Application of microvascular ultrasound-assisted thyroid imaging report and data system in thyroid nodule risk stratification.

IF 4.1 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Insights into Imaging Pub Date : 2024-09-23 DOI:10.1186/s13244-024-01806-5

Guangrong Ma, Libin Chen, Yong Wang, Zhiyan Luo, Yiqing Zeng, Xue Wang, Zhan Shi, Tao Zhang, Yurong Hong, Pintong Huang

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Abstract

Objectives: To establish superb microvascular imaging (SMI) based thyroid imaging reporting and data system (SMI TI-RADS) for risk stratification of malignancy in thyroid nodules.

Methods: In total, 471 patients, comprising 643 thyroid nodules, who received conventional ultrasound (US), SMI, and a final diagnosis were extensively analyzed. A qualitative assessment of US features of the nodules was performed followed by univariable and multivariable logistic regression analyses, leading to the construction of the SMI TI-RADS, which was further verified using internal and external validation cohorts.

Results: Among the stand-alone US, predictive factors were the shape and margins of the nodules, echogenicity and echogenic foci, vascularity, extrathyroidal extension, ring-SMI patterns, penetrating vascularity, flow-signal enlarged, and vascularity area ratio. SMI TI-RADS depicted an enhanced area under the receiver operating characteristic curve (AUC) of 0.94 (95% CI: 0.92, 0.96; p < 0.001 relative to other stratification systems), a 79% biopsy yield of malignancy (BYM, 189/240 nodules), and a 21% unnecessary biopsy rate (UBR, 51/240 nodules). In the verification cohorts, we demonstrated AUCs, malignancy biopsy yields, and unnecessary biopsy rates of 0.88 (95% CI: 0.83, 0.94), 79% (59/75 nodules), and 21% (16/75 nodules) for the internal cohort, respectively, and 0.91 (95% CI: 0.85, 0.96), 72% (31/43 nodules), and 28% (12/43 nodules) for the external cohort, respectively.

Conclusion: SMI TI-RADS was found to be superior in diagnostic sensitivity, specificity, and efficiency than existing TI-RADSs, showing better stratification of the malignancy risk, and thus decreasing the rate of unnecessary needle biopsy.

Critical relevance statement: To develop an imaging and data system based on conventional US and SMI features for stratifying the malignancy risk in thyroid nodules.

Key points: SMI features could improve thyroid nodule risk stratification. SMI TI-RADS showed superior diagnostic efficiency and accuracy for biopsy guidance. SMI TI-RADS can provide better guidance for clinical diagnosis and treatment of thyroid nodules.

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微血管超声辅助甲状腺成像报告和数据系统在甲状腺结节风险分层中的应用

目的建立基于超级微血管成像（SMI）的甲状腺成像报告和数据系统（SMI TI-RADS），用于甲状腺结节恶性风险分层：方法：对471例甲状腺结节患者（包括643个甲状腺结节）进行了广泛分析，这些患者接受了常规超声检查（US）、SMI和最终诊断。对结节的 US 特征进行定性评估，然后进行单变量和多变量逻辑回归分析，最终建立了 SMI TI-RADS 标准，并通过内部和外部验证队列对其进行了进一步验证：在独立的US检查中，预测因素包括结节的形状和边缘、回声性和回声灶、血管性、甲状腺外扩展、环状-SMI模式、穿透性血管、血流信号增大和血管面积比。SMI TI-RADS 的接收器操作特征曲线下面积（AUC）为 0.94（95% CI：0.92, 0.96；P 结论：SMI TI-RADS 的接收器操作特征曲线下面积为 0.94（95% CI：0.92, 0.96）：与现有的 TI-RADS 相比，SMI TI-RADS 在诊断灵敏度、特异性和效率方面更胜一筹，能更好地对恶性肿瘤风险进行分层，从而降低不必要的针刺活检率：基于传统 US 和 SMI 特征开发一套成像和数据系统，用于对甲状腺结节的恶性风险进行分层：SMI特征可改善甲状腺结节风险分层。SMI TI-RADS 在活检指导方面显示出更高的诊断效率和准确性。SMI TI-RADS可为甲状腺结节的临床诊断和治疗提供更好的指导。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.