This publication received support from the Shaanxi Provincial Key Research and Development Plan: 2023-ZDLSF-56 and the Shaanxi Provincial &#34;Scientist + Engineer&#34; Team Construction: 2022KXJ-019.

This study was approved by the Institutional Review Board of Sunsimiao Hospital affiliated with the Beijing University of Chinese Medicine. The patient was recruited from the Department of Thyroid, Sunsimiao Hospital. The patient underwent a thyroid ultrasound examination and gave informed consent for the study. In this investigation, 4D ultrasound data acquired using a handheld device were utilized to reconstruct triplanar views of the thyroid gland. Furthermore, real-time synchronous color Doppler imaging was achieved....

Synchronous Visualization of Thyroid Structural and Functional Information

<ol>
	<li>Ragusa, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hashimotos'+thyroiditis:+Epidemiology,+pathogenesis,+clinic+and+therapy.">Hashimotos' thyroiditis: Epidemiology, pathogenesis, clinic and therapy.</a> Best Pract Res Clin Endocrinol Metab. 33 (6), 101367 (2019).</li><li>Ralli, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hashimoto's+thyroiditis:+An+update+on+pathogenic+mechanisms,+diagnostic+protocols,+therapeutic+strategies,+and+potential+malignant+transformation.">Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation.</a> Autoimmun Rev. 19 (10), 102649 (2020).</li><li>Soh, S., Aw, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laboratory+testing+in+thyroid+conditions+-+pitfalls+and+clinical+utility.">Laboratory testing in thyroid conditions - pitfalls and clinical utility.</a> Ann Lab Med. 39 (1), 3-13 (2019).</li><li>Cansu, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+value+of+3D+power+Doppler+ultrasound+in+the+characterization+of+thyroid+nodules.">Diagnostic value of 3D power Doppler ultrasound in the characterization of thyroid nodules.</a> Turk J Med Sci. 49, 723-729 (2019).</li><li>Haugen, B. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=2015+American+Thyroid+Association+Management+Guidelines+for+adult+patients+with+thyroid+nodules+and+differentiated+thyroid+cancer:+The+American+Thyroid+Association+Guidelines+Task+Force+on+Thyroid+Nodules+and+Differentiated+Thyroid+Cancer.">2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.</a> Thyroid. 26 (1), 1-133 (2016).</li><li>Acharya, U. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+of+Hashimoto's+thyroiditis+in+ultrasound+using+tissue+characterization+and+pixel+classification.">Diagnosis of Hashimoto's thyroiditis in ultrasound using tissue characterization and pixel classification.</a> Proc Inst Mech Eng H. 227 (7), 788-798 (2013).</li><li>Zhang, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Deep+learning+to+diagnose+Hashimoto's+thyroiditis+from+sonographic+images.">Deep learning to diagnose Hashimoto's thyroiditis from sonographic images.</a> Nat Commun. 13 (1), 3759 (2022).</li><li>Huang, J., Zhao, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+diagnosis+progress+of+ultrasound+imaging+technology+in+thyroid+diffuse+diseases.">Quantitative diagnosis progress of ultrasound imaging technology in thyroid diffuse diseases.</a> Diagnostics. 13 (4), 700 (2023).</li><li>Gasic, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+low+vitamin+D+levels+with+Hashimoto+thyroiditis.">Relationship between low vitamin D levels with Hashimoto thyroiditis.</a> Srp Arh Celok Lek. 151 (5-6), 296-301 (2023).</li><li>Sultan, S. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+3D+ultrasound+reliable+for+the+evaluation+of+carotid+disease?+A+systematic+review+and+meta-analysis.">Is 3D ultrasound reliable for the evaluation of carotid disease? A systematic review and meta-analysis.</a> Med Ultrason. 25 (2), 216-223 (2023).</li><li>Arsenescu, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=3D+ultrasound+reconstructions+of+the+carotid+artery+and+thyroid+gland+using+artificial-intelligence-based+automatic+segmentation-qualitative+and+quantitative+evaluation+of+the+segmentation+results+via+comparison+with+CT+angiography.">3D ultrasound reconstructions of the carotid artery and thyroid gland using artificial-intelligence-based automatic segmentation-qualitative and quantitative evaluation of the segmentation results via comparison with CT angiography.</a> Sensors. 23 (5), 2806 (2023).</li><li>Kr&#246;nke, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracked+3D+ultrasound+and+deep+neural+network-based+thyroid+segmentation+reduce+interobserver+variability+in+thyroid+volumetry.">Tracked 3D ultrasound and deep neural network-based thyroid segmentation reduce interobserver variability in thyroid volumetry.</a> PLoS One. 17 (7), e0268550 (2022).</li><li>Hazem, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+shear+wave+elastography+in+the+evaluation+of+diffuse+thyroid+diseases+in+children+and+adolescents.">Reliability of shear wave elastography in the evaluation of diffuse thyroid diseases in children and adolescents.</a> Eur J Radiol. 143, 109942 (2021).</li><li>Herickhoff, C. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Low-cost+volumetric+ultrasound+by+augmentation+of+2D+systems:+design+and+prototype.">Low-cost volumetric ultrasound by augmentation of 2D systems: design and prototype.</a> Ultrasound Imaging. 40 (1), 35-48 (2017).</li><li>Seifert, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimization+of+thyroid+volume+determination+by+stitched+3D-ultrasound+data+sets+in+patients+with+structural+thyroid+disease.">Optimization of thyroid volume determination by stitched 3D-ultrasound data sets in patients with structural thyroid disease.</a> Biomedicines. 11 (2), 381 (2023).</li></ol>

