The Great Synergistic Performance for Adjunction of ACR TI-RADS and Color Flow Imaging Vascularity Scoring in Predicting Malignant Thyroid Nodules

Purpose: To investigate the diagnostic performance of Color Doppler Flow Imaging (CFI) vascularity score in comparison to the ACR TI-RADS for prediction of malignancy in thyroid nodules (TNs). Materials: and Methods: A cross-sectional prospective study design was used. Patients underwent thyroid ultrasound imaging for TNs which classified the TNs using ACR TI-RADS and CFI vascularity score. Receiver operating characteristic (ROC) analysis was applied to compare between the CFI vascularity score and ACR TI-RADS. Results: : A total of 222 patients participated in this study, 76.6% of them were female, with a mean age of 44.73 ± 13.31 years (range, 18 to 85). Ultrasound imaging classified TNs as: (TI-RADS 4= 41%), (TI-RADS 5=30.6%), and (TI-RADS 3= 28.4%). TNs of TIRADS 3, 4, and 5 and with CFI vascularity score category 1 were100% benign, and TNs of TIRADS 3, 4, and 5 and with CFI vascularity score category 4 were malignant in 82.5%, 91.3%, 100%, respectively, (p<0.001). A significant difference in the area under ROC curve among CFI vascularity scores and ACR TI-RADS was found. CFI vascularity showed sensitivity of 85.2%, specificity of 86.8%, PPV of 86% and NPV of 86.1%, in prediction malignancy in TNs, where CFI scores>2. However, the ACR TI-RADS showed sensitivity 57.4%, specificity 94.7%, PPV 91.2% and NPV 70.1% in prediction malignancy, in ACR TI-RADS ≥ 4, (p<0.001). Conclusion: Combining CFI vascularity score and TI-RADS can be consider as a safe and non-invasive diagnostic method for accurate risk stratification of TNs and can resolve the gap in follicular TNs.