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Normal thyroid gland. Transverse ultrasound through the neck shows that the normal thyroid consists of two lobes and a bridging isthmus with a homogenous appearance on ul- trasound.
Source publication
Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultra...
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Background Many different risk stratification systems have been formulated for thyroid nodules, differing in their fine-needle aspiration cytology (FNAC) indication, suggesting a lack of consensus around the world.
Purpose This prospective study was conducted to find the best guideline for risk stratification, for a better malignancy yield, and wit...
Objective
The objective of the study is to analyze the influencing factors on the results of thyroid fine-needle aspiration biopsy (FNAB).
Method
A total of 339 patients who underwent FNAB in our hospital from December 2018 to July 2021 were retrospectively selected. The patients were chosen according to the gender ratio, age, and thyroid ultrasou...
Background:
The sonography-based risk stratification of thyroid nodules is based on the different sonographic features of benign and malignant thyroid nodules. The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS) and the Chinese-TIRADS define different risks for malignancy categories and the size criteria for...
Purpose:
To evaluate the diagnostic reliability of Thyroid Imaging Reporting and Data System (TI-RADS) classifications described by American College of Radiology (ACR) and Kwak et al. by calculating the risk of malignancy, to assess the role of TI-RADS in reducing fine-needle aspiration cytology (FNAC) of benign lesions.
Material and methods:
Th...
The current thyroid ultrasound relies heavily on the experience of the sonographer and radiologist, which would be physically and cognitively exhausting. Here we report a novel fully autonomous robotic ultrasound system (FARUS) that can scan thyroid regions without human assistance. In this application, human skeleton point recognition, image segme...
Citations
... US is the favorite ancillary examination for assessing the structure of the thyroid gland [6]. It is systematically used in human [6][7][8] and pet medicine [9][10][11], when thyroid disease is suspected. There are many conditions that can be detected by US examination, ranging from diffuse diseases such as chronic autoimmune thyroiditis (Hashimoto's thyroiditis) or Grave's diseases, to lesions in the thyroid parenchyma such as cysts or nodules [6][7][8]12]. ...
... It is systematically used in human [6][7][8] and pet medicine [9][10][11], when thyroid disease is suspected. There are many conditions that can be detected by US examination, ranging from diffuse diseases such as chronic autoimmune thyroiditis (Hashimoto's thyroiditis) or Grave's diseases, to lesions in the thyroid parenchyma such as cysts or nodules [6][7][8]12]. ...
... Thyroid volume was estimated using the formulae previously validated in humans (a) [7], dogs (a) [9] and goats (b) [29]. ...
Thyroid ultrasonography examination is widely used in human and small animal medicine. However, it has rarely been applied in cattle. The aim of this study was to determine whether the measurements of the thyroid gland by ultrasound examination correlate to those taken during post-mortem examination. A sample of 22 cows and 23 calves was selected for thyroid gland evaluation. An ultrasound scan was performed ante-mortem, followed by euthanasia (for medical reasons) or slaughtered in the food chain and the dissection of the thyroid gland was therefore performed. Post-mortem, the gland was weighed and its dimensions and volume measured. The volume and weight measurements were compared with the predicted ones on US using the formulas available in the literature. Finally, histological examination was performed on thyroid glands. The dimensions of the thyroid gland measured by ultrasonography were significantly different (p<0.05) from those observed post-mortem, except for lobe lengths in calves (p>0.1). However, in calves, there was no systematic bias between the ultrasound and post-mortem examination of the thyroid gland, which were concordant (with an average error of 18%). Cystic lesions were observed on ultrasound in 9/22 cows and could be found on histological examination in 7 of these. Other lesions, such as follicular hypoplasia and hyperplasia, were seen on histological examination but not on ultrasound. Although the ultrasound measurements did not significantly correlate with those taken post-mortem, this examination may allow to differentiate non-standard thyroids in the case of hyperplastic goiter, as demonstrated in other species. This study also describes and illustrates interesting lesions of the thyroid gland in cattle. These findings are innovative in the description of the use of thyroid ultrasound in cattle, although further studies are needed to allow deeper conclusions.
... In comparison, the A-P dimension measures 0.8 to 0.9 cm in newborns and 1.3 to 1.8 cm in adults. [1]. ...