Critical steps in the protocol 
While Figure 1 and Figure 2 have value for inspection and diagnosis, determining lesion location and views from other perspectives requires expert experience. For the diagnosis of Hashimoto&#39;s thyroiditis (HT), synchronizing Figure 1 and Figure 2 in real time is also an important and critical step. Protocol step 3.3 is one of the key steps where, ...

Hashimoto's thyroiditis (HT), the most frequent autoimmune thyroid disorder (AITD), is the leading cause of hypothyroidism in iodine-sufficient areas of the world1. It is characterized by lymphocytic infiltration and autoantibodies against thyroid antigens, leading to the destruction of thyroid architecture and hypothyroidism2. Staging of HT aims to assess the severity and guide treatment decisions. It relies on a combination of biochemical markers such as thyroid stimulating hormone (TSH) and thyroid autoantibodies3, as well as ultrasonographic features visible on thyroid ultrasound4,5,6.
On ultrasound examination, HT demonstrates characteristic findings, including diffusely decreased echogenicity, heterogeneous echotexture, micronodularity, and increased blood flow on color Doppler6,7. However, conventional two-dimensional (2D) grayscale ultrasound lacks quantitative methods for systematically analyzing these features for HT staging8. The assessment of vascularity changes is also limited to qualitative visual inspection in 2D mode. The complex three-dimensional (3D) architecture of the thyroid gland further hampers thorough evaluation using conventional 2D slicing9,10. These factors lead to imaging blind spots and misinterpretation, resulting in low sensitivity and specificity, especially for less experienced practitioners11,12.
Conventional handheld ultrasound scanning integrates real-time acquisition and diagnosis. This coupled workflow reliance increases the likelihood of oversight errors during scanning. The lack of spatial localization and tracking also makes lesion identification and monitoring imprecise12,13. Dedicated 3D ultrasound systems have emerged to address these limitations and have shown promising results14,15. However, most 3D ultrasound technologies require complex mechanical scanning mechanisms and specialized transducers, leading to high costs and barriers to adoption.
To overcome the limitations of conventional 2D and 3D ultrasound techniques, this study proposes a novel 3D reconstruction and visualization solution tailored for thyroid examination. Using widely available handheld ultrasound, multiple 2D sweeps are first acquired to scan the entire thyroid gland. 3D volumetric reconstruction is then realized by spatial registration and fusion of the 2D sequences. Concurrently, color Doppler frames are coregistered to create vascularity maps visualizing blood flow changes. The reconstructed 3D grayscale volumes and colored vascularity maps are finally integrated into a single platform, enabling synchronized multi-planar visualization and combined structural-functional inspection.
This proposed 3D fusion technique provides a systematic and comprehensive evaluation of the complex thyroid morphology from different aspects. By minimizing blind spots and enabling global overview, it could help improve diagnostic accuracy and reduce oversight errors, especially benefiting novice practitioners. The multi-modal visualization also facilitates rapid and precise localization of lesions, holding promise for early diagnosis and treatment of thyroid nodules and tumors. Moreover, the method introduces quantitative 3D feature analysis which has not been investigated for HT staging before. With wide adoption, it has the potential to standardize and objectify the currently experience-dependent ultrasound diagnosis procedures. By synergistically integrating handheld 3D reconstruction, multi-modal fusion, quantitative feature analysis, and flexible visualization into a streamlined workflow, this low-cost, easy-to-use technique represents a diagnostically powerful leap from conventional 2D ultrasound for advancing thyroid examination.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>MATLAB</td>
			<td>MathWorks&#160;</td>
			<td>2023B</td>
			<td>Computing and visualization&#160;</td>
		</tr>
		<tr>
			<td>Tools for Thyroid Disease Precision Quantification</td>
			<td>Intelligent Entropy</td>
			<td>Thyroid-3D V1.0</td>
			<td>Beijing Intelligent Entropy Science &#38; Technology Co Ltd. 
			Modeling for Thyroid Disease</td>
		</tr>
	</tbody>
</table>

