Research Presentation Session: Head and Neck

RPS 1808 - Thyroid and salivary gland imaging

March 2, 09:30 - 11:00 CET

7 min
Role of superb microvascular imaging for differentiation between benign and malignant neck lymph nodes
Hye Ree Cho, Changwon / Korea, Republic of
Author Block: H. R. Cho, M. Sunwoo, Y. Nam; Changwon-si, Gyeongsangnam-do/KR
Purpose: Ultrasound examination reveals different types of disease that cause lumps in the cervical lymph nodes. However, different types of disease can produce similar ultrasound findings, and despite the criteria that have been proposed to distinguish between them, greyscale ultrasound is still limited. Therefore, methods are being used to analyse vascular patterns using colour or power Doppler ultrasound. However, benign and malignant vascular patterns still overlap, and the use of superficial microvascular imaging techniques that detect microvasculature may help distinguish them.
Methods or Background: From January to August 2023, 163 patients who received FNAB or biopsy for enlarged neck lymph nodes were included. All patients underwent US examinations of LNs consisting of greyscale US, PDUS and SMI. After sonography, each lymph node was evaluated histologically by ultrasound-guided FNAB or biopsy.
Results or Findings: Out of 163 patients, 18 patients were excluded due to non-diagnostic results. Of the 145 total lymph nodes, 49 were identified as malignant. SMI evaluation of nodal vascular pattern was of high sensitivity (69.4%), specificity (90.6%), and accuracy (83.4%) for differentiating metastatic and benign nodes, however SMI alone does not have a significant advantage in differentiating metastatic nodules compared to greyscale or PDUS. There were 38 indeterminate nodes on the greyscale Doppler image, of which five were histologically confirmed to be malignant. Of 38 indeterminate nodes, 23 were reclassified as benign by SMI, all of which were confirmed as benign.
Conclusion: Using a nodal classification based on a combination of sonographic features and SMI is effective in detecting and diagnosing metastatic lymphadenopathy, leading to improved treatment and prognosis for patients.
Limitations: Identified limitation were: (1) this was a short-term prospective study with a small number of cases; (2) inter-observer agreement could not be assessed due to on-site pattern analysis.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by an ethics committee.
7 min
Blood leukocyte DNA methylation biomarker for distinguishing malignant from benign thyroid nodules
Feihang Wang, Shanghai / China
Author Block: F. Wang, D. Zhao, L. Liu; Shanghai/CN
Purpose: Discriminating between malignant thyroid nodules (MTNs) and benign thyroid nodules (BTNs) presents challenges in clinical practice. Our objective was to develop a blood leukocyte-based classifier to distinguish MTNs from BTNs, and to assess its potential for enhancing diagnostic performance.
Methods or Background: This study included 91 MTNs and 114 BTNs. Differential methylation haplotype blocks (MHBs) in blood leukocytes between MTNs and BTNs were detected using reduced representation bisulfite sequencing (RRBS). Subsequently, a blood leukocyte DNA methylation (BLDM) classifier was developed.
Results or Findings: A 60-marker BLDM classifier achieved an area under the curve (AUC) of 0.86 in the validation cohort. The specificity of it was 90.91%, outperforming the 43.64% specificity of ultrasonography, albeit with a slightly lower sensitivity compared to ultrasonography (83.33% versus 97.62%). The BLDM classifier correctly identified 93.55% of patients whose nodules were suspected to be malignant by ultrasonography, but which were finally histologically benign. In micronodules, a higher specificity of 93.33% and accuracy of 88.24% for diagnosis of MTNs was displayed by this classifier, in comparison to the 6.67% specificity and 72.55% accuracy of ultrasonography.
Conclusion: We identified a novel BLDM classifier for distinguishing MTNs from BTNs. The clinical application of this classifier leads to enhanced diagnostic specificity compared to ultrasonography.
Limitations: The main limitation of this study is that all participants were recruited from a single centre, and this classifier will require validation in larger external cohorts in the future.
