Contrast Enhanced Ultrasound: A Quantitative Ultrasound Imaging Mode for the Differential Diagnosis of Benign and Malignant Thyroid Nodules

OBJECTIVE: To compare the qualitative contrast enhanced ultrasound (CEUS) performance with grayscale US with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) in differentiating benign and malignant thyroid nodules. METHODS: In this retrospective study, 539 patients with thyroid nodules underwent grayscale US and CEUS. Four predictive models including grayscale US and CEUS sonographic features were constructed using univariable and multivariable logistic regression. RESULTS: A total of 539 thyroid nodules with confirmed cytological results (350 malignant thyroid nodules) in 539 participants were involved. Four predictive models incorporated nodule features at ACR TI-RADS, CEUS features (enhancement degree, homogeneity and rim enhancement), quantitative CEUS features (peak intensity) and ACR TI-RADS with quantitative PI. In fine-needle aspiration biopsy or pathologic results in thyroid nodules, the highest area under the receiver operating characteristic curve (AUC) was 0.87 (95% CI: 0.84, 0.90) for the ACR TI-RADS with quantitative PI model, which had a significant difference compared to the other three models (p < 0 0.05). CONCLUSION: TI-RADS with quantitative PI model played a better diagnostic performance in differentiating benign and malignant thyroid nodules.