Korean J Radiol.  2010 Dec;11(6):594-602. 10.3348/kjr.2010.11.6.594.

Role of Duplex Power Doppler Ultrasound in Differentiation between Malignant and Benign Thyroid Nodules

• Algin O
• Algin E
• Gokalp G
• Ocakoglu G
• Erdogan C
• Saraydaroglu O
• Tuncel E

• KMID: 1119221
• DOI: http://doi.org/10.3348/kjr.2010.11.6.594

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.

Keyword

Thyroid cancer; Thyroid nodules; Power Doppler ultrasonography, RI, PI

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/pathology/*ultrasonography
Thyroid Nodule/pathology/*ultrasonography
*Ultrasonography, Doppler, Duplex
Ultrasonography, Interventional

Figure

• 

  Fig. 1 Mixed vascular, solid and hypoechoic nodule diagnosed with papillary carcinoma. Pulsatility index and resistive index values calculated by spectral Doppler US were 1.15-0.73 (A) and 1.3-0.76 (B) in center and periphery of nodule, respectively. In C, characteristic papillary formation of carcinoma cells with nuclear grooving and nuclear clearing was seen.

• 

  Fig. 2 Mixed vascular, solid, and hypoechoic benign nodule (A). Nodule was diagnosed as nodular goiter by fine needle aspiration biopsy. Pulsatility index and resistive index values calculated by spectral Doppler US were 0.91-0.50 (B) and 0.73-0.53 (C) in central and peripheral section of nodule, respectively.

• 

  Fig. 3 Hypoechoic, solid nodule with mixed vascular pattern observed using power Doppler US without halo and calcification (result of fine needle aspiration biopsy was nodular hyperplasia). Pulsatility index and resistive index values calculated by spectral Doppler US were 1.29-0.69 (A) and 0.82-0.51 (B) in central and peripheral sections of nodule, respectively. Pigmented histiocyte and follicular epithelial cells are seen in this sample of cystic nodular hyperplasia (May-Grünwald-Giemsa staining, ×200) (C).

• 

  Fig. 4 Hypoechoic, solid nodule with smooth borders. Although there is no halo or calcification, it was diagnosed as medullary carcinoma. It has mixed vascular pattern in power Doppler US. Pulsatility index and resistive index values calculated by spectral Doppler US were 1.26-0.73 (A) and 1.63-0.80 (B) in center and periphery of nodule, respectively. Isles of cells with large nuclei and wide granular cytoplasm showed marked pleomorphism (C).

• 

  Fig. 5 Receiver operating characteristic (ROC) curves of resistive index (RI) (A) and pulsatility index (PI) (B) indexes.

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