Role of duplex power Doppler ultrasound in differentiation between malignant and benign thyroid nodules

Korean J Radiol. 2010 Nov-Dec;11(6):594-602. doi: 10.3348/kjr.2010.11.6.594. Epub 2010 Oct 29.

Abstract

Objective: To evaluate the usage of duplex power Doppler ultrasound (PDUS) for the differentiation of benign and malignant thyroid nodules.

Materials and methods: We prospectively examined 77 thyroid nodules in 60 patients undergoing ultrasound-guided fine needle aspiration biopsy (FNAB). Each nodule was described according to size, inner structure, borders, parenchymal echogenicity, peripheral halo formation, and the presence of calcification (B-mode ultrasound findings). Vascularity as determined by PDUS imaging was defined as non-vascular, peripheral, central, or of mixed type. For each nodule, the pulsatility index (PI) and resistive index (RI) values were obtained. Results of FNAB and surgical pathological examination (if available) were used as a proof of final diagnosis to categorize all nodules as benign or malignant. A receiver operating characteristic (ROC) curve analysis was performed to establish cut-off, sensitivity, and specificity values associated with RI-PI values.

Results: A significant relationship was observed between malignancy and irregular margins, microcalcifications, and hypoechogenicity on ultrasound examination (p < 0.05). The pattern of vascularity as determined by PDUS analysis was not a statistically significant criterion to suggest benign or malignant disease in this study (p > 0.05). The central, peripheral, and mean RI-PI values were higher in malignant nodules when compared to the other cytologies (p < 0.05).

Conclusion: Vascularity is not a useful parameter for distinguishing malignant from benign thyroid nodules. However, RI and PI values are useful in distinguishing malignant from benign thyroid nodules.

Keywords: Power Doppler ultrasonography, RI, PI; Thyroid cancer; Thyroid nodules.

MeSH terms

  • Adult
  • Aged
  • Biopsy, Fine-Needle
  • Chi-Square Distribution
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • ROC Curve
  • Sensitivity and Specificity
  • Statistics, Nonparametric
  • Thyroid Neoplasms / diagnostic imaging*
  • Thyroid Neoplasms / pathology
  • Thyroid Nodule / diagnostic imaging*
  • Thyroid Nodule / pathology
  • Ultrasonography, Doppler, Duplex*
  • Ultrasonography, Interventional