Additional Value of Superb Microvascular Imaging for Thyroid Nodule Classification with the Thyroid Imaging Reporting...

Area of Science:

• Radiology and Imaging
• Medical Ultrasound
• Thyroidology

Background:

• Conventional color Doppler imaging (CDI) and power Doppler imaging (PDI) have limitations in detecting microvascular blood flow in thyroid nodules.
• Superb microvascular imaging (SMI) is an advanced ultrasound technique offering superior sensitivity for visualizing small blood vessels.

Purpose of the Study:

• To evaluate the diagnostic performance of SMI in characterizing thyroid nodule vascularity.
• To compare the diagnostic accuracy of the American College of Radiology's Thyroid Imaging Reporting and Data System (TI-RADS) alone versus its combination with SMI for thyroid nodules.

Main Methods:

• A study involving 203 thyroid nodules in 195 patients.
• Assessment using TI-RADS (2017) and SMI, comparing diagnostic classifications and receiver operating characteristic (ROC) curves.
• Analysis of diagnostic efficiency for different TI-RADS categories (TR2-TR5).

Main Results:

• The combination of TI-RADS and SMI resulted in a larger area under the ROC curve (0.952) compared to TI-RADS alone (0.883) (p=0.001).
• Diagnostic efficiency for TR4 thyroid nodules was significantly higher with the TI-RADS + SMI combination than with TI-RADS alone (p < 0.05).
• No significant differences in diagnostic efficiency were observed for TR3 and TR5 nodules between the two methods.

Conclusions:

• SMI effectively characterizes thyroid nodule vascularity.
• The combined use of gray-scale ultrasound and SMI improves the diagnostic performance of TI-RADS, especially for TR4 thyroid nodules.
• SMI represents a valuable addition to ultrasound for enhanced thyroid nodule evaluation.