benign from malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT.
本研究旨在评估超声造影（CEUS）、剪切波弹性成像（SWE）及其联合应用在鉴别美国放射学会（ACR）甲状腺影像报告和数据系统（TI-RADS）4类和5类合并桥本甲状腺炎（HT）的甲状腺结节中的价值。
纳入113例患者中133个经病理证实的ACR TI-RADS 4类和5类合并HT的结节；对所有结节均行CEUS和SWE检查。分别比较SWE、CEUS及其联合应用鉴别良恶性结节的敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）、准确性及受试者操作特征曲线下面积（AUC）。
单独使用CEUS时，敏感性、特异性、PPV、NPV及准确性分别为89.2%、66.0%、81.3%、78.6%及80.5%。单独使用SWE时，在鉴别良恶性结节方面，Emax优于Emin、Emean及Eratio，最佳截断值Emax>46.8 kPa，其敏感性、特异性、PPV、NPV及准确性分别为65.1%、90.0%、91.5%、60.8%及74.4%。与定性CEUS或/和定量SWE的诊断性能相比，CEUS与SWE联合应用具有最佳的敏感性、准确性及AUC；敏感性、特异性、PPV、NPV、准确性及AUC分别为94.0%、66.0%、82.1%、86.8%、83.5%及0.80（95%置信区间：0.713，0.886）。
总之，CEUS和SWE有助于鉴别ACR TI-RADS 4类和5类合并HT的甲状腺结节的良恶性。与单独使用CEUS或SWE相比，CEUS与SWE联合应用可提高敏感性和准确性。它可能是一种鉴别ACR TI-RADS 4类和5类合并HT的甲状腺结节良恶性的无创、可靠且有用的方法。
