Super Resolution Contrast-Enhanced Ultrasound (SR CEUS) in Evaluation of Thyroid Nodules Recommended for FNA...

The present study aims to assess the clinical utility of super resolution contrast-enhanced ultrasound (SR CEUS) in differentiating benign and malignant thyroid nodules for which fine-needle aspiration (FNA) is recommended according to the ACR guidelines, thereby providing incremental value beyond conventional ultrasound.

A total of 51 patients with thyroid nodules were recruited in this prospective research. All the conventional ultrasound, CEUS and SR CEUS images were acquired and all of the CEUS parameters were analyzed. SR CEUS analysis included qualitative and quantitative parameters. The independent sample t-test, the Mann-Whitney U test, a chi-square test and the Fisher's exact probability method were used to compare the difference between benign and malignant groups.

A total of 23 malignant nodules, 27 benign nodules and 1 borderline follicular tumor were included. With respect to CEUS characteristic, malignant lesions were associated with hypoenhancement, centripetal enhancement, later arrival time, heterogeneity enhancement, and earlier wash out time. With respect to microvascular morphology, malignant lesions were associated with convergence pattern and radial pattern. Benign lesions were associated with ring pattern, regular line-like and branch-like patterns and puncture vessel or avascular. The min interval, mean interval and med interval of local lesion were statistically different between benign and malignant nodules (p < 0.05).

The qualitative microvascular morphology based on SR CEUS showed high diagnostic value in the evaluation of thyroid nodules. For thyroid nodules recommended for FNA according to ACR guidelines, SR CEUS can provide additional diagnostic information and enhance the diagnostic performance of ultrasound.

This study verified for the first time the diagnostic value of super-resolution contrast-enhanced ultrasound for thyroid nodules.