Detection of microvascularization of thyroid carcinomas using linear high resolution contrast-enhanced ultrasonography (CEUS)

Background: Preoperative differentiation of thyroid nodules in benign and malignant pathologies still represents an unsolved problem in endocrinology. In the presented study, contrast-enhanced ultrasonography (CEUS) was applied as a new diagnostic tool detecting the microvascularisation of thyroid carcinomas. Methods: 167 patients underwent surgery for suspicious thyroid nodules between 05/2011 and 08/2012. Contrast-enhanced ultrasonography (CEUS) with a linear probe (6-9 MHz, LOGIQE9/GE), color coded Doppler sonography (CCDS) and Power Doppler ultrasonography (PD) were performed in all patients preoperatively. Removed nodules were proved by histology. In case of carcinoma morphological characteristics and especially microvascularization were analyzed using time intensity curves (TIC) in selected regions of interest (ROI). Results: In total, 22 thyroid carcinomas could be identified by histology. Using CEUS thyroid carcinomas in 19 patients showed early and irregular arterial vascularization followed by early arterial central wash-out. CCDS/PD, however, revealed irregular peripheral vascularization with low flow only in 8 cases. Further analysis resulted in a significant higher area under the curve (AUC) at the edge than in the tumor center but in a similar time to peak (TTP) in both regions. Conclusions: CEUS represents a highly sensitive method for the detection of the microvascularization of thyroid carcinomas. Future studies should compare these findings to benign pathologies in order to establish CEUS as a standard diagnostic procedure in the preoperative evaluation of suspicious thyroid nodules.