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Using B-mode images from selected patients and measuring GSM with Adobe Photoshop and area with ImageJ, malignant nodules showed lower GSMr and larger cross-sectional area, with excellent observer reproducibility (ICC 0.997–0.998).",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/quantitative-ultrasound-grayscale-analysis-and-size-of-benign-and-malignant-solid-thyroid-nodules-study-report/369009/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/quantitative-ultrasound-grayscale-analysis-and-size-of-benign-and-malignant-solid-thyroid-nodules-study-report/369009.png","ImageObject",300,407,{"name":42,"@type":43},"mieayamfan","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-03","2026-09-23",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What was the study’s main goal?","Question",{"text":63,"@type":64},"To evaluate diagnostic performance and interobserver agreement of quantitative ultrasound grayscale analysis and nodule area for distinguishing benign from malignant solid thyroid nodules.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How were quantitative grayscale features measured?",{"text":68,"@type":64},"Grayscale median (GSM) values were measured from B-mode images, and the GSM ratio (GSMr) was computed by dividing nodule GSM by adjacent normal tissue GSM.",{"name":70,"@type":61,"acceptedAnswer":71},"What quantitative findings distinguished malignant from benign nodules?",{"text":72,"@type":64},"Malignant nodules had significantly lower GSMr than benign nodules and were also significantly larger based on cross-sectional area measurements.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},369009,1790734143,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":140,"language":141,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":12,"update_tm":145,"read_time":146},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Article  \nQuantitative Ultrasound Grayscale Analysis and Size of Benign and Malignant Solid Thyroid Nodules  \nSalahaden R. Sultan 1,2, *, Faisal Albin Hajji 1, Abdulrahman Alhazmi 1, Shahad Alamri 1, Abrar Alsulami 1, Ahmed Albukhari 1, Asseel Filimban 1, Bander Almutairi 2, Ahmad Albngali 1, Reham Kaifi 3,4,5, Mohammad Khayat 6, Mohammed Alkharaiji 7, Mohammad Khalil 8 and Abrar Alfatni 1  \nAcademic Editor: Emilio Quaia  \nReceived: 15 October 2025  \nRevised: 19 November 2025  \nAccepted: 26 November 2025  \nPublished: 27 November 2025  \nCitation: Sultan, S.R.; Albin Hajji, F.; Alhazmi, A.; Alamri, S.; Alsulami, A.; Albukhari, A.; Filimban, A.; Almutairi, B.; Albngali, A.; Kaifi, R.; et al. Quantitative Ultrasound Grayscale Analysis and Size of Benign and Malignant Solid Thyroid Nodules. Tomography 2025, 11, 133 . [https://doi.org/10.3390/](https://doi.org/10.3390/)[ ](https://doi.org/10.3390/)tomography11120133  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://creativecommons.org/](https://creativecommons.org/)[ ](https://creativecommons.org/)[licenses/by/4.0/](licenses/by/4.0/)) .  \n1 Department of Radiologic Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia  \n2 Department of Radiology, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia  \n3 College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia  \n4 King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia  \n5 Medical Imaging Department, Ministry of the National Guard—Health Affairs, Jeddah 21577, Saudi Arabia  \n6 Department of Radiology, King Fahad General Hospital, Ministry of Health, Al-Madinah 42351, Saudi Arabia  \n7 Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh 11673, Saudi Arabia  \n8 Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia  \n* Correspondence: [srsultan@kau.edu.sa](srsultan@kau.edu.sa)  \nSimple Summary  \nThyroid nodules are very common, and ultrasound is used to check whether they are likely to be cancerous or non-cancerous. Many ultrasound features are assessed visually, which can lead to differences between clinicians. In this study, we used computer-based measurements of how bright the nodules looked and how large they were, providing more objective information. Cancerous nodules tended to appear darker and larger, and these measurements were very consistent between observers. Our findings suggest that adding quantitative tools to routine thyroid ultrasound may improve diagnostic confidence of thyroid nodules.  \nAbstract  \nBackground: 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 grayscale 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 ","cbCaiiJYSoeepZjj","https://ap.wps.com/l/cbCaiiJYSoeepZjj","pdf",1331220,14,"English","# Introduction\n# Materials and Methods\n## Quantitative grayscale measurements\n## Nodule size assessment\n# Results\n# Conclusions","[{\"question\":\"What was the study’s main goal?\",\"answer\":\"To evaluate diagnostic performance and interobserver agreement of quantitative ultrasound grayscale analysis and nodule area for distinguishing benign from malignant solid thyroid nodules.\"},{\"question\":\"How were quantitative grayscale features measured?\",\"answer\":\"Grayscale median (GSM) values were measured from B-mode images, and the GSM ratio (GSMr) was computed by dividing nodule GSM by adjacent normal tissue GSM.\"},{\"question\":\"What quantitative findings distinguished malignant from benign nodules?\",\"answer\":\"Malignant nodules had significantly lower GSMr than benign nodules and were also significantly larger based on cross-sectional area measurements.\"}]","Quantitative Ultrasound Grayscale Analysis and Size of Benign and Malignant Solid Thyroid Nodules - Study report | PDF",1790180134,35]