Peritumoral Ultrasound Viscoelastic Imaging for Differentiating Benign from Malignant Thyroid Nodules: A Prospective...

This study aimed to evaluate and compare the diagnostic value of ultrasound viscoelastic parameters derived from both intratumoral and peritumoral (2-mm) regions in differentiating benign from malignant thyroid nodules. Additionally, we assessed the diagnostic performance of combining these parameters with the Thyroid Imaging Reporting and Data System (TI-RADS).

A total of 107 patients with 155 thyroid nodules were prospectively and consecutively enrolled from October 2024 to April 2025. All nodules underwent conventional ultrasound and ultrasound viscoelastic imaging prior to biopsy or surgery. Elasticity and viscosity parameters were measured within the intratumoral region, the peritumoral region (2-mm rim), and the combined intratumoral-peritumoral region. Using histopathological results as the gold standard, the diagnostic performance of individual parameters and their combination with the Thyroid Imaging Reporting and Data System (TI-RADS) was evaluated by receiver operating characteristic (ROC) curve analysis. The DeLong test was employed to compare the areas under the curve (AUC).

The maximum and mean values of both elasticity and viscosity parameters in the intratumoral, peritumoral, and combined regions were significantly higher in malignant nodules than in benign nodules (all p < 0.05). The diagnostic performance of the optimal peritumoral parameters was superior to that of the corresponding optimal intratumoral and combined region parameters (all p < 0.05). For all three regions (intratumoral, peritumoral, and combined), the combined diagnostic models integrating the optimal elasticity and/or viscosity parameters with TI-RADS showed significantly higher diagnostic efficacy than TI-RADS alone (all p < 0.05). Furthermore, the optimal combined model based on peritumoral parameters demonstrated superior diagnostic performance compared to the optimal models based on intratumoral or combined region parameters (p < 0.05).

Ultrasound viscoelastic imaging of the peritumoral, intratumoral, and combined regions holds significant value in differentiating benign from malignant thyroid nodules, with peritumoral parameters exhibiting the highest diagnostic performance. The combined model integrating optimal peritumoral elasticity and viscosity parameters with TI-RADS achieves the best diagnostic efficacy, demonstrating promising potential for clinical application.