With the ultimate objective of reducing nerve injury, considering the uniqueness of each surgery to accommodate the patient best relies heavily on the intricacies presented within the surgery coupled with an understanding of when and how to implement monitoring. Thyroid and parathyroid surgeries present significant risks to patient outcomes, with the most frequent postoperative deficits resulting from injury to the vagal nerve and the recurrent laryngeal nerve (RLN). While visual identification has historically been used, the potential of permanent vocal cord damage necessitates new methods. As these nerves are particularly susceptible to insult during these procedures, we sought to establish the connection between IONM and analyze the role it plays in the reduction of these deficits.
Advantages alongside limitations of IONM were considered as we compared the success rates of nerve function retention and instances in which it was reported that monitoring did not produce ideal outcomes. The implications of these findings suggest that IONM aids in the early determination of damage, allowing clinicians the opportunity to make revisions that prevent loss and best preserve the integrity of nerves following procedures. Proper application of developing protocols should influence physicians' decisions of utilizing IONM techniques in the most advantageous way to the case, amending surgical strategy when needed.
... Ultrasound (US) of the thyroid has been used as a diagnostic tool since the late 1960s [1] and is nowadays well established for a variety of indications and applications. US is the most sensitive imaging test available for the examination of the thyroid gland and the estimation of its size, to detect and characterize focal lesions [2], accurately calculate their dimensions, identify the internal structure and vascularization using color Doppler imaging (CFD) [3] and evaluate diffuse changes in the thyroid parenchyma [4]. Thyroid US is able to confirm the presence of a thyroid nodule as well as other lesions or masses and is superior compared to the traditional physical examination using palpation [5]. ...
Ultrasound (US) of the thyroid has been used as a diagnostic tool since the late 1960s. US is the most important imaging tool for diagnosing thyroid disease. In the majority of cases a correct diagnosis can already be made in synopsis of the sonographic together with clinical findings and basal thyroid hormone parameters. However, the characterization of thyroid nodules by US remains challenging. The introduction of Thyroid Imaging Reporting and Data Systems (TIRADSs) has improved diagnostic accuracy of thyroid cancer significantly. Newer techniques such as elastography, superb microvascular imaging (SMI), contrast enhanced ultrasound (CEUS) and multiparametric ultrasound (MPUS) expand diagnostic options and tools further. In addition, the use of artificial intelligence (AI) is a promising tool to improve and simplify diagnostics of thyroid nodules and there is evidence that AI can exceed the performance of humans. Combining different US techniques with the introduction of new software, the use of AI, FNB as well as molecular markers might pave the way for a completely new area of diagnostic accuracy in thyroid disease. Finally, interventional ultrasound using US-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for benign as well as malignant thyroid diseases.
... US is the primary means of screening and monitoring thyroid nodules [40]. Radiologists calculate a TI-RADS score based on the US images characteristics of the nodule, and the TI-RADS category determines the final clinical decision for the patient [41,42]. In US diagnosis, cystic nodules are usually anechoic and well-defined, have a low probability of malignancy, and are relatively easy to diagnose. ...
This study aimed to propose a deep learning (DL)–based framework for identifying the composition of thyroid nodules and assessing their malignancy risk.
We conducted a retrospective multicenter study using ultrasound images from four hospitals. Convolutional neural network (CNN) models were constructed to classify ultrasound images of thyroid nodules into solid and non-solid, as well as benign and malignant. A total of 11,201 images of 6784 nodules were used for training, validation, and testing. The area under the receiver-operating characteristic curve (AUC) was employed as the primary evaluation index.
The models had AUCs higher than 0.91 in the benign and malignant grading of solid thyroid nodules, with the Inception-ResNet AUC being the highest at 0.94. In the test set, the best algorithm for identifying benign and malignant thyroid nodules had a sensitivity of 0.88, and a specificity of 0.86. In the human vs. DL test set, the best algorithm had a sensitivity of 0.93, and a specificity of 0.86. The Inception-ResNet model performed better than the senior physicians (p < 0.001). The sensitivity and specificity of the optimal model based on the external test set were 0.90 and 0.75, respectively.
This research demonstrates that CNNs can assist thyroid nodule diagnosis and reduce the rate of unnecessary fine-needle aspiration (FNA).
High-resolution ultrasound has led to increased detection of thyroid nodules. This results in unnecessary fine-needle aspiration and anxiety for patients whose nodules are benign. Deep learning can solve these problems to some extent.
• Thyroid solid nodules have a high probability of malignancy.
• Our models can improve the differentiation between benign and malignant solid thyroid nodules.
• The differential performance of one model was superior to that of senior radiologists. Applying this could reduce the rate of unnecessary fine-needle aspiration of solid thyroid nodules.
