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

作者：Guangrong Ma, Libin Chen, Yong Wang, Zhiyan Luo, Yiqing Zeng, Xue Wang, Zhan Shi, Tao Zhang, Yurong Hong, Pintong Huang · 发表于：Insights into Imaging · 年份：2024 · DOI：10.1186/s13244-024-01806-5 · 被引用次数：10 · 研究领域：Thyroid Cancer Diagnosis and Treatment、Thyroid and Parathyroid Surgery、Thyroid Disorders and Treatments

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. CONCLU...