Contrast-Enhanced Ultrasonography for Differential Diagnosis of Benign and Malignant Thyroid Lesions: Single-Institutional Prospective Study of Qualitative and Quantitative CEUS Characteristics.

Objectives: To extend and revise the diagnostic value of contrast-enhanced ultrasonography (CEUS) for differentiation between malignant and benign thyroid nodules. Methods: This single-institution prospective study aims to compare CEUS qualitative and objective quantitative parameters in benign and malignant thyroid nodules. Consecutive cohort of 100 patients was examined by CEUS, 68 out of them were further analysed in detail. All included patients underwent cytological and/or histopathological verification of the diagnosis. Results: Fifty-five (81%) thyroid nodules were benign, and 13 (19%) were malignant. Ring enhancement pattern was strongly associated with a benign aetiology (positive predictive value 100%) and heterogeneous enhancement pattern with malignant aetiology (positive predictive value 72.7%). The shape of the TIC (time-intensity curve) was more often identical in the benign lesion (98.2%) than in malignant lesions (69.2%), p=0.004. Conclusions: This study indicates that CEUS enhancement patterns were significantly different in benign and malignant lesions. Ring enhancement was a very strong indicator of benign lesions, whereas heterogeneous enhancement was valuable to detect malignant lesions.

Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy.

OBJECTIVES: The aim of the study was to evaluate the ability of contrast-enhanced ultrasonography compared to gray-scale B-mode and power Doppler in distinction between benign and malignant lymphadenopathy. METHODS: In a prospective study ultrasonography was performed in 133 patients with superficial lymphadenopathy (73 men, 60 women; mean age of 51 years, range: 18-86 years), who were examined for palpable mass in the neck, axilla or groin (104/133) and for clinical suspicion of lymphoma on the basis of positive PET/CT (29/133). 133 nodes were examined, subsequently preoperatively localized under ultrasound guidance and surgically removed; longitudinal to transverse ratio, location of nodal vessels by power Doppler and pattern of enhancement by contrast-enhanced ultrasonography with 1.5ml intravenous bolus of sulphur hexafluoride contrast agent were documented. The ultrasound findings were compared with the histology. RESULTS: Of all the nodes extirpated, 33 were benign, 100 were malignant (40 metastases, 60 lymphomas). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of conventional techniques were 72%, 63.6%, 85.7%, 42.9%, 67.8% for longitudinal to transverse ratio; 73%, 60.6%, 84.9%, 42.6%, 68.3% for power Doppler versus 98.0%, 54.5%, 86.7%, 90.0%, 76.3% for contrast-enhanced ultrasonography according to Receiver Operating Characteristic analysis. CONCLUSIONS: Receiver Operating Characteristic analysis confirmed higher degree of diagnostic accuracy of contrast-enhanced ultrasonography in comparison with conventional techniques. Evaluation of nodal perfusion after intravenous administration of microbubble contrast agent can be helpful in differentiation of benign from malignant nodes.