... VI. To guide diagnostic (e.g., fine-needle aspiration cytology, FNAC) and therapeutic (e.g., radiofrequency ablation) procedures [5,6]. ...
... However, some studies have shown that thyroid volumes below 5 mL may not be sufficient for adequate thyroid hormone production. The internal structure of a normal thyroid gland is homogenously bright comparable to the salivary glands and markedly hyperechogenic compared to the adjacent cervical muscles [6,8]. ...
... 6 Overview of potential PET radiopharmaceuticals in thyroid diseases and their measured effects ...
Thyroid sonography has made substantial progress over the last decades in terms of spatial resolution and additional parameters including vascularity, perfusion, and elasticity of lesions. The improved depictability of thyroid nodules has led to a more detailed sonographic characterization of malignant thyroid nodules considering features like microcalcification, capsular invasion, and reduced elasticity. Thus, ultrasound (US) has become the most important single tool for risk assessment of thyroid nodules. Predominantly cystic and spongiform nodules as well as many nodules with a mixed composition of solid and cystic components can safely be identified as benign on ultrasound and need no further work-up for risk assessment. Predominantly solid nodules, however, require a structured and consistent sonographic assessment including the evaluation of nodule composition, echogenicity, calcifications, shape, margins, and additional sonographic parameters. One should adhere to one of the TIRADS when reporting ultrasound findings on thyroid nodules categorizing each nodule to a certain risk class. However, the risk of malignancy reported in studies for each class may not be readily transferrable to daily routine, since the prevalence of malignant nodules in tertiary care centers is as high as 20% whereas in primary care units the prevalence may be as low as 1 per mille, thus lowering positive predictive values by one to two orders of magnitude. In addition, some suspicious features found in those studies may not be directly transferable to daily practice: microcalcifications are often difficult to discern from benign colloidal spots, even after having run through learning sessions; a taller-than-wide shape of nodules with contact to the dorsal parts of the thyroid gland does not imply malignancy according to a pole concept which has been recently developed.
Thyroid scintigraphy (TS) has long been an indispensable modality for functional characterization of thyroid nodules. It should be applied to rule out malignancy in a substantial proportion of predominantly solid nodules by showing a hyperfunctioning (“hot”) nodule. Such nodules are almost always benign with few exceptions (e.g., “trapping only” nodules). If laboratory findings and scintigraphic appearance of a hot nodule do not match, further diagnostic work-up is warranted including ¹²³ I ⁻ scintigraphy with late imaging at 24 h and fine-needle aspiration cytology (FNAC). In settings with a rather low prevalence of malignant thyroid nodules such as in primary or secondary care units, a combined use of US and TS may be adopted to rule in suspicious nodules for further work-up by FNAC, including predominantly solid hypofunctioning (“cold”) nodules. MIBI scintigraphy can be used in hypofunctioning nodules with indeterminate cytology and if contraindications preclude patients from FNAC.
TS is a valuable tool to detect functional abnormalities not only in nodules but also in the thyroid gland as a whole by assessing the overall radionuclide uptake. As such, it has long been used to confirm the diagnosis of Graves’ disease and thyroid autonomy. For disseminated autonomy, it is the only tool to definitely verify the diagnosis. In destructive thyroiditis, TS reliably shows a reduced overall radionuclide uptake justifying its application in selected cases with doubtful sonographic or laboratory findings. The user of TS is encouraged to calculate a site-specific normal range for the uptake value normalized to TSH in addition to the raw uptake. Thus, even subtle functional disorders of the thyroid can be detected and graded.
Functional or metabolic imaging is increasingly combined with morphological imaging and is acquired and displayed as volume data rather than planar images including SPECT/CT, PET/CT, and PET/MRI. These combined modalities increase the restricted morphological field of view from ultrasound enabling to reliably image substernal, ectopic, or dystopic localizations of thyroid tissue. Combined modalities also benefit from the increasing spectrum of functional or metabolic tracers including MIBI, iodine isotopes (e.g., 124I-) and newer PET tracers.
... In human medicine, thyroid ultrasound (TU) is one of the most sensitive imaging examinations to evaluate the size of this gland and its structures (nodules, cysts) [20][21][22]. This examination also allows the detection of diffuse thyroid diseases, such as thyroiditis. ...
... There is currently no standardized TU method for cattle, whereas this examination is inexpensive and easily practicable on a standing animal. Two recent studies have used TU in calves [33,34], using the same method described in human medicine [20][21][22]35]. It appears that TU is non-invasive, inexpensive and easy to perform on standing calves [33,34]. ...