Funding for this study: Funding was provided by the National Health Commission Capacity Building And Continuing Education Center (GWJJ2022100303) and Fudan University Integrated Medical Engineering Program (yg2022-6).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Institutional Review Committee of Zhongshan Hospital, Fudan University (B2022-390R).
7 min
CEUS as an additional tool in differentiating hyperthyroid diffuse disease: destructive vs hyperproduction conditions
Andreea Borlea, Timisoara / Romania
Author Block: A. Borlea, D. I. Stoian; Timisoara/RO
Purpose: This study aims to evaluate the efficacy and added value of contrast-enhanced ultrasound (CEUS) in differentiating between destructive thyroiditis and hyperproduction states in patients presenting with diffuse thyroid disease.
Methods or Background: Hyperthyroid diffuse diseases present as multifaceted pathological entities, often categorised into destructive thyroiditis and hyperproduction-induced hyperthyroidism. A prospective cohort of 56 patients diagnosed with hyperthyroid diffuse disease underwent CEUS, alongside conventional ultrasound and other standard diagnostic investigations. Qualitative CEUS parameters, including perfusion patterns, enhancement intensity, and washout timing, were analysed and compared between the destructive thyroiditis group and the hyperproduction group.
Results or Findings: Preliminary results indicated distinctive CEUS perfusion patterns between destructive thyroiditis and hyperproduction-induced hyperthyroidism. Destructive thyroiditis demonstrated rapid enhancement (12 seconds, 10-14.5) followed by a swift washout (20 seconds, 18-26), reflective of increased vascular permeability and inflammation. In contrast, hyperproduction states typically exhibited prolonged enhancement, suggestive of increased vascularity due to important thyroid activity. CEUS exhibited very good diagnostic accuracy (AUC 0.905, sensitive 91%, specificity 88.3%), with an appreciable sensitivity and specificity when integrated with existing diagnostic paradigms. Furthermore, CEUS findings correlated with biochemical markers, strengthening its diagnostic usefulness.
Conclusion: By presenting distinct perfusion patterns and enhancement characteristics, CEUS enables a more precise imaging-based understanding of the underlying pathophysiological processes, thereby facilitating informed diagnostic and therapeutic decision-making.
Limitations: One primary limitation of this study resides in the relatively small sample size of 56 patients, which potentially constrains the generalisability of the findings. While the preliminary results provide insightful correlations and trends within the examined parameters, a more expansive, multicentric study with a larger patient cohort is crucial to validate and consolidate these findings
Funding for this study: The study received no external funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the UMF Victor Babes Timisoara Ethics Committee.
7 min
Radiomics analysis of thyroid ultrasound in relation to the radioactive iodine therapy-related sialadenitis
Hyein Kim, Suwon / Korea, Republic of
Author Block: H. Kim, D. H. Lee; Suwon/KR
Purpose: Radioactive iodine therapy (RAIT) is a widely employed therapy after total thyroidectomy but is often associated with the development of RAIT-sialadenitis. This study aims to investigate whether preoperative thyroid ultrasound can identify the occurrence of sialadenitis in patients who have undergone total thyroidectomy followed by RAIT.
Methods or Background: This retrospective single-centre study was conducted at Ajou University Hospital, a tertiary referral centre in Suwon, Korea. The study included patients who underwent total thyroidectomy and subsequent RAIT between January 2010 and October 2022.
Regions of interest were drawn as 2D square regions, each with a minimum size of 100×100 point, encompassing only non-cancerous thyroid parenchyma. Radiomics features were extracted using a commercial program (AVIEW Research, Coreline Soft, Seoul, Korea).
Radiomics features were selected through univariable logistic regression (p-value<.05). The performance of the diagnostic model in distinguishing the occurrence of RAIT-sialadenitis was evaluated by the area under the curve (AUC) of the receiver operating characteristic curve.
Results or Findings: The study included 62 normal patients and 20 patients with RAIT-sialadenitis. RAIT-sialadenitis was predicted by the excess kurtosis (p-value=.003) from the first order and histogram feature, as well as contrast (p-value=.043) from the neighbouring grey-tone difference matrix (NGTDM). The combination of the excessive kurtosis and contrast of NGTDM demonstrated good diagnostic ability to differentiate the occurrence of RAIT-sialadenitis (AUC 0.75, 95% confidence interval: 0.64–0.87).