synchronous triplanar reconstruction integrated with color doppler mapping for precise and rapid localization of thyroid lesions

This paper proposes a novel thyroid examination technique based on five-dimensional (5D) synchronous reconstruction of ultrasound data. The raw temporal sequences are reconstructed into 3D volumetric data reflecting anatomical structure. Triplanar visualization from three orthogonal planes is realized to provide a systematic inspection of the entire gland. Color Doppler imaging is integrated into each triplanar slice to map vascularity changes. This multi-modal fusion enables synchronous display of structural, functional, and blood flow information in the reconstructed 5D space. Compared to conventional scanning, this technique offers the benefits of flexible offline diagnosis, reduced dependency on scanning, enhanced intuitive interpretation, and comprehensive multi-aspect evaluation. By minimizing oversight errors, it could improve diagnostic accuracy, especially for novice practitioners. The proposed 5D fusion method allows rapid and precise localization of lesions for early detection. Future work will explore integration with biochemical markers to further improve diagnostic precision. The technique has considerable clinical value for advancing thyroid examination.

Author Spotlight: Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis

Synchronous Triplanar Reconstruction Integrated with Color Doppler Mapping for Precise and Rapid Localization of Thyroid Lesions

The scope of our research focus on the precise, quantitative diagnosis of thyroid disease, specifically exploring how different status of the disease can be accurately quantified. Currently, the fusion diagnosis of ultrasound imaging and the solid biochemical markers is being utilized to advance research in our field. We have established significant findings in our field by synchronizing the ultrasound, and the Color Doppler ultrasound in 3D space to diagnose solid imaging indicators and integrate them with biochemical indicators.With our protocol, we are addressing the research gap by utilizing portable handheld ultrasound devices to achieve panoramic observation and diagnosis of the triplanar views of solid ultrasound imaging. Our protocol offers the advantage of high cost-effectiveness, and comprehensive precise diagnosis compared to other techniques.

As shown in the graphical user interface (GUI) in Figure 1 and Figure 2, the ultrasound scanning sequence can be checked continuously. However, this two-dimensional examination relies heavily on the thyroidologist&#39;s anatomical knowledge to mentally reconstruct the lesion&#39;s location, which is challenging for novices and results in a lack of quantitative consistency. Figure 3 fuses the B-mode grayscale with co...

Watch this Scientific Journal Video about Integrating Ultrasound Imaging with Biochemical Markers for Thyroid Disease Diagnosis at JoVE.com

Here we present a 5D ultrasound technique combining multi-planar 3D reconstruction and color Doppler fusion, which enables synchronous visualization of thyroid structural and functional information. By minimizing blind spots, this method allows rapid, precise localization of lesions to improve diagnostic accuracy, especially benefiting novice practitioners.

This paper proposes a novel thyroid examination technique based on five-dimensional (5D) synchronous reconstruction of ultrasound data. The raw temporal ...