Diagnostic Value of Contrast Enhanced Ultrasound Evaluation of Malignant and Benign Solitary Thyroid Nodules
Abstract The aim of the study was to investigate the diagnostic value of contrast enhanced ultrasound (CEUS) in differentiating benign and malignant thyroid nodules. Thirty five patients with morphologically proved thyroid nodules (17 malignant; 18 benign) underwent CEUS examination. Five enhancement patterns were evaluated: vascularisation, homogeneity, presence of peripheral rim type enhancement, wash out rate of the contrast medium, and enhancement using microvascular imaging application. Time intensity curves (TIC) were analysed in post processing and defined as three types: slow versus rapid and stable versus rapid biphasic wash out. Diagnostic value of the listed CEUS parameters was calculated. The results showed medium strength correlation between morphology (benign versus malignant nodule) and type of TIC curve rs 0.38 (p 0.021) as well as between mode of contrast enhancement rs 0.39 (p 0.022) and wash out pattern rs =0.39 (p 0.024) The overall pooled sensitivity of selected diagnostic parameters was 82% specificity 57% and accuracy 70% Malignant nodules were characterised by iso or hypovascular contrast enhancement and slow wash out, while benign nodules showed hypervascular enhancement with rapid wash out TIC curve and rim like pattern. The CEUS patterns significantly differed between malignant and benign thyroid nodules with high diagnostic accuracy. Thus, CEUS has important clinical value as an additional tool to ultrasound and fine needle biopsy.