To compare the accuracy of the conventional Ultrasound 'TI-RADS', US elastography, DWI MRI, and its ADC value in characterization and differentiation of thyroid nodules.
Thyroid nodules are one of the most common endocrine carcinomata (1) Most thyroid tumors have a good prognosis if early diagnosis and timely treated (2) An Ultrasound (US) exam is a safe, non-invasive imaging technique for detecting thyroid nodules (3) However, still there are no dependable criteria to discriminate malignant from benign lesions. (4) In 2009, Horvath et al proposed the Thyroid Imaging Report and Data System (TI-RADS). The new version of TI-RADS was launched by ACR in 2017. (5) Color Doppler ultrasound is also used to differentiate benign from malignant thyroid nodules. The presence of intra-nodular vascularity (Type 1b) was considered close to be malignant (6) US elastography is a novel tool to increase the diagnostic value of Ultrasound and as an adjuvant tool (7) Shear wave elastography evaluates elasticity through the propagation speed of shear waves, with the wave speed being faster in hard tissue (8) Conventional T1-and T2-weighted MR imaging can-not differentiate benign from malignant nodules (9) Diffusion-weighted imaging (DWI) is a non-invasive tool used to distinguish benign from malignant nodules (10). Malignant thyroid nodules usually have a lower ADC value attributed to cellular density and tissue perfusion. (11) Combining subjective MRI features with a quantitative measurement could improve the diagnostic yield of DW-MRI (12) The cytological examination by fine-needle aspiration (FNA) has become a reliable tool to diagnose thyroid cancers (2) Suspicious cytological findings reach up to 30% of all aspirated nodules, suggesting the need for less invasive methods (13)
Study Type
OBSERVATIONAL
Enrollment
50
First local anesthesia with lidocaine 2%, then 3 smears will be obtained for each nodule using a 20-22 gauge needle, multiple passes within the lesion will be made to obtain sufficient cells, the aspirate will be spread over a glass, fixed with ethanol 95% and submitted to the pathology department to be reported.
compare findings of ultrasound, elastography values , ADC value with the gold standard (biopsy results)
To assess concordance of US suspicious features, US elastography results , MRI DWI, ADC value results, and the gold standard US-guided FNAB and ability to differentiate benign from malignant thyroid nodules.
Time frame: 1 year
Apply ADC value Cut-off level to differentiate benign from malignant thyroid nodules
compare ADC value of benign and malignant nodules to obtain a cutoff level
Time frame: 1 year
Apply US shear elastography parameters Cut-off levels to differentiate benign from malignant thyroid nodules.
compare also benign and malignant nodules qualitative and quantitative elastography results. qualitative measurement is defined as :each nodule was assigned an elasticity score based on the color pattern type according to the classification proposed by Ueno classification method (color coded map) ranging from blue to green colors. hard nodules on the map appears as blue color and soft nodules appears as red color. Quantitative assessment of the velocity of US wave propagation through tissue. measurement units are: kilopascal (Kpa), and shear wave velocity (m/sec).
Time frame: 1 year
Compare individual specific US features with the Gold standard US-guided FNAB which is more important.
which is the most suspicious feature in ulrasound. The five Ultrasound suspicious features are: 1. predominantly Solid nodule. 2. Marked hypoechogenicity. 3. Microlobulated or irregular margins. 4. Micro-Calcifications. 5. Taller-than-wide in shape with a ratio ≥ 1.
Time frame: 1 year
Study role of color doppler in differentiating benign from malignant thyroid nodules
which pattern of color doppler study is the most suspicious: Classified into 4 groups: 0= Avascular. 1a= Peri-nodular vascularity. 1b= Intra-nodular vascularity. 1c= Peri-nodular and intranodular vascularity.
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Time frame: 1 year
Compare the added value of combining different modalities, which have the higher sensitivity and specificity in differentiating benign from malignant thyroid nodules
combination of different imaging modalities which will have the best sensitivity and specificity for diagnosis of malignant thyroid nodules
Time frame: 1 year