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Simple Summary: As the incidence of thyroid lesions in Europe is rising, more and more people affected by thyroid pathologies seek treatment in a clinic. Every suspicious thyroid nodule needs to be confirmed as benign or malignant in order to be treated correctly. Unnecessary invasive diagnostics and thyroid surgery should be avoided. The aim of this retrospective study was to improve the distinction between benign and malignant nodules by using new high-performance multiparametric ultrasound examination techniques. By analyzing 122 thyroid nodules we created a score-based system combining B-mode, shear-wave elastography and contrast-enhanced ultrasound malignancy criteria. This system allows for a quite accurate detection of thyroid carcinomas with a sensitivity of 95% and specificity of 75.49%. Shear-wave elastography and contrast-enhanced ultrasound can detect unique malignancy features, which cannot be found in B-mode. Therefore, these criteria would present a relevant addition to the B-mode TI-RADS classification. Background: The aim was to improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance multiparametric ultrasound examination techniques. Methods: Multiparametric ultrasound consists of B-mode, shear-wave elastography and contrast enhanced ultrasound (CEUS) including Time-Intensity-Curve (TIC) analysis. A bolus of 1–2.4 mL Sulfur Hexafluorid microbubbles was injected for CEUS. Postoperative histopathology was the diagnostic gold standard. Results: 116 patients were included in this study. 102 benign thyroid nodules were diagnosed as well as 20 carcinomas. Suspicious B-mode findings like microcalcifications, a blurry edge and no homogeneous sonomorphological structure were detected in 60, 75 and 80% of all carcinomas but only in 13.7, 36.3 and 46.1% of all benign lesions. The average shear-wave elastography measurements of malignant lesions (4.6 m/s or 69.8 kPa centrally and 4.2 m/s or 60.1 kPa marginally) exceed the values of benign nodules. Suspicious CEUS findings like a not-homogeneous wash-in and a wash-out were detected almost twice as often in carcinomas. Conclusion: Multiparametric ultrasound offers new possibilities for the preoperative distinction between benign and malignant thyroid nodules. A score based system of B-mode, shear-wave and CEUS malignancy criteria shows promising results in the detection of thyroid carcinomas. It reaches a sensitivity of 95% and specificity of 75.49%. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]