Simple Summary
Cattle are not routinely screened for thyroid anomalies. Scientific data regarding thyroid diseases are also scarce. This may be due to the lack of easily accessible tools to assess the thyroid function of these animals. Thyroid ultrasound examination is a cheap, easy and non-invasive technique that can be performed without sedation. Apart from morphological information, it may also provide functional data about this gland. In this study, we attempted to validate the use of thyroid ultrasound in cattle by measuring intra- and inter-observer variability. Thyroid estimated measurements were repeated in five calves and five cows, by three different operators with different trainings. Results show that this examination has good repeatability and may be used more routinely in veterinary practice.
Abstract
Little is known about thyroid diseases in ruminants, probably due to the lack of diagnosis techniques developed in this species. However, thyroid ultrasound (TU) is widely used in human and in companion animal’s medicine. It is a cheap and non-invasive examination, which allows for the identification of thyroid structures or diffuse diseases. The aim of this study was to evaluate the accuracy of TU in five calves and five cows through inter- and intra-observer repeatability. The size of the thyroid gland was measured from three views: left sagittal, right sagittal and transverse; nine measurements per view. The intra-observer coefficient was calculated for each observer. For the inter-observer, the first observer was a board-certified imagist (European College of Veterinary Diagnostic Imaging diplomate), the second was a board-certified specialist in bovine and herd management (European College of Bovine Health Managementdiplomate) and the third was an in-trained veterinarian for the TU. They each scanned the thyroid gland successively, following the same method. The intra-observer variabilities for observers 1, 2 and 3 were 8.22%, 5.53%, 5.38%, and 7.18%, 8.65% and 6.36%, respectively, for calves and cows. The inter-observer variability for calves was 10.4% and for cows, 11.8%. This study confirms the feasibility of repeatable intra- and inter-observer TU-estimated measurements in cattle.
... The ultrasound (US) evaluation may suggest the diagnosis and is helpful, particularly in subclinical forms of the disease [8]. In addition to the volume enlargement, the typical inhomogeneous, hypoechoic, pseudonodular ultrasound appearance of the disease is caused by immune cell-mediated cytotoxicity leading to thyrocyte destruction and infiltration of the parenchyma with inflammatory cells and eventually to fibrosis [9]. ...
... Thyroid elastography has great potential in the US detection of autoimmune thyroiditis, given its pathological features and the presence of fibrosis. Radioiodine scans are not recommended for diagnostic purposes in CAT [8]. ...
The estimation of viscosity by measuring the shear-wave dispersion (SWD) using ultrasound 2D shear-wave elastography (SWE) is becoming more and more popular. Recent research suggests that SWD can be used in addition to 2D-SWE (shear-wave speed) to diagnose diffuse liver disease. Viscosity was studied for the assessment of normal thyroid tissue. This study aims to evaluate the use of viscosity measurements in patients with chronic autoimmune thyroiditis using the SuperSonic MACH®30 ultrasound machine (Hologic SuperSonic Imagine, Aix-en-Provence, France) which provides the Vi PLUS mode for viscosity and the 2D SWE PLUS mode for shear-wave speed measurements. Valid measurements were obtained in 308 cases, 153 with chronic autoimmune thyroiditis (CAT) and 155 with no thyroid pathology (95.95% feasibility of the methods). The differences between the healthy group and the CAT group were statistically significant both for Vi PLUS (2.5 ± 0.4 vs. 2.8 ± 0.5, p < 0.0001) and for 2D-SWE PLUS (13.5 ± 3.3 vs. 23.1 ± 8.3, p < 0.0001). The diagnostic performance was poor for Vi PLUS alone (AUC = 0.69; cut-off > 2.5 Pa·s, se = 68.6%; sp = 64.52%) and good for 2D-SWE PLUS alone (AUC = 0.861; cut-off > 18.4 kPa, se = 69.9%; sp = 92.2%). Vi PLUS correlated with 2D-SWE PLUS, with the presence of CAT, the thyroid volume, levothyroxine replacement therapy and age. Statistically significant differences were found between the CAT subgroup receiving thyroid replacement therapy and the subgroup without therapy: 24.74 ± 8.33 vs. 21.93 ± 8.12 kPa for 2D-SWE (p = 0.0380) and 3 ± 0.5 vs. 2.7 ± 0.4 Pa·s for Vi PLUS (p = 0.0193). Elastography-based methods improve the classic ultrasound evaluation: 2D-SWE PLUS performed somewhat better in distinguishing CAT from normal thyroid tissue, while Vi PLUS made a slightly better assessment regarding the functional status.
