VueBox^® perfusion analysis of dynamic contrast enhanced ultrasound provides added value in the diagnosis of small thyroid nodules

Article type: Research Article

Authors: Huang, Yunlin^{a; b; #} | Wang, Ying^{a; #} | Liu, Lingxiao^{c; #} | Zhu, Lei^d | Qiu, Yijie^{a; b} | Zuo, Dan^{a; b} | Lu, Xiuyun^{a; b} | Dong, Yi^{a; *} | Jung, Ernst-Michael^{e; *} | Wang, Wenping^b

Affiliations: [a] Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China | [b] Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China | [c] Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China | [d] Department of Ultrasound, Haikou Hospital of The Maternal and Child Health, Haikou, China | [e] Department of Radiology, University Medical Center Regensburg, Germany

Correspondence: [*] Corresponding author. Prof. Dr. med. Yi Dong, Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China. Tel.:+86 (0)21 25076104; E-mail: drdaisydong@hotmail.com Prof. Dr. med. Ernst-Michael Jung, Universitätsklinikum Regensburg, Institut für Röntgendiagnostik, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.ernst-michael.jung@ukr.de.

Note: [#] These authors share the co-first authorship.

Abstract: OBJECTIVES:To explore the potential added value of dynamic contrast enhanced ultrasound (DCE-US) using VueBox® software for the diagnosis of small solid thyroid nodules (≤1.0 cm). PATIENTS AND METHODS:This prospective study was approved by the institutional review board and it was performed at two hospitals from January 2020 to October 2020. B mode ultrasound and contrast enhanced ultrasound (CEUS) images were obtained for 79 small solid thyroid nodules (≤1.0 cm) confirmed by ultrasound-guided fine needle aspiration cytology results in 79 consecutive patients (55 women and 24 men, median age: 41 years). The CEUS time-intensity curves (TICs) of thyroid nodules and surrounding parenchyma were created by VueBox® software (Bracco, Italy). The CEUS quantitative parameters were obtained after curve fitting. The diagnostic performance of CEUS and DCE-US was evaluated and compared. The weighted kappa statistic (κ) was performed to assess the interobserver agreement and consistency between the diagnosis of CEUS and DCE-US. RESULTS:Among the 79 thyroid nodules, 56 (70.9 %) were malignant and 23 (29.1 %) were benign lesions. Hypoenhancement during the arterial phase of CEUS was associated with malignancy (P < 0.001), with an AUC of 0.705 (sensitivity 71.4 %, specificity 69.6 %). Among all CEUS quantitative parameters, the peak enhancement (PE), wash-in rate (WiR), and wash-out rate (WoR) of DCE-US in malignancies were significantly lower than those in benign nodules (P = 0.049, P = 0.046, and P = 0.020, respectively). The area under the receiver operating characteristic curves (AUCs) of PE, WiR, and WoR were 0.642 (sensitivity 65.2 %, specificity 67.9 %), 0.643 (sensitivity 43.5 %, specificity 91.1 %), and 0.667 (sensitivity 69.6 %, specificity 69.6 %) in differentiation between benign and malignant small solid thyroid nodules (≤1.0 cm), respectively. Comparing the quantitative parameters of DCE-US between small solid thyroid nodules and surrounding normal thyroid parenchyma, the PE, WiAUC, WiR, wash-in perfusion index (WiPI), WoAUC, WiWoAUC, and WoR of the nodules were significantly lower than those of normal thyroid tissue (P = 0.008, P < 0.001, P = 0.037, P = 0.009, P = 0.003, P = 0.002, P = 0.049, respectively). A total of 16 (20.3 %) nodules showed isoenhancement during the arterial phase of CEUS, while the median PE ratio of surrounding tissue and thyroid nodules was 1.70 (IQR: 1.33–1.89). CONCLUSIONS:VueBox® is a helpful tool for the evaluation of dynamic microvascularization of thyroid nodules, and DCE-US using VueBox® perfusion analysis could provide added values for differential diagnosis of small solid thyroid nodules (≤1.0 cm).

Keywords: Dynamic contrast enhanced ultrasound, thyroid nodule, time intensity curves, quantitative parameters, diagnosis

DOI: 10.3233/CH-221681

Journal: Clinical Hemorheology and Microcirculation, vol. 83, no. 4, pp. 409-420, 2023