Background: The aim was to improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance multiparametric ultrasound examination techniques. Methods: Multiparametric ultrasound consists of B-mode, shear-wave elastography and contrast enhanced ultrasound (CEUS) including Time-Intensity-Curve (TIC) analysis. A bolus of 1–2.4 mL Sulfur Hexafluorid microbubbles was injected for CEUS. Postoperative histopathology was the diagnostic gold standard. Results: 116 patients were included in this study. 102 benign thyroid nodules were diagnosed as well as 20 carcinomas. Suspicious B-mode findings like microcalcifications, a blurry edge and no homogeneous sonomorphological structure were detected in 60, 75 and 80% of all carcinomas but only in 13.7, 36.3 and 46.1% of all benign lesions. The average shear-wave elastography measurements of malignant lesions (4.6 m/s or 69.8 kPa centrally and 4.2 m/s or 60.1 kPa marginally) exceed the values of benign nodules. Suspicious CEUS findings like a not-homogeneous wash-in and a wash-out were detected almost twice as often in carcinomas. Conclusion: Multiparametric ultrasound offers new possibilities for the preoperative distinction between benign and malignant thyroid nodules. A score based system of B-mode, shear-wave and CEUS malignancy criteria shows promising results in the detection of thyroid carcinomas. It reaches a sensitivity of 95% and specificity of 75.49%.

Background: We aimed to evaluate multiparametric ultrasound, to achieve a better understanding of the baseline characteristics of suspected cervical lymph node metastases in head and neck cancer before induction chemotherapy or chemoradiation. Methods: From February 2020 to April 2021, our complete ultrasound examination protocol was carried out on clinically evident malignant lymph nodes of histologically proven HNSCC in the pre-therapeutic setting. Results: A total of 13 patients were eligible for analysis. Using elastography, irregular clear hardening in areas in the center of the lymph node could be detected in all cases. Elastographic Q-analysis showed a significantly softer cortex compared to the center and surrounding tissue. The time–intensity curve analysis showed high values for the area under the curve and a short time-to-peak (fast wash-in) in all cases compared to the surrounding tissue. A parametric evaluation of contrast enhanced the ultrasound in the early arterial phase and showed an irregular enhancement from the margin in almost all investigated lymph nodes. These results show that the implementation of comprehensive, multiparametric ultrasound is suitable for classifying suspected lymph node metastasis more precisely than conventional ultrasound alone in the pre-therapeutic setting of HNSCC. Thus, these parameters may be used for improvements in the re-staging after chemoradiation or neoadjuvant therapy monitoring, respectively.

To develop a training model for contrast-enhanced ultrasound (CEUS)-guided biopsy during the learning phase. An in-vitro model using porcine liver with olive-shaped lesions marked by pepper seeds was employed to simulate tumor biopsies. After targeted injection of sulfur-hexafluoride microbubbles as contrast agent, both native and CEUS-guided biopsies were performed using 18G core needles. Linear transducers of a high-end ultrasound device (3–15 MHz) and of a portable handheld ultrasound device (3–12 MHz) were utilized. Freehand biopsies were conducted both in-plane and out-of-plane. Twelve procedures each were performed by experienced and novice examiners on lesions located at depths of 2–4 cm, with comparisons made regarding procedure duration and image quality. Image and procedure quality were assessed by two independent readers using a scale from 0 (insufficient) to 5 (excellent). CEUS enabled more precise localization and marking of poorly delineated lesions, thereby facilitating targeted biopsy, even in deeper tissue layers. Particularly under challenging acoustic conditions, CEUS improved the planning and execution of interventions for both experienced and novice users when using handheld ultrasound devices. In this in-vitro study, CEUS provided a significant advantage for experienced users working with handheld systems (p < 0.05), whereas its integration into high-end systems did not lead to a significant difference in procedure time (p > 0.05). Novice users, however, benefited significantly from CEUS when using high-end systems (p < 0.01). CEUS-marked lesions in the in-vitro model allow for realistic training of targeted punctures and biopsies – even for lesions not clearly visible in B-mode imaging. Despite the absence of circulation, the contrast effect remains sufficiently stable to practice CEUS techniques under conditions closely resembling clinical practice. This supports the safe application of portable ultrasound systems in interventional procedures.