Endoscopic ultrasound elastography: the first step towards virtual biopsy? Preliminary results in 49 patients

BACKGROUND AND STUDY AIMS: It is well known that some diseases, such as cancer, lead to changes in the hardness of tissue. Sonoelastography, a technique that allows the elasticity of tissue to be assessed during ultrasound examination, provides the ultrasonographer with important additional information that can be used for diagnosis. The aim of this study was to evaluate the ability of endoscopic ultrasound elastography to differentiate between benign and malignant pancreatic masses and lymph nodes. PATIENTS AND METHODS: During a 12-month period, 49 patients underwent endoscopic ultrasound (EUS) examinations with elastography, conducted by a single endoscopist. Twenty-four patients underwent evaluation of a pancreatic mass (mean diameter 24.7 +/- 11.1 mm) and 25 underwent evaluation of 31 lymph nodes. The mean diameter of the lymph nodes was 19.7 +/- 8.6 mm, and they were found in the cervical area (n = 3), mediastinum (n = 17), celiac arterial trunk region (n = 5), and aortocaval region (n = 6). RESULTS: The sonoelastography images of pancreatic masses were interpreted as benign in four cases and malignant in 20. The sensitivity and specificity of sonoelastography in the diagnosis of malignant lesions were 100% and 67%, respectively. The sonoelastography images of the lymph nodes were interpreted as showing malignancy in 22 cases, benign conditions in seven, and indeterminate status in two. The sensitivity and specificity of sonoelastography for evaluating malignant lymph-node invasion were 100% and 50%, respectively. CONCLUSIONS