{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:01:16Z","timestamp":1792000876666,"version":"4.4.0"},"reference-count":62,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004054","name":"King Abdulaziz University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004054","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Ultrasound is the primary imaging modality for evaluating thyroid nodules, with echogenicity and nodule size serving as parameters for malignancy risk stratification. Though the TI-RADS classification system is standardized, interpretation varies among observers due to subjectivity, and can affect diagnostic consistency. This study aimed to evaluate the diagnostic and interobserver agreement of quantitative ultrasound gray-scale analysis and nodule area in differentiating benign from malignant solid thyroid nodules. Methods: This retrospective study reviewed 600 patients who underwent thyroid ultrasound at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, in 2023 and 2024. Of these 600, 107 adult patients with 116 solid thyroid nodules (96 benign and 20 malignant) who subsequently underwent ultrasound-guided fine-needle aspiration were included in the final analysis. From B-mode ultrasound images, the grayscale median (GSM) values of each nodule and adjacent normal thyroid tissue were measured using Adobe Photoshop. The GSM ratio (GSMr) was calculated by dividing nodule GSM by normal tissue GSM. Nodule size, taken as cross-sectional area, was assessed using ImageJ software version 1.53. The Mann\u2013Whitney U test was used to compare GSMr and the area between benign and malignant nodules. Inter-observer agreement was evaluated using the intraclass correlation coefficient (ICC). Results: Malignant nodules had significantly lower GSMr compared to benign nodules (malignant: median 0.76, IQR 0.27; benign: median 0.88, IQR 0.55, p = 0.02). Malignant nodules were also significantly larger than benign nodules (malignant: median 2.77 cm2, IQR: 5.08; benign: median 1.78 cm2, IQR 1.65, p = 0.02). Inter-observer reproducibility was excellent for both GSMr (ICC = 0.998) and area (ICC = 0.997). Conclusions: Quantitative ultrasound assessment of grayscale echogenicity and nodule area provides valuable diagnostic information for differentiating benign from malignant solid thyroid nodules. These objective measures may enhance diagnostic confidence and support more precise clinical decision-making in thyroid nodule evaluation.<\/jats:p>","DOI":"10.3390\/tomography11120133","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T11:50:13Z","timestamp":1764244213000},"page":"133","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Quantitative Ultrasound Grayscale Analysis and Size of Benign and Malignant Solid Thyroid Nodules"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9981-6138","authenticated-orcid":false,"given":"Salahaden R.","family":"Sultan","sequence":"first","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"},{"name":"Department of Radiology, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faisal","family":"Albin Hajji","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Alhazmi","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahad","family":"Alamri","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abrar","family":"Alsulami","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0838-4087","authenticated-orcid":false,"given":"Ahmed","family":"Albukhari","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1188-7820","authenticated-orcid":false,"given":"Asseel","family":"Filimban","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bander","family":"Almutairi","sequence":"additional","affiliation":[{"name":"Department of Radiology, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9304-7064","authenticated-orcid":false,"given":"Ahmad","family":"Albngali","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5490-6639","authenticated-orcid":false,"given":"Reham","family":"Kaifi","sequence":"additional","affiliation":[{"name":"College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia"},{"name":"Medical Imaging Department, Ministry of the National Guard\u2014Health Affairs, Jeddah 21577, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Khayat","sequence":"additional","affiliation":[{"name":"Department of Radiology, King Fahad General Hospital, Ministry of Health, Al-Madinah 42351, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-0939","authenticated-orcid":false,"given":"Mohammed","family":"Alkharaiji","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh 11673, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5188-9626","authenticated-orcid":false,"given":"Mohammad","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5878-7737","authenticated-orcid":false,"given":"Abrar","family":"Alfatni","sequence":"additional","affiliation":[{"name":"Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1530\/EJE-20-0204","article-title":"Performance of EU-TIRADS in malignancy risk stratification of thyroid nodules: A meta-analysis","volume":"183","author":"Castellana","year":"2020","journal-title":"Eur. 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