(Ultrasound Review) Analyzing the color Doppler signal intensity variation after Levovist injection might provide useful information to differentiate benign from malignant thyroid nodules, according to results from a prospective study by researchers in Naples, Italy.
Fifty-four patients with a single thyroid nodule who were scheduled for surgical removal of the nodule or the entire gland were enrolled in the study, and this research was published in the Journal of Ultrasound in Medicine.
"At cytologic examination, 13 patients had follicular lesions, 24 had malignancy, and the remaining 17 had a single benign hyperplastic nodule in a goiter," the study stated.
Color Doppler time-intensity curves were obtained after a bolus injection (0.5–1mL/s) of the ultrasound contrast agent Levovist.
The ultrasound equipment used (Esaote Biomedica) was fitted with software that enabled quantification of ultrasonic signal intensity changes that produced wash-in and wash-out contrast enhancement curves. Although power Doppler is more sensitive to low flow, it was not used in this study because it was considered too sensitive to movement artifact.
Analysis of the results demonstrated that this ultrasonic method of vascular quantification enabled differentiation of thyroid carcinomas, hyperplastic benign nodules, and follicular adenomas. Each type of pathology displayed a characteristic curve.
Carcinomas showed "an early arrival time, time to peak, and a very delayed, irregular return to baseline, which lasted longer than the maximal acquisition time in 64% of cases." In comparison, a delayed arrival time, a delayed time to peak with a regular return to baseline was characteristic for hyperplastic benign nodules. Adenomas displayed an early arrival time, an early time to peak with a regular and progressive return to baseline.
"Although cytologic examination still remains the standard of reference for the presurgical diagnosis of thyroid nodules, the preliminary data of this pilot study demonstrate that the analysis of time-intensity curves after Levovist injection might provide useful, complementary, and quantitative information to differentiate benign from malignant thyroid nodules," the study concluded.
"Analysis of color Doppler signal intensity variation after Levovist injection:A new approach to the diagnosis of thyroid nodules"
Stefano Spiezia et al
Santa Maria del Popolo degli Incurabili Hospital, Azienda Santiaria Locale Napoli 1, via M. Longo 50, 80138 Naples, Italy
J Ultrasound Med 2001 (March); 20:223–231
By Ultrasound Review
June 5, 2001
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