... High-frequency ultrasonography (HFUS) in conventional two-dimensional grayscale mode can provide diagnostic information about the morphology, structure, and internal echogenic changes of the thyroid parenchyma in a non-invasive and rapid manner, which is of great significance in guiding clinical intervention strategies. Based on this, combined with color Doppler flow imaging (CDFI), the distribution of blood flow in the thyroid parenchyma can be visualized dynamically, which can help improve the accuracy of qualitative diagnosis [8][9][10]. However, the conventional ultrasound imaging techniques mentioned above are mainly used for the preliminary determination of morphological, structural, and blood flow changes due to DTD. ...
High-frequency ultrasound (HFUS), the imaging modality of choice for thyroid screening, is most commonly used in the study of diffuse thyroid disease (DTD) with Hashimoto’s thyroiditis (HT) and Graves’ disease (GD). DTD can involve thyroid function and severely affect life quality, so early diagnosis is important for the development of timely clinical intervention strategies. Previously, the diagnosis of DTD relied on qualitative ultrasound imaging and related laboratory tests. In recent years, with the development of multimodal imaging and intelligent medicine, ultrasound and other diagnostic imaging techniques have gradually become more widely used for quantitative assessment of the structure and function of DTD. In this paper, we review the current status and progress of quantitative diagnostic ultrasound imaging techniques for DTD.
... During ultrasonography, presence of nodules in the thyroid was assessed. Thyroid volume greater than 9 cm 3 was considered abnormal for each lobe (18). The level of anti-TPO antibody was measured with DEIA05731 kit and the level above 9 IU/mL was abnormal based on the kit catalog. ...
Introduction: Goiter is a common problem in the world; however, it is more prevalent in countries with iodine deficiency. Goiter has different etiologies while one of them is Hashimoto's thyroiditis. Selenium is a trace element that has different important effects in the body. It has also some effects in the thyroid. Objectives: This study aimed to evaluate the effect of selenium intake on goiter size and the correlation with goiter type. Patients and Methods: In prospective observational study, 20 patients with Hashimoto's goiter and 40 patients with non-Hashimoto's goiter were evaluated for thyroid sizes. The nodule sizes were else evaluated. After the first evaluation, daily selenium supplement (200 mg) was prescribed for all patients for six months. After this time, the sizes of goiter and nodules were measured again. Results: Results showed that the size of both goiter lobes in both Hashimoto's and non-Hashimoto's groups was significantly reduced before and after selenium intake (P < 0.001). The reduction rate in left lobe size in patients with Hashimoto's goiter was 50.73% and in non-Hashimoto's goiter patients was 20.89% (P < 0.001). The reduction rate in right lobe size in patients with Hashimoto's goiter was 53.37% and in non-Hashimoto's goiter was 20.46 (P < 0.001). Conclusion: We conclude that administration of selenium is effective in reducing the size of the goiter.
... In recent years, with higher health awareness among people and more advanced medical devices, the detection rate of thyroid nodules is increasing, making it one of the most prevalent diseases in humans (29). Ultrasonography is currently the preferred imaging modality for screening thyroid nodules in clinical practice, and the subsequent treatment plan is based on the ultrasonography result, either continued follow-up or surgery (30). Thyroid nodules are characterized by homogeneous echogenicity, indistinct borders, and varying morphology on different ultrasound instruments, so that ultrasound radiologists cannot accurately identify them and give results without differences (31). ...
Objective
This study was designed to distinguish benign and malignant thyroid nodules by using deep learning(DL) models based on ultrasound dynamic videos.
Methods
Ultrasound dynamic videos of 1018 thyroid nodules were retrospectively collected from 657 patients in Zhejiang Cancer Hospital from January 2020 to December 2020 for the tests with 5 DL models.
Results
In the internal test set, the area under the receiver operating characteristic curve (AUROC) was 0.929(95% CI: 0.888,0.970) for the best-performing model LSTM Two radiologists interpreted the dynamic video with AUROC values of 0.760 (95% CI: 0.653, 0.867) and 0.815 (95% CI: 0.778, 0.853). In the external test set, the best-performing DL model had AUROC values of 0.896(95% CI: 0.847,0.945), and two ultrasound radiologist had AUROC values of 0.754 (95% CI: 0.649,0.850) and 0.833 (95% CI: 0.797,0.869).
Conclusion
This study demonstrates that the DL model based on ultrasound dynamic videos performs better than the ultrasound radiologists in distinguishing thyroid nodules.
