This study evaluates the added diagnostic value of Superb Microvascular Imaging (SMI) and elastosonography in stratifying malignancy risk in thyroid nodules, which are typically classified according to TI-RADS (Thyroid Imaging Reporting and Data System) via B-mode ultrasound and color Doppler. Conducted on 260 nodules from 251 patients (average age of 58.6), all of whom were candidates for needle aspiration, the study compared outcomes against the needle aspiration results, considered the gold standard for diagnosis. After performing a standard TI-RADS classification, each nodule underwent further assessment with SMI and elastosonography by experienced operators. ROC (Receiver Operating Characteristic) curve analysis was then used to determine the diagnostic accuracy of these techniques, both individually and in combination.
Results showed that the standalone use of SMI had an AUC (Area Under the Curve) of 0.57, with a confidence interval of 95% between 0.49 and 0.66, while elastosonography alone had an AUC of 0.58 (95% CI 0.49–0.67). When SMI and elastosonography were used together, the AUC rose slightly to 0.62 (95% CI 0.52–0.71). TI-RADS alone demonstrated a higher AUC of 0.67 (95% CI 0.59–0.75), and when combined with SMI and elastosonography, the AUC reached 0.69 (95% CI 0.61–0.77). The findings suggest that while SMI and elastosonography add some incremental value to TI-RADS, their standalone effectiveness in increasing diagnostic accuracy is limited. In clinical practice, using SMI and elastosonography alongside TI-RADS could provide a modest enhancement in risk stratification, yet these tools individually do not strongly impact diagnostic reliability.
