Objective

The aim was to investigate the ability of superb microvascular imaging (SMI) to improve the differential diagnosis of mummified thyroid nodules (MTNs) and papillary thyroid carcinomas (PTCs) using the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS).

Materials and methods

We enrolled 110 cases of MTNs and 110 cases of PTCs confirmed by fine needle aspiration (FNA) or surgery. Conventional ultrasound (US) and the quantity of microvessels detected by SMI were analyzed for all nodules. Thyroid nodules were initially categorized by ACR-TIRADS based on US imaging features and then reclassified based on ACR-TIRADS combined with SMI blood-flow grade (SMI-TIRADS). We compared the diagnostic performances of ACR-TIRADS and SMI-TIRADS by receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).

Results

US-detected margin, shape, and echogenic foci differed between MTNs and PTCs (P < 0.05). The SMI blood-flow grade was significantly greater in PTCs compared with MTNs (Χ ² = 158.78, P < 0.05). There was no significant difference in ACR-TIRADS indicators between MTNs and PTCs (Χ ² = 1.585, P = 0.453); however, reclassification by SMI-TIRADS showed significant differences between the groups (Χ ² = 129.521, P < 0.001). The area under the curve was significantly lower for ACR-TIRADS compared with SMI-TIRADS (0.517 vs 0.887, P < 0.05). SMI-TIRADS had significantly higher diagnostic value for distinguishing MTNs and PTCs than ACR-TIRADS (sensitivity: 91.82% vs 74.55%, P < 0.05; specificity: 84.55% vs 21.82%, P < 0.05; accuracy: 88.18% vs 48.18%, P < 0.05; PPV: 85.59% vs 48.81%, P < 0.05; and NPV: 91.18% vs 46.15%, P < 0.05).

Conclusion

The detection of microvascular flow and large vessels in thyroid nodules by SMI resulted in high diagnostic specificity and sensitivity. ACR-TIRADS combined with SMI could effectively distinguish between MTNs and PTCs, to avoid unnecessary FNA or surgical excision.

中文翻译：

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ACR-TIRADS 的诊断性能结合卓越的微血管成像对木乃伊甲状腺结节和甲状腺乳头状癌的鉴别诊断

目的：利用2017年美国放射学会甲状腺成像报告和数据系统（ACR-TIRADS）探讨超微血管成像（SMI）提高木乃伊甲状腺结节（MTN）和甲状腺乳头状癌（PTC）鉴别诊断的能力。

材料和方法：我们入组了110例经细针抽吸（FNA）或手术证实的MTN和110例PTC。对所有结节进行常规超声 (US) 和 SMI 分析。甲状腺结节最初分为ACR-TIRADS和ACR-TIRADS结合SMI（SMI-TIRADS）。我们通过受试者工作特征曲线、敏感性、特异性、准确性、阳性​​预测值 (PPV) 和阴性预测值 (NPV) 比较了 ACR-TIRADS 和 SMI-TIRADS 的诊断性能。

结果：MTN 和 PTC 之间超声检测到的边缘、形状和回声病灶存在差异 (P<0.05)。与MTN相比，PTC的SMI血流分级更高（c2=158.78，P<0.05）。MTN与PTC之间ACR-TIRADS指标无显着性差异（c2=1.585，P=0.453）；SMI-TIRADS 重新分类显示各组之间存在显着差异（c2=129.521，P<0.001）。与 SMI-TIRADS 相比，ACR-TIRADS 的曲线下面积较低（0.517 vs 0.887，P<0.05）。SMI-TIRADS对区分MTN和PTC的诊断价值高于ACR-TIRADS（敏感性：91.82% vs 74.55%，P<0.05；特异性：84.55% vs 21.82%，P<0.05；准确性：88.18% vs 48.18%，P <0.05；PPV：85.59% vs 48.81%，P<0.05；NPV：91.18% vs 46.15%，P<0.05)。

结论：SMI检测甲状腺结节微血管和大血管具有较高的诊断特异性和敏感性。ACR-TIRADS结合SMI可以有效区分MTN和PTC，避免不必要的FNA或手术。