title: "Focal thyroid inferno" on color Doppler ultrasonography: a specific feature of focal Hashimoto's thyroiditis.
abstract: OBJECTIVE
  To evaluate color-Doppler features predictive of focal Hashimoto's thyroiditis.
  
  
  METHODS
  A total of 521 patients with 561 thyroid nodules that underwent surgeries or gun biopsies were included in this study. These nodules were divided into three groups: focal Hashimoto's thyroiditis (104 nodules in 101 patients), benignity other than focal Hashimoto's thyroiditis (73 nodules in 70 patients), and malignancy (358 nodules in 350 patients). On color Doppler sonography, four vascularity types were determined as: hypovascularity, marked internal flow, marked peripheral flow and focal thyroid inferno. The χ2 test was performed to seek the potential vascularity type with the predictive ability of certain thyroid pathology. Furthermore, the gray-scale features of each nodule were also studied.
  
  
  RESULTS
  The vascularity type I (hypovascularity) was more often seen in focal Hashimoto's thyroiditis than other benignity and malignancy (46% vs. 20.5% and 19%). While the type II (marked internal flow) showed the opposite tendency (26.9% [focal Hashimoto's thyroiditis] vs. 45.2% [other benignity] and 52.8% [malignancy]). However, type III (marked peripheral flow) was unable to predict any thyroid pathology. Importantly, type IV (focal thyroid inferno) was exclusive to focal Hashimoto's thyroiditis. All 8 type IV nodules appeared to be solid, hypoechoic, and well-defined. Using "focal thyroid inferno" as an indicator of FHT, the diagnostic sensitivity and specificity were 7.7% and 100% respectively.
  
  
  CONCLUSIONS
  The vascularity type of "focal thyroid inferno" is specific for focal Hashimoto thyroiditis. Recognition of this particular feature may avoid unnecessary interventional procedures for some solid hypoechoic thyroid nodules suspicious of malignancy.
authors.affiliation: Department of Ultrasound, Peking University Third Hospital, 49 Huayuanbeilu Road, Beijing 100191, China. fuxs1968@163.com
authors.forename: Xianshui
authors.initials: X
authors.lastname: Fu
authors.forename: Limei
authors.initials: L
authors.lastname: Guo
authors.forename: Huabin
authors.initials: H
authors.lastname: Zhang
authors.forename: Weiqiang
authors.initials: W
authors.lastname: Ran
authors.forename: Peng
authors.initials: P
authors.lastname: Fu
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Li
authors.forename: Wen
authors.initials: W
authors.lastname: Chen
authors.forename: Ling
authors.initials: L
authors.lastname: Jiang
authors.forename: Jinrui
authors.initials: J
authors.lastname: Wang
authors.forename: Jianwen
authors.initials: J
authors.lastname: Jia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050031:Hashimoto Disease / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013961:Thyroid Gland / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult