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Color Doppler Imaging in Thyroid Tumors

Color Doppler (CD) imaging has enabled identification of flow in thyroid tumors, but its role in evaluation of thyroid nodules for malignancy has not been accurately defined. CD and spectral parameters were analyzed in 50 benign and 20 malignant thyroid nodules. Following patterns of vascularity were identified: pattern 0 – no visible flow ; pattern 1 – minimal internal flow without a peripheral ring ; pattern 2 – peripheral ring of flow but minimal or no internal flow ; pattern 3 – peripheral ring of flow and a small-to moderate amount of internal flow ; pattern 4 – extensive internal flow with or without a peripheral ring. Peak systolic velocities (PSV) and end diastolic velocities (EDV) were measured and resistance index (RI) was calculated. Significantly more benign nodules had vascularization patterns 1, 2 and 3 (χ2-test ; χ2=32, 106, p<0, 0001). Significantly more malignant nodules had vascularization patterns 3 and 4 (χ2-test ; χ2=16, 978, p<0, 0001), and only pattern 4 (χ2-test ; χ2=32, 106, p<0, 0001). EDV was significantly (Kruskal-Wallis test ; H=15, 0595, p<0, 0001) lower in malignant nodules then in benign (6, 06±4 cm/s vs 13, 01±8, 74 cm/s). RI was significantly higher (Kruskal-Wallis test ; H=34, 3776, p<0, 0001) in malignant then benign thyroid nodules (0, 75±0, 08 vs 0, 56±0, 09). For RI ≥ 0, 70 ; 80% sensitivity, 92% specificity, 80% positive predictive value, 92% negative predictive value, and 88, 6% accuracy, was calculated in characterizing malignant thyroid nodules. We believe that internal flow without or minimal peripheral flow on CD and RI≥0, 70 can be used to relatively reliably distinguish malignant and benign thyroid nodules. Nodules with prevailing peripheral vascularization and minimal or no internal vascularization, and RI below 0, 70 are probably benign.

Ultrasound; Radiology; Thyroid; Color Doppler

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