Conclusion: Radiomics features from thyroid ultrasound, excess kurtosis, and contrast of NGTDM, may help the prediction of RAIT-sialadenitis and enhance patient care before RAIT.
Limitations: A relatively small number of patients were included. In addition, there was data heterogeneity derived from the ultrasound scanner and practitioners. Furthermore, there was no pathologic confirmation of the salivary gland.
Funding for this study: This study was supported by the Ajou University (M-2023-C0460-00050).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This retrospective study was approved by the Institutional Review Board of Ajou University Hospital (approval number: AJOUIRB-MDB-2022-226). The requirement for written informed consent was waived by the Clinical Research Review Committee of Ajou University Hospital. All procedures performed in this study complied with both the US Health Insurance Portability and Accountability Act regulations and the Declaration of Helsinki.
7 min
Arterial spin labelling MR technique in assessing blood perfusion of thyroid nodules and differentiating the malignancy by comparing with CT enhancement
Yuyun Xu, Hangzhou / China
Author Block: Y. Xu; Hangzhou/CN
Purpose: To investigate the feasibility of arterial spin labelling (ASL) MR technique to evaluate thyroid and nodule blood perfusion by comparing with enhanced thyroid CT examination, and to differentiate between benign and malignant nodules. .
Methods or Background: A retrospective analysis was conducted on data of patients with thyroid nodules who underwent routine MRI and ASL examinations with thyroid CT enhancement from August 2022 to August 2023 in our hospital. Two radiologists independently rated the ASL image quality, measured the TBF (thyroidal blood flow) of thyroid and nodules, as well as the CT values of thyroid nodules in plain, arterial, and venous phases. The consistency of image quality between the two radiologists was analysed using Kappa analysis. The consistency of TBF and CT values measured by the two radiologists for thyroid and nodules was analysed using ICC analysis. The correlation between CT values and thyroid blood flow (TBF) in the thyroid and nodules was evaluated using Pearson correlation.
Results or Findings: A total of 70 patients with thyroid nodules underwent thyroid CT enhancement and ASL examination. A total of 11 cases were excluded. Finally, 59 patients with a total of 64 thyroid nodules were included. The consistency of image quality scores between the two radiologists was good (Kappa=0.745, P<0.001). The consistency of TBF measurements was ICC=0.780, 0.856, respectively (P<0.001). The correlation between TBF of thyroid and arterial CT enhancement value was mild (r=0.283, p=0.023), while the correlation between TBF of thyroid nodules and CT enhancement value was significant (r=0.754, P<0.01). TBF of thyroid nodule between benign and malignant was significant (p=0.034).
Conclusion: ASL can non-invasively quantitatively evaluate the blood perfusion of the thyroid and nodules with good repeatability, and can help differentiate between benign and malignant nodules.
Limitations: The small sample size was an identified limitation of this study.
Funding for this study: This study was supported by the Zhejiang Medicine and Health Project of Science and Technology (2022KY581, 2022KY525).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was conducted in accordance with the requirements of the institutional medical ethics committee (Hangzhou Medical College, Zhejiang Provincial People's Hospital Research Ethics Committee, document number: 202101291419000446756).
7 min
Risk stratification of incidental 18F-Fluorodeoxyglucose-avid thyroid nodules based on six societies’ ultrasound risk stratification systems
Chae Young Shin, Gangneung-si / Korea, Republic of
Author Block: C. Y. Shin1, D. G. Na1, H. S. Lee1, H. S. Ahn2; 1Gangneung-si/KR, 2Seoul/KR
Purpose: This study was aimed to determine the risk of malignancy in thyroid incidentalomas (TIs) detected on 18F-FDG PET/CT using the six societies’ ultrasound (US)-risk stratification systems (RSSs) and to evaluate the diagnostic value of the SUVmax in PET-TIs.
Methods or Background: This study included 215 consecutive patients with 236 TIs detected by focal thyroid uptake on 18F-FDG PET/CT. The final diagnoses were obtained by US-guided biopsy or thyroidectomy. The malignancy risk of all TIs were assessed according to the six US-RSSs including ACR-, Chinese (C)-, European (EU)-, and Korean-TIRADS.
Results or Findings: The overall malignancy rate of TIs was 47% and the malignancy risk of TIs was stratified by all US-RSSs (all, P<0.001). The observed malignancy risks of high-suspicion TIs were higher than the estimated malignancy risks only in ACR-, C-, and EU-TIRADSs (P≤0.035). The malignancy risks of intermediate-suspicion TIs were higher than the estimated malignancy risks in all US-RSSs (24.8-48.2%, P≤0.002). The malignancy risks of low-suspicion TIs were higher than the estimated malignancy risk only in the C- and EU-TIRADS (35% and 10%, respectively, P≤0.01). The SUVmax of malignant tumours was higher than that of benign nodules (4.7 versus 2.8, P<0.001) and the AUC for malignancy was 0.708. The SUVmax of high-grade malignancy was higher than that of low-grade malignancy (7.4 versus 4.0, P=0.002).
Conclusion: The malignancy risk of intermediate-suspicion TIs was increased in all US-RSSs, whereas the malignancy risks of high- and low-suspicion TIs was increased in only some RSSs. The biopsy size thresholds for intermediate suspicion TIs should be lowered in all US-RSSs. The SUVmax showed a fair diagnostic performance for malignancy in PET-TIs and the SUVmax needs to be considered in biopsies.
Limitations: No limitation were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: This study is under the review of the ethics committee (number: 2023-09-007).
7 min
Quantitative evaluation of thyroid gland vascularisation with microvascular ultrasonography and contribution of vascular index for differential diagnosis of Graves' disease and subacute thyroiditis
Zeynep Sezgi Erdal, Ankara / Turkey
Author Block: Z. S. Erdal, M. N. Cerit, H. N. Şendur, S. Özhan Oktar, M. Yalçın, Ş. E. Doğan, M. Coşkun; Ankara/TR
Purpose: Microvascular ultrasonography (MVUS) is a new Doppler technique that provides higher sensitivity in differentiating slow flow from motion artifacts. The vascular index obtained by MVUS measures the blood flow rate in the tissue by determining the ratio of coloured pixels (blood flow) to all pixels in the ROI (region of interest) and gives a quantitative real time evaluation. The aim of the present study is to test the ability of the MVUS technique in differentiating cases with Graves' disease and subacute thyroiditis.
Methods or Background: 86 cases (28 Graves' disease, 28 subacute thyroiditis, and 30 control group) were selected. Age, gender, BMI, fT3, fT4, TSH, TRAb, ESR, and CRP values were recorded. During the thyroid gland ultrasonography, vascular indexes were measured in the transverse and longitudinal axes in both lobes after measuring the thyroid gland dimensions. The correlations between mean vascular index value, age, BMI, and laboratory results were assessed. ROC (Receiver operating characteristic) curve analysis was performed to investigate the diagnostic performance of the vascular index in differentiating Graves' disease from subacute thyroiditis.
Results or Findings: In conclusion, mean thyroid gland volume and vascular index values were significantly higher in both disease groups than in the control group. The mean vascular index value was higher in the group with Graves' disease than in subacute thyroiditis. Remarkably, 88% sensitivity and 92% specificity were achieved with an optimum cut-off value of 26.31% for vascular index in differentiating Graves' disease from subacute thyroiditis.
Conclusion: Our results highlight the potential benefit of microvascular ultrasonography in the differential diagnosis of Graves' disease and subacute thyroiditis.
Limitations: The limitation of the study is the limited number of cases. In addition, we didn't compare the MVUS with other Doppler techniques.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Gazi University School of Medicine ethics committee (Reference number 782, 24.10.2022).
7 min
Possibility to predict BRAFV600E mutations of papillary thyroid carcinoma via nomogram based on dual-layer detector spectral CT and clinical characteristics
Dan Zhang, Chongqing / China
Author Block: D. Zhang; Chongqing/CN
Purpose: The aim of this study was to investigate the effectiveness of a nomogram based on dual-layer detector spectral computed tomography (DLCT) for predicting BRAFV600E mutation in PTC.
Methods or Background: The BRAFV600E is the most common mutant oncogene in thyroid cancer and is closely related to the aggressiveness of papillary thyroid carcinoma (PTC). The medical records of 253 patients with PTCs who underwent DLCT and BRAFV600E mutation detection (mutant group: n=203; wild group: n=50) were reviewed. DLCT quantitative parameters of arterial phase, typical radiological features and clinical information were compared by univariate and multivariate analysis between the mutant and wild-type BRAFV600E groups. A nomogram was developed based on the significantly different variables using multivariate logistic regression analysis. The nomogram performance was evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis (DCA).
Results or Findings: The normalised iodine concentration (NIC), calcification and Hashimoto's thyroiditis (HT) were identified as independent risk factors of BRAFV600E mutation in PTC. The AUC value of the nomogram based on the three parameters was 0.75. The calibration curve of the nomogram revealed that the prediction result was in good agreement with actual observation. The decision curve demonstrated that the nomogram can provide a more satisfactory net benefit than the simple all or none-intervention standard strategy within a large range of threshold probabilities.
Conclusion: The DLCT-based nomogram with NIC, calcification, and HT has good effectiveness for predicting the BRAFV600E mutation in PTC.
Keywords: dual-layer detector spectral CT, papillary thyroid carcinoma, BRAFV600E mutation, nomogram
Limitations: The two samples were somewhat imbalanced.
Funding for this study: No funding was received for this work.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study is retrospective.
7 min
Magnetic Resonance (MR) sialographic assessment of masseter muscle and ductal kinking in patients with recurrent parotitis
Sonia Triggiani, Milan / Italy
Author Block: M. C. Firetto, S. Triggiani, G. Conte, L. Pignataro, G. M. M. Nicolino, G. Carrafiello; Milan/IT
Purpose: The aim of this study was to assess the anatomical relationship between Stensen's duct and masseter muscle and analyse their implications in etiopathogenesis of recurrent parotitis secondary to masseter muscle dysfunction.
Methods or Background: We enrolled 50 patients with suspect of masseter dysfunction due to bruxism: 41 unilateral recurrent parotitis, 9 bilateral parotitis. 33 patients made up the control group. All underwent power doppler ultrasonography, dynamic MR sialography, sialendoscopy. Basal and dynamic images of salivary glands were acquired at US by a small-parts transducer. MRI were acquired by 1.5T with head bobina. The before lemon sequences were STIR coronal and trasversal; T1 tse tra; T2 spc tra; T2 haste tra fs; T2 spc tra rst iso. 3-5 cc of lemon are administered through the mouth. Post lemon sequences were T2 haste tra fs; T2 spc tra; T2 spc rst tra. The scan lasts 40 minutes. At sialendoscopies, Stensen's duct ostium was dilated, then angled sialendoscope was inserted; exams end when all viable branches have been explored, pervious, without mucous plugs.
Results or Findings: Ultrasonography did not reveal Stensen's duct dilatation or obstruction. MRI sialography showed no statistically significant difference in imaging metrics. A subgroup analysis by gender, showed both parotids of male subjects with sialadenitis had a longer duct length compared to control subjects. In unilateral sialadenitis, comparison showed that parotids with sialadenitis had a wider duct. Sialendoscopy revealed acute duct angle in middle third of main duct; some mucous plugs were detected. Complete concordance between evidence of acute duct angle during sialendoscopy and wider duct in patients with parotitis was observed although not statistically significant.
Conclusion: This is one of the first studies in the literature analysing anatomical features relevant for the etiopathogenesis of recurrent parotitis secondary to the masseter muscle; we aim to increase the cohort population.
Limitations: There was a small number of patients.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No information provided by the submitter.
