Differential Diagnosis of Thyroid Nodules by the Demetics Ultrasound-Assisted Diagnosis System and Contrastenhanced Ultrasound Combined With Thyroid Image Reporting and Data Systems

Guojuan Wang; Fang Nie; Yanfang Wang; Dan Yang; Tiantian Dong; Ting Liu; Peihua Wang


Clin Endocrinol. 2022;97(1):116-123. 

In This Article

Abstract and Introduction


Background: More and more new ultrasound techniques with their own characteristics are applied in the differential diagnosis of thyroid nodules. This study amied to assess and compare the diagnostic value of the Demetics ultrasound-assisted diagnosis system and contrast-enhanced ultrasound (CEUS) combined with the Thyroid Image Reporting and Data Systems (TI-RADS) for thyroid nodules.

Design and Patients: A total of 600 thyroid nodules with pathological findings were retrospectively analysed. Demetics and CEUS were performed for all nodules. The diagnostic efficacy of Demetics and CEUS for nodules of different sizes was evaluated and compared in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−). The characteristics of nodules diagnosed and misdiagnosed by Demetics were compared to analyse the factors affecting the diagnostic accuracy of Demetics. The necessity of CEUS for nodules that are prone to misdiagnosis in Demetics was assessed.

Results: Both Demetics and CEUS can be used for the differential diagnosis of benign and malignant thyroid nodules of different sizes. The diagnostic agreement between Demetics and CEUS for thyroid nodules of different sizes was moderate, substantial and fair, respectively. The sensitivity and NPV of Demetics were higher than those of CEUS, and the specificity, PPV and LR+ of CEUS were higher than that of Demetics. The LR− of Demetics was lower than those of CEUS. There were significant differences in age, calcification and margin in analysing the factors affecting Demetics. CEUS correctly diagnosed 50 of the 101 nodules misdiagnosed by Demetics.

Conclusions: Demetics showed high sensitivity in diagnosing thyroid nodules, while CEUS showed high specificity. In clinical practice, CEUS can further improve the diagnostic accuracy for nodules that are easily misdiagnosed by Demetics.


Thyroid nodules are extremely common in clinical practice, and can be detected in more than 65% of the general population. However, only approximately 10% of patients with thyroid nodules are at risk of malignancy.[1] Ultrasonography (US) is the preferred imaging tool for risk stratification of thyroid nodules and determines whether further management, such as fine needle aspiration (FNA), is required.[2] Despite its inherent advantages, including easy accessibility, nonradiating, inexpensive and well-tolerated technique, the operator dependency and interobserver variability may lead to nonstandard diagnosis and treatment.

Artificial intelligence (AI) computer-aided diagnosis (CAD) systems can compensate for the above problem, reduce the misdiagnosis caused by the inexperience of radiologists, and improve the accuracy of noninvasive diagnosis. The AI-SONIC™ Thyroid (Demetics) is a newly developed ultrasonic intelligence diagnosis system by Deshangyunxing, Zhejiang Province, which is based on a new type of hybrid deep learning framework independently developed by the company. Based on big data,[3–5] it detects the nodules, extracts the grey-scale characteristics of the nodules and gives its benign or malignant ultrasonic prejudgement automatically. However, it does not cover the blood flow information of thyroid nodules.

Contrast-enhanced ultrasound (CEUS) is a new technique to assess the microvascular perfusion status of lesions and organs in a noninvasive modality, and is used in many organs to differentiate benign and malignant tumours. A previous study[6] demonstrated a 94.02% accuracy of CEUS combined with TI-RADS in differentiating benign from malignant thyroid nodules. Hypoenhancement is the most precise predictor of malignant thyroid nodules.[7] Unfortunately, contrast agents are expensive and increase the economic burden on the patients.

Therefore, in this study, we compared the diagnostic efficacy of Demetics and CEUS combined with TI-RADS for diagnosing benign and malignant thyroid nodules of different sizes. And we analysed the nodule characteristics misdiagnosed by Demetics, and screened out the nodules that are needed for CEUS further. Aiming to reduce the economic burden on patients and avoid overdiagnosis.