Risk Stratification of Thyroid Nodules Using Ultrasound Cine-Loop Video Sequences

Static image captures (SICs) are the prevailing methodology for documenting thyroid nodules (TNs) on ultrasound examinations. Ultrasound cine-loop (CL) video sequences of the thyroid enable the storage and review of the entire organ in PACS, analogous to sectional imaging modalities such as CT or MRI. Expanding on SIC, the collection of more extensive datasets is possible, with the potential to enhance diagnostic performance. However, there is an absence of reliable data concerning this process.

This retrospective, tertiary care, single-center study included all patients with cytologically and histopathologically diagnosed TNs from 01/16 to 12/23. A standardized CL protocol was routinely acquired in addition to conventional SIC. The diagnostic performance of ACR and Kwak TIRADS was examined for both CL and SIC in a PACS. Advantages, challenges, and limitations of CL were analyzed.

In total, 189 patients with 329 TNs (78% females, aged 54 ± 15 years; 76% diagnosed via surgery; 14% malignant) were included. On SIC, 58 TNs (18%) were not identified (all benign). When comparing CL with SIC, a strong correlation was observed for nearly all ultrasound features (echogenicity, composition, margin, and foci; each p < 0.001) and both TIRADSs (each p < 0.001). The diagnostic accuracy of CL was slightly superior, with maximum values of 85% for ACR and 87% for Kwak TIRADS, respectively. Rating confidence and image quality exhibited superiority on SIC (each p < 0.001). The occurrence of image artifacts was more prevalent in CL (p < 0.001). The integration of cine loops into thyroid ultrasound was found to be a seamless process, thereby enhancing the risk stratification of nodules. Image quality impairments manifested more frequently in cine loops, while static image captures demonstrated higher levels of assessment confidence.