AIM:To improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance ultrasound techniques: optimized B-mode morphology, elastography, Color-Coded Doppler-Sonography (CCDS) and contrast enhanced ultrasound (CEUS) MATERIALS AND METHODS:In 33 cases solid, non-cystic thyroid lesions were rated as TIRADS 3 and up from conventional B-mode examinations. Additional high resolution Power Doppler including HR- and Glazing-Flow as optimized macrovascularization techniques, shear wave elastography and CEUS were performed on these patients by one experienced examiner. For CEUS a bolus of 1–2.4 ml Sulfurhexafluorid microbubbles (SonoVue®, Bracco, Milan, Italy) was injected into a cubital vein and then the distribution kinetics of the contrast agent were documented from the early arterial phase (10 to 15 seconds after injection) to the late venous phase (5 minutes after injection). Postoperative histopathology was the diagnostic gold standard as it provides the most reliable proof. RESULTS:33 patients (13 males, 20 females; age 29 –77 years; mean 55 years; SD 13 years) were included in this study. 28 of them had benign regressive thyroid nodules, 3 had adenomas and 4 were diagnosed with carcinomas (3 were histologically identified as papillary thyroid carcinomas, one as a medullary thyroid carcinoma). The volume of the thyroid gland ranged from 6.6 to 401.3 cm2 (mean 72.6±92.0 cm2).The adenomas diameters ranged from 9 to 40 mm (mean 22±16 mm) and the carcinoma diameters ranged from 19 to 33 mm (mean 26±6 mm). The 3 adenomas had different echogenicities: One was completely echofree, one was hypoechoic and one isoechoic. The 4 carcinomas however were equally characterized as hypoechoic and echofree. Two of three adenomas and all of the carcinomas showed an incomplete or diffuse margin. Micro-calcifications were found in one adenoma and in every carcinoma. However, no micro-calcifications were observed in cases of benign regressive nodules.Performing shear-wave elastography the adenomas showed lower values than the carcinomas: The tissue velocity of the adenomas ranged from 2.86 m/s to 3.85 m/s (mean 3.32±0.5 m/s) and in carcinomas from 3.89 m/s to 5.66 m/s (mean 4.18±0.3 m/s).Marginal hypervascularization was detected in two adenomas after applying CCDS. One adenoma was hypovascularized. The four carcinomas showed an irregular extreme hypervascularization along their margins as well as an irregular central normo- or hypervascularization in CCDS. The additional HR-Flow helped reducing artefacts.In CEUS the dynamic capillary microvascularization of all carcinomas was very irregular with early enhancement and followed by partial or complete wash-out. In CEUS two adenomas had no wash-out and the other one showed a partial wash-out. CONCLUSION:Using modern multimodal imaging offers new possibilities for the differentiation between benign and malignant thyroid lesions. It is a very important diagnostic tool in addition to the B-Mode TIRADS classification and eases the decision between TIRADS 3, 4 and 5. However, additional multicenter studies are required for more detailed evaluations.

中文翻译：

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非囊性甲状腺病变的高性能超声多模态成像：术前诊断与组织病理学相关的可能性

目的：通过使用新的高性能超声技术：优化的 B 型形态学、弹性成像、彩色编码多普勒超声 (CCDS) 和对比增强超声 (CEUS) 材料和方法，改进实性非囊性甲状腺病变的术前诊断：在 33 例实性、非囊性甲状腺病变中，常规 B 型检查被评为 TIRADS 3 级及以上。一位经验丰富的检查员对这些患者进行了额外的高分辨率能量多普勒，包括 HR 和 Glazing 流作为优化的大血管化技术、剪切波弹性成像和 CEUS。对于 CEUS，推注 1–2.4 ml 六氟化硫微泡（SonoVue®, Bracco, Milan, 意大利）被注入肘静脉，然后记录造影剂从早期动脉期（注射后 10 至 15 秒）到晚期静脉期（注射后 5 分钟）的分布动力学。术后组织病理学是诊断的金标准，因为它提供了最可靠的证据。结果：33 名患者（13 名男性，20 名女性；年龄 29-77 岁；平均 55 岁；SD 13 岁）被纳入本研究。其中 28 例为良性退行性甲状腺结节，3 例为腺瘤，4 例被诊断为癌（3 例经组织学鉴定为甲状腺乳头状癌，1 例为甲状腺髓样癌）。甲状腺体积为 6.6 至 401.3 cm2（平均 72.6±92.0 cm2）。腺瘤直径范围为 9 至 40 毫米（平均 22±16 毫米），癌直径范围为 19 至 33 毫米（平均 26±6 毫米）。3个腺瘤具有不同的回声：一个完全无回声，一个低回声，一个等回声。然而，这 4 种癌的特征是低回声和无回声。三个腺瘤中的两个和所有癌都显示出不完整或弥漫的边缘。在一个腺瘤和每个癌中都发现了微钙化。然而，在良性退行性结节的病例中未观察到微钙化。进行剪切波弹性成像显示腺瘤的值低于癌：腺瘤的组织速度范围为 2.86 m/s 至 3.85 m/s（平均 3.32± 0.5 m/s) 和从 3.89 m/s 到 5.66 m/s（平均 4.18±0.3 m/s）的癌。应用CCDS后，在两个腺瘤中检测到边缘血管增生。一个腺瘤是血供不足的。这四种癌在其边缘显示出不规则的极端血管生成，以及在 CCDS 中不规则的中央正常或血管生成过多。额外的 HR-Flow 有助于减少伪影。在 CEUS 中，所有癌的动态毛细血管微血管化都非常不规则，早期强化，随后部分或完全清除。在 CEUS 中，两个腺瘤没有洗出，另一个显示部分洗出。结论：使用现代多模态成像为区分良恶性甲状腺病变提供了新的可能性。除了 B 模式 TIRADS 分类之外，它还是一个非常重要的诊断工具，可以简化 TIRADS 3、4 和 5 之间的决定。但是，