title: Role of Gray Scale, Color Doppler and Spectral Doppler in Differentiation Between Malignant and Benign Thyroid Nodules.
abstract: BACKGROUND
  High resolution ultrasound is the most sensitive imaging test available for the examination of the thyroid gland and due to increase in use of ultrasound more incidental thyroid nodules are diagnosed. In this study we try to establish the specific grayscale, color and spectral Doppler characteristics of malignant and benign thyroid nodules.
  
  
  OBJECTIVE
  To determine the specific gray scale characteristics, angioarchitecture and cut-off values of Doppler indices of malignant and benign thyroid nodules. To assess the efficacy of grayscale, Doppler and combined conventional and Doppler using defined criteria in differentiating malignant from benign nodules.
  
  
  METHODS
  We prospectively examined 194 thyroid nodules which were confirmed on FNAC. Each nodule was described according to size, number, contents, echogenicity, margins, halo, shape, calcification, local infiltration and lymphnode enlargement. Vascularity, RI and PI values of each nodule were assessed on Doppler. Each nodule was characterized as benign, indeterminate or malignant based on grayscale and Doppler characteristics. Cut-off RI and PI values for malignant thyroid nodules were obtained by ROC.
  
  
  RESULTS
  Out of 194 nodules, 151 nodules were benign and 43 nodules were malignant. Significant relationship was observed between malignancy and hypoechogenicity, irregular margins, taller than wide, thick incomplete halo, micro calcifications, lymphnode enlargement and local infiltration. Intranodular vascularity was a significant criterion to suggest malignancy in thyroid nodules on color Doppler. Malignant nodules had a mean RI of 0.73 and mean PI of 1.3 which were significantly higher than the benign nodules. Accuracy of detecting malignant thyroid nodules by combining gray scale and Doppler is higher than either of them alone.
  
  
  CONCLUSIONS
  Using specific morphological pattern recognition features like microcalcifications, hypoechogenicity, taller than wide, irregular thick halo, lymphadenopathy and local extra thyroidal invasion has helped in differentiating malignant from benign features. Intranodular vascularity and high RI indices were the specific Doppler signs for malignant thyroid nodules. Since, Gray scale and Doppler have their own strengths and weaknesses, they were complementary rather than competitive modalities in diagnosing benign from malignant thyroid nodules.
authors.affiliation: Consultant, Department of Radiodiagnosis, Apollo First Med Hospitals , Chennai, Tamilnadu, India .
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Palaniappan
authors.affiliation: Associate Professor, Department of Radiodiagnosis, SRM Medical College Hospital and Research Centre , Kattangulathur, Kancheepuram, Tamilnadu, India .
authors.forename: Senthil Kumar
authors.initials: SK
authors.lastname: Aiyappan
authors.affiliation: Consultant, Department of Radiodiagnosis, Apollo First Med Hospitals , Chennai, Tamilnadu, India .
authors.forename: Upasana
authors.initials: U
authors.lastname: Ranga
keywords: Doppler indices; Intranodular vascularity; Ultrasound