Key result
Microvascular ultrasonography vascularity index effectively differentiated Graves' disease from destructive thyroiditis with an AUC of 0.852, demonstrating non-inferiority to conventional color Doppler (p=0.05).
Why the study?
Microvascular ultrasonography is a third-generation Doppler technique developed to increase sensitivity compared to conventional Doppler, but its ability to differentiate Graves' disease from destructive thyroiditis compared with conventional color Doppler and power Doppler imaging was unproven.
Does microvascular ultrasonography improve the differentiation of Graves' disease from destructive thyroiditis compared to conventional Doppler in thyrotoxic patients?
Observational (n=101)
No
Does microvascular ultrasonography improve the differentiation of Graves' disease from destructive thyroiditis compared to conventional Doppler in thyrotoxic patients?
Effect estimate: AUC 0.852 (95% CI 0.774-0.930)
Absolute Event Rate: 0.852% vs 0.822%
p-value: p=<0.001
Quantitative microvascular ultrasonography is a reliable, real-time tool for differentiating Graves' disease from destructive thyroiditis, showing comparable or superior diagnostic accuracy to conventional Doppler.
May support microvascular US as Doppler alternative in thyrotoxicosis differentiation; leaves open prospective validation before practice change.
BACKGROUND: Microvascular ultrasonography (MVUS) is a third-generation Doppler technique that was developed to increase sensitivity compared to conventional Doppler. The purpose of this study was to compare MVUS with conventional color Doppler (CD) and power Doppler (PD) imaging to distinguish Graves' disease (GD) from destructive thyroiditis (DT). METHODS: This prospective study included 101 subjects (46 GDs, 47 DTs, and eight normal controls) from October 2020 to November 2021. All ultrasonography examinations were performed using microvascular flow technology (MV-Flow). The CD, PD, and MVUS images were semi-quantitatively graded according to blood flow patterns. On the MVUS images, vascularity indices (VIs), which were the ratio (%) of color pixels in the total grayscale pixels in a defined region of interest, were obtained automatically. Receiver operating characteristic curve analysis was performed to verify the diagnostic performance of MVUS. The interclass correlation coefficient and Cohen's kappa analysis were used to analyze the reliability of MVUS (ClinicalTrials.gov:NCT04879173). RESULTS: The area under the curve (AUC) for CD, PD, MVUS, and MVUS-VI was 0.822, 0.844, 0.808, and 0.852 respectively. The optimal cutoff value of the MVUS-VI was 24.95% for distinguishing GD and DT with 87% sensitivity and 80.9% specificity. We found a significant positive correlation of MVUS-VI with thyrotropin receptor antibody (r=0.554) and with thyroid stimulating immunoglobulin bioassay (r=0.841). MVUS showed high intra- and inter-observer reliability from various statistical method. CONCLUSION: In a real time and quantitative manner, MVUS-VI could be helpful to differentiate GD from thyroiditis in thyrotoxic patients, with less inter-observer variability.
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A 2022 study conducted an observational in Thyrotoxicosis (Graves' disease vs Destructive thyroiditis) (n=101). Microvascular ultrasonography (MVUS) vascularity index vs. Conventional color Doppler and power Doppler was evaluated on Area under the curve (AUC) for distinguishing Graves' disease from destructive thyroiditis (AUC 0.852, 95% CI 0.774-0.930, p=<0.001). Microvascular ultrasonography vascularity index effectively differentiated Graves' disease from destructive thyroiditis with an AUC of 0.852, demonstrating non-inferiority to conventional color Doppler (p=0.05).
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