title: Detection of microvascularization of thyroid carcinomas using linear high resolution contrast-enhanced ultrasonography (CEUS).
abstract: 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.
authors.affiliation: Department of Surgery, University Hospital Regensburg, Regensburg, Germany. matthias.hornung@klinik.uni-regensburg.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Hornung
authors.forename: Ernst Michael
authors.initials: EM
authors.lastname: Jung
authors.forename: Martina
authors.initials: M
authors.lastname: Georgieva
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszczynski
authors.forename: Ayman
authors.initials: A
authors.lastname: Agha
mesh_terms: D003287:Contrast Media; D054459:Elasticity Imaging Techniques / Q000379:methods; D006801:Humans; D055806:Microvessels / Q000000981:diagnostic imaging; D009367:Neoplasm Staging; D013964:Thyroid Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D003287:Contrast Media