7 min
The role of magnetic resonance elastography in the evaluation of benign parotid tumours
Vitaliy Atamaniuk, Rzeszów / Poland
Author Block: V. Atamaniuk, L. Hanczyk, M. Obrzut, I. Palasz-Krasowska, W. Domka, M. Cholewa, B. Obrzut; Rzeszow/PL
Purpose: Magnetic resonance elastography (MRE) is the method of choice for the non-invasive evaluation of the biomechanical properties of numerous organs. MRE can be regarded as an advanced version of palpation, where the tissue is evaluated both qualitatively and quantitatively. We hypothesise that MRE can be a valuable tool for evaluating parotid tumours, which are often first diagnosed as palpable masses inside the parotid gland. This study aims to determine the feasibility of the parotid tumour MRE and assess the added value of tissue stiffness in tumour diagnosis and treatment. We believe that this new method can potentially enable us to circumvent the need for aspiration biopsy before surgery.
Methods or Background: Seven patients with benign parotid tumours (two men and five women), aged between 45 and 70, participated in this study. A 1.5 T whole-body MRI scanner and a motion-sensitised 2D GRE MRE sequence were utilised for data acquisition. Shear waves in the parotid gland were induced using a custom passive driver fixed against the patient's face. Excitation frequencies of 40, 60, 70, 80, and 100 Hz were tested. Mean tumour stiffness was calculated using manually drawn masks delineating tumour areas.
Results or Findings: Among the tested frequencies, 60 Hz vibrations provided optimal shear wave illumination in the tumour area, allowing for the assessment of tumour stiffness in all patients. The estimated mean ± SD stiffness of parotid tumours was 1.44 ± 0.43 kPa. Tumour stiffness exhibited high heterogeneity both between and within patients.
Conclusion: This study demonstrates the feasibility of MRE for parotid tumours using a specific passive driver and appropriate excitation frequency. However, reliable reference data from healthy parotid glands are required for results comparison.
Limitations: The primary limitation of this study is its small sample size.
Funding for this study: No external funding was obtained for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study received approval from the ethics committee of the Regional Medical Chamber (Resolution No 60/2022/B) and each volunteer provided written informed consent before participating in this study.
7 min
Ultrasound-assisted identification of the cricothyroid ligament: use in head and neck ultrasound education
Andreas Weimer, Heppenheim / Germany
Author Block: A. Weimer1, J. Weimer2, L. Müller2, C. Chrissostomou3, R. Klöckner4, M. Rink3, J. Künzel3; 1Heidelberg/DE, 2Mainz/DE, 3Regensburg/DE, 4Lübeck/DE
Purpose: When other attempts to secure the airway are unsuccessful, a cricothyrotomy may be indicated. Sonographic guidance can support the identification of the cricothyroid ligament. The aim of this prospective study was to establish a structured training as part of head and neck ultrasound courses.
Methods or Background: The training consisted of a 10-min lecture and a worksheet with an additional 10-min video tutorial followed by hands-on (45 min in groups of 4). To measure previous skills and satisfaction with the training as well as subjective and objective level of competence, evaluations were completed before (T1) and after (T2) the training. Furthermore, a practical test using a pocket device at T2 was performed. The answers of the evaluations were recorded using a Likert scale.
Results or Findings: Most participants had neither seen a cricothyrotomy (64.6%) nor had they performed it (79.6%) and they had no previous experience in using pocket devices (76.1%). Regarding the subjective competence, a significant improvement (T1 to T2) was measured in all competency areas (P <0.001), with the "Sonographic identification of Lig. conicum" (Δ=3.1 ± 1.6 scale points) reaching a particularly high increase. In the practical test, 89.2% of the possible points were achieved and an average of 101 seconds was needed for identification. Participants who already performed a cricothyrotomy, a tracheostomy or at least 30 head and neck sonographies tended to achieve higher scores and required less time.
Conclusion: Integration of a training concept for sonographic identification of the cricothyroid ligament was well accepted. Significant improvement in subjective competence as well as a high objective level of competence was achieved. Therefore, such training concepts should be standardised in head and neck ultrasound training.
Limitations: No evaluation of objective competence level at T1 was conducted; there was no control group without training.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: This study was approved by the ethics committee of the University of Regensburg.

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