Skip to main content

Advertisement

SpringerLink
Log in

Superb microvascular imaging compared with contrast-enhanced ultrasound to assess microvessels in thyroid nodules

  • Original Article–Breast & Thyroid
  • Published:
Journal of Medical Ultrasonics Aims and scope Submit manuscript

Abstract

Purpose

Contrast-enhanced ultrasound (CEUS) and superb microvascular imaging (SMI) can detect microvessels in thyroid nodules. Here, SMI and CEUS were compared for differentiating thyroid nodules.

Methods

Seventy-six patients (102 nodules) underwent SMI and CEUS. The SMI blood flow (BF) grade and CEUS enhanced intensity (EI) were recorded for the periphery and center of each nodule, and evaluated relative to pathological findings.

Results

SMI of malignant nodules showed abundant BF in the periphery but lack of BF in the center, while CEUS showed hypoenhancement in the center and periphery. Large and small vessels had greater saliency on SMI-BF grade and CEUS-EI, respectively. Analysis of SMI-BF as diagnostic of thyroid carcinoma specifically at the nodule periphery indicated rates of 82.2%, 79.3%, and 81.3% for sensitivity, specificity, and accuracy, respectively. The corresponding rates for CEUS hypoenhancement were 80.8%, 86.2%, and 82.3%, respectively. Thus, SMI and CEUS rates were similar.

Conclusion

SMI-BF grade was more affected by vessels of larger inner diameter, while CEUS-EI was more affected by vessels of smaller inner diameter. SMI alone is sufficient for evaluation of blood flow in thyroid nodules, and the diagnostic value of SMI-BF of the periphery is comparable to CEUS hypoenhancement to differentiate thyroid cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.

    Article  Google Scholar 

  2. Smith-Bindman R, Lebda P, Feldstein VA, et al. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics. JAMA Intern Med. 2013;173:1788–96.

    Article  Google Scholar 

  3. Kwak JY, Han KH, Yoon JH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011;260:892–9.

    Article  Google Scholar 

  4. Stabenow E, Tavares MR, Ab'Saber AM, et al. Angiogenesis as an indicator of metastatic potential in papillary thyroid carcinoma. Clinics (Sao Paulo). 2005;60:233–40.

    Article  Google Scholar 

  5. Ferrari SM, Fallahi P, Politti U, et al. Molecular targeted therapies of aggressive thyroid cancer. Front Endocrinol (Lausanne). 2015;6:176.

    Article  Google Scholar 

  6. Baig FN, Lunenburg J, Liu S, et al. Computer-aided assessment of regional vascularity of thyroid nodules for prediction of malignancy. Sci Rep. 2017;7:14350.

    Article  Google Scholar 

  7. Ma X, Zhang B, Ling W, et al. Contrast-enhanced sonography for the identification of benign and malignant thyroid nodules: Systematic review and meta-analysis. J Clin Ultrasound. 2016;44:199–209.

    Article  Google Scholar 

  8. Weidner N, Semple JP, Welch WR, et al. Tumor angiogenesis and metastasis–correlation in invasive breast carcinoma. N Engl J Med. 1991;324:1–8.

    Article  CAS  Google Scholar 

  9. Skuletic V, Radosavljevic GD, Pantic J, et al. Angiogenic and lymphangiogenic profiles in histological variants of papillary thyroid carcinoma. Pol Arch Intern Med. 2017;127:429–37.

    PubMed  Google Scholar 

  10. Lee JH, Shin HJ, Yoon JH, et al. Predicting lymph node metastasis in patients with papillary thyroid carcinoma by vascular index on power Doppler ultrasound. Head Neck. 2017;39:334–40.

    Article  Google Scholar 

  11. Zhou Q, Jiang J, Shang X, et al. Correlation of contrast-enhanced ultrasonographic features with microvessel density in papillary thyroid carcinomas. Asian Pac J Cancer Prev. 2014;15:7449–522.

    Article  Google Scholar 

  12. Wilson NM, Masoud AM, Barsoum HB, et al. Correlation of power Doppler with microvessel density in assessing prostate needle biopsy. Clin Radiol. 2004;59:946–50.

    Article  CAS  Google Scholar 

  13. Iared W, Shigueoka DC, Cristófoli JC, et al. Use of color Doppler ultrasonography for the prediction of malignancy in follicular thyroid neoplasms: systematic review and meta-analysis. J Ultrasound Med. 2010;29:419–25.

    Article  Google Scholar 

  14. Hong Y, Wu Y, Luo Z, et al. Impact of nodular size on the predictive values of gray-scale, color-Doppler ultrasound, and sonoelastography for assessment of thyroid nodules. J Zhejiang Univ Science B. 2012;13:707–16.

    Article  Google Scholar 

  15. Yang G, Fried KO. Most thyroid cancers detected by sonography lack intranodular vascularity on color Doppler imaging: review of the literature and sonographic–pathologic correlations for 698 thyroid neoplasms. J Ultrasound Med. 2017;36:89–94.

    Article  Google Scholar 

  16. Wu MH, Chen CN, Chen KY, et al. Quantitative analysis of dynamic power Doppler sonograms for patients with thyroid nodules. Ultrasound Med Biol. 2013;39:1543–51.

    Article  Google Scholar 

  17. Kim DW, Jung SJ, Eom JW, et al. Color Doppler features of solid, round, isoechoic thyroid nodules without malignant sonographic features: a prospective cytopathological study. Thyroid. 2013;23:472–6.

    Article  Google Scholar 

  18. Iannuccilli JD, Cronan JJ. Monchik JM Risk for malignancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound Med. 2004;23:1455–64.

    Article  Google Scholar 

  19. Zhang Y, Zhou P, Tian S, et al. Usefulness of combined use of contrast-enhanced ultrasound and TI-RADS classification for the differentiation of benign from malignant lesions of thyroid nodules. Eur Radiol. 2017;27:1527–36.

    Article  Google Scholar 

  20. Lu R, Meng Y, Yan Z, et al. Superb microvascular imaging (SMI) compared with conventional ultrasound for evaluating thyroid nodules. BMC Med Imaging. 2017;17:65.

    Article  Google Scholar 

  21. Yongfeng Z, Ping Z, Wengang L, et al. Application of a novel microvascular imaging technique in breast lesion evaluation. Ultrasound Med Biol. 2016;42:2097–105.

    Article  Google Scholar 

  22. Wu L, Yen H, Soon M. Spoke-wheel sign of focal nodular hyperplasia revealed by superb micro-vascular ultrasound imaging. QJM. 2015;108:669–70.

    Article  CAS  Google Scholar 

  23. Xiao XY, Chen X, Guan XF, et al. Superb microvascular imaging in diagnosis of breast lesions: a comparative study with contrast-enhanced ultrasonographic microvascular imaging. Br J Radiol. 2016;89:20160546.

    Article  Google Scholar 

  24. Kong J, Li JC, Wang HY, et al. Role of superb micro-vascular imaging in the preoperative evaluation of thyroid nodules: comparison with power Doppler flow imaging. J Ultrasound Med. 2017;36:1329–37.

    Article  Google Scholar 

  25. Kim JW, Jeong YY, Chang NK, et al. Perfusion CT in colorectal cancer: comparison of perfusion parameters with tumor grade and microvessel density. Korean J Radiol. 2012;13:S89–97.

    Article  Google Scholar 

  26. Liu JY, Yuan JP, Geng XF, et al. Morphological study and comprehensive cellular constituents of milky spots in the human omentum. Int J Clin Exp Pathol. 2015;8:12877–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Sancak S. Aricken H Increased percentage of microvessels but decreased density of large vessels in papillary carcinomas as compared to hot and cold thyroid nodules. Exp Clin Endocrinol Diabetes. 2009;117:637–44.

    Article  CAS  Google Scholar 

  28. Rzeszutko M, Rzeszutko W, Dziegiel P. The morphological analysis of vasculature in thyroid tumours: immunoexpression of CD34 antigen. Folia Histochem Cytobiol. 2004;42:235–40.

    PubMed  Google Scholar 

  29. De la Torre NG, Buley I, Wass JA, et al. Angiogenesis and lymphangiogenesis in thyroid proliferative lesions: relationship to type and tumour behaviour. Endocr Relat Cancer. 2006;13:931–44.

    Article  Google Scholar 

  30. Gulubova M, Ivanova K, Ananiev J, et al. VEGF expression, microvessel density and dendritic cell decrease in thyroid cancer. Biotechnol Biotechnol Equip. 2014;28:508–17.

    Article  CAS  Google Scholar 

  31. Greis C. Quantitative evaluation of microvascular blood flow by contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc. 2011;49:137–49.

    Article  Google Scholar 

  32. Alexander AA, Nazarian LN, Capuzzi DM, et al. Color Doppler sonographic detection of tumor flow in superficial melanoma metastases: histologic correlation. J Ultrasound Med. 1998;17:123–6.

    Article  CAS  Google Scholar 

  33. Forsberg F, Kuruvilla B, Pascua MB, et al. Comparing contrast-enhanced color flow imaging and pathological measures of breast lesion vascularity. Ultrasound Med Biol. 2008;34:1365–72.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ultrasound, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China

    Zhao Yongfeng, Zhou Ping, Peng Hong, Liu Wengang & Zhang Yan

Authors
  1. Zhao Yongfeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhou Ping
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peng Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liu Wengang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhang Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhou Ping.

Ethics declarations

Ethical statements

All procedures were conducted in accordance with the ethical standards of The Ethics Committee of The Third Xiangya Hospital of Central South University, and with the Helsinki Declaration. Informed consent was obtained from the patients.

Conflict of interest

Zhao Yongfeng, Zhou Ping, Peng Hong, Liu Wengang, and Zhang Yan declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 2010 kb)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yongfeng, Z., Ping, Z., Hong, P. et al. Superb microvascular imaging compared with contrast-enhanced ultrasound to assess microvessels in thyroid nodules. J Med Ultrasonics 47, 287–297 (2020). https://doi.org/10.1007/s10396-020-01011-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10396-020-01011-z

Keywords

Search

Navigation