Cannavale Alessandro, Corona Mario, Lucatelli Pierleone, Nardis Piergiorgio, Basilico Fabrizio, Bonito Giacomo, Giuliani Luca, Conte Gianmarco Lo, Pacini Patrizia, Pushkarenko Olha, Catalano Carlo, Cantisani Vito
Department of Radiological Sciences, Policlinico Umberto I University Hospital, Vascular and Interventional Unit, Rome, Italy.
Department of Radiological Sciences, Policlinico Umberto I University Hospital, 'Sapienza' University of Rome, Rome, Italy.
J Ultrasound. 2025 Aug 14. doi: 10.1007/s40477-025-01058-z.
We primarily assessed the capability of ultrasound quantitative microvascularity imaging (qMI) in identifying high risk thyroid nodules. In addition, the diagnostic performance of computer aided diagnosis (CAD) was evaluated and correlated with qMI and cytology results.
This single centre prospective study was carried out from 2023 to 2024 and included 165 target thyroid nodules,that were assessed by using CAD for semi-automatic EU-TIRADS classification and qMI, that. Subsequently, all nodules underwent Fine Needle Aspiration Biopsy and Cytology. CAD derived EU-TIRADS and qMI results (Vascularity Index - VI) were correlated with cytology results, that were used as a reference standard, using regression analyses.
Target nodules showed mean size of 15.6 mm ± 9 (range 4-40 mm) and mean vascularity index of 29.03% ± 24.3 (range 0-98.7%)at qMI analysis. Mean vascularity index of 'benign' nodules (TIR2) and low risk nodules (TIR3A) was 35% (range 5-98.7%), that was significantly higher than that of high risk (TIR3B) and malignant nodules (TIR 4/5) (24.2%, p = 0.04.). However, within the malignant group, small nodules (< 10 mm) showed higher vascularity mean VI = 31.45%) than larger nodules (mean VI = 16.91%, p = 0.03). CAD showed very high overall sensitivity and specificity for all EU-TIRADS, allowing for EU-TIRADS 3 and 4 nodules.
Vascularity index showed a weak relationship with nodule size and cytology results. High vascularity may be observed more frequently in small malignant tumours and large benign tumours. Some EU-TIRADS 3 and 4 nodules may benefit of qMI assessment, as CAD shows lower accuracy.
我们主要评估超声定量微血管成像（qMI）识别高风险甲状腺结节的能力。此外，还评估了计算机辅助诊断（CAD）的诊断性能，并将其与qMI和细胞学结果相关联。
这项单中心前瞻性研究于2023年至2024年进行，纳入了165个目标甲状腺结节，这些结节通过CAD进行半自动EU-TIRADS分类和qMI评估。随后，所有结节均接受细针穿刺活检和细胞学检查。使用回归分析将CAD得出的EU-TIRADS和qMI结果（血管指数-VI）与用作参考标准的细胞学结果相关联。
在qMI分析中，目标结节的平均大小为15.6 mm±9（范围4-40 mm），平均血管指数为29.03%±24.3（范围0-98.7%）。“良性”结节（TIR2）和低风险结节（TIR3A）的平均血管指数为35%（范围5-98.7%），显著高于高风险（TIR3B）和恶性结节（TIR 4/5）（24.2%，p = 0.04）。然而，在恶性组中，小结节（<10 mm）的血管平均VI更高（= 31.45%），大于较大结节（平均VI = 16.91%，p = 0.03）。CAD对所有EU-TIRADS显示出非常高的总体敏感性和特异性，适用于EU-TIRADS 3和4类结节。
血管指数与结节大小和细胞学结果之间存在弱相关性。高血管性可能在小的恶性肿瘤和大的良性肿瘤中更频繁地观察到。一些EU-TIRADS 3和4类结节可能受益于qMI评估，因为CAD显示出较低的准确性。
