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Evaluation of parenchymal vascularity of the thyroid gland with vascularization index by color superb microvascular imaging in patients with Graves’ disease

Abidin Kılınçer
Abidin Kılınçer
, 
Mehmet Sedat Durmaz
Mehmet Sedat Durmaz
, 
Cem Onur Kıraç
Cem Onur Kıraç
, 
Süleyman Baldane
Süleyman Baldane
, 
Fatih Ateş
Fatih Ateş
 e 
Abdüssamet Batur
Abdüssamet Batur
   | 24 mar 2021
Journal of Ultrasonography's Cover Image
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Article Category: research-article
Pubblicato online: 24 mar 2021
Pagine: 41 - 47
Ricevuto: 22 set 2020
Accettato: 20 gen 2021
DOI: https://doi.org/10.15557/jou.2021.0006
Parole chiave
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

A 47-year-old female patient with GD. Quantitative VI values (arrows) were obtained by manually drawing the outer margin of the thyroid gland, on the cSMI mode in the largest longitudinal plane of the right lobe for 5 seconds and the mean of the highest three measurements was calculated. The mean VI value for the right lobe in the longitudinal plane was 10.6 % ( 9.7 + 11 + 11.2 3 )
A 47-year-old female patient with GD. Quantitative VI values (arrows) were obtained by manually drawing the outer margin of the thyroid gland, on the cSMI mode in the largest longitudinal plane of the right lobe for 5 seconds and the mean of the highest three measurements was calculated. The mean VI value for the right lobe in the longitudinal plane was 10.6 % ( 9.7 + 11 + 11.2 3 )

Fig. 2.

A 35-year-old female patient with GD. Quantitative VI values (arrows) were obtained by free ROI on the cSMI mode from both thyroid lobes in the transverse and longitudinal planes as demonstrated
A 35-year-old female patient with GD. Quantitative VI values (arrows) were obtained by free ROI on the cSMI mode from both thyroid lobes in the transverse and longitudinal planes as demonstrated

Fig. 3.

Box plot graphs of VI values in GD and control groups
Box plot graphs of VI values in GD and control groups

Fig. 4.

The ROC curves of VI values to discriminate patients with GD
The ROC curves of VI values to discriminate patients with GD

Vascularization index (VI) measured with cSMI of patients with Graves disease and control group* #

Vascularization index of Measurement plane/lobe Graves disease subgroups Graves disease (n:37) Control group (n:40)
New diagnosis (n:11) Follow up (n:26)
Right lobe (R) Transverse (T) 15.2 (2.5-30) 13 (2.9–41.2) 13.2 (2.5-41.2) 4.8 (0.7-10.1)
Longitudinal (L) 13 (1.35-29.2) 11.6 (0.7-32.8) 11.8 (0.7-32.8) 5.8 (1.6-12)
(T+L)/2 13.3 (3.1-29.6) 12.3 (3-35.05) 12.4 (3-35.05) 5.15 (1.75-9.65)
Left lobe (L) Transverse 9.5 (4.6-25) 12.1 (1.5-29.1) 12.1 (1.5-29.1) 4.8 (0.8-10)
Longitudinal 12.6 (4.9-31.3) 9.9 (1.7-29.4) 11.5 (1.7-31.3) 5.4 (0.3-15.6)
(T+L)/2 11.4 (5.2-28.5) 11.2 (1.6-29.2) 11.4 (1.6-29.2) 5 (0.5-12.8)
Transverse (R+L)/2 13.05 (4.6-27.5) 13.1 (2.95-35.1) 13.05 (2.95-35.1) 4.8 (0.75-10)
Longitudinal (R+L)/2 11.2 (4.5-30.2) 12.2 (1.2-29.1) 11.95 (1.2-30.2) 5.05 (1.55-11.7)
Total thyroid (R+L)/2 11.9 (4.7-28.9) 12.1 (2.3-32.1) 12 (2.3-32.1) 5.04 (1.1-10.8)

Correlation analysis between total thyroid VI and laboratory values, isthmus thickness, and total thyroid volume

Correlation analysis between p Spearman’s rho
Total thyroid vascularization index (VI) and TSH 0.001* -0.426
fT4 0.018* -0.270
fT3 0.001* 0.67
TPOAbs 0.28 0.179
TgAbs 0.36 -0.155
Isthmus thickness 0.004* 0.327
Total volume 0.001* 0.466

Best cutoff values according to the ROC analysis of VI values of the thyroid gland

VI values Cutoff value Sensitivity, % Specificity, % AUC 95% Confidence interval
Lower bound Upper bound
Transverse average 6.3 83.8 82.5 0.872 0.786 0.958
Longitudinal average 7.25 78.4 75 0.852 0.761 0.944
Total thyroid 6.3 83.8 70 0.872 0.785 0.958

Comparison of VI values of the study population according to the average values and measurement planes

Comparison of VI values P *
Right transverse Right longitudinal 0.61
Left transverse Left longitudinal 0.96
Right transverse Left transverse 0.28
Right longitudinal Left longitudinal 0.25
Right average Total thyroid 0.14
Left average Total thyroid 0.13
Right average Left average 0.14
Transverse average Longitudinal average 0.67
Transverse average Total thyroid 0.6
Longitudinal average Total thyroid 0.67

Characteristics of study population* #

Variables Graves disease subgroups Graves disease (n: 37) Control group (n: 40)
New diagnosis (n: 11) Follow up (n: 26)
Gender 2 M / 9 F 8 M / 18 F 10 M / 27 F 11 M / 29 F
Age (mean ±SD) 37.7 ± 8.7 41.4 ± 10.9 40.3 ± 10.3 40.9 ± 11.5
Isthmus thickness (mm) 4.4 (3-12) 4.2 (1.7-7.8) 4.4 (1.7-12) 3 (1.2-7.3)
Volumes Right lobe volume (cm ³ ) 12.4 (4.5-31.1) 9 (4.4-32.6) 10.3 (4.4-32.6) 5.8 (2.5-23.4)
Left lobe volume (cm ³ ) 11.1 (2.2-21.3) 7.3 (3-46.5) 8.5 (2.2–46.5) 5.6 (2.8-17.8)
Total volume (cm ³ ) 23 (6.7-50.8) 16.2 (7.4-79.1) 19.4 (6.7-79.1) 11.5 (5.3-31.2)
Hormone levels TSH (mU/L) 0.01 (0.01-0.18) 1.07 (0.01-4.67) 0.12 (0.01–4.67) 2.24 (0.56-4.14)
fT4 (ng/dL) 2.2 (0.88-7.47) 1.16 (0.89-3.04) 1.23 (0.88-7.47) 3.27 (2.67–4.1)
fT3 (ng/L) 6.2 (2.76-28.1) 3.37 (2.59-11.2) 3.63 (2.59-28.1) 1.28 (0.9-1.69)
Autoantibodies TPOAbs (IU/mL) 91.3 (11.7-600) 110 (10-600) 108.4 (10-600) -
TgAbs (IU/mL) 47 (21.6-591) 89.2 (10.9-1478) 78.6 (10.9-1478) -

Median VI values of total thyroid according to the echogeni-city of the thyroid parenchyma in the GD group. The echoge-nicity of the thyroid parenchyma was not correlated with VI values (p = 0.26)

Echogenicity of thyroid parenchyma GD group (n:37) VI values of total thyroid Median (min–max)
Hyperechoic 7 (18.9%) 12.26 (5.7-32.1)
Isoechoic 20 (54.1%) 10.75 (2.3-22.8)
Hypoechoic 10 (27%) 16.77 (4.5-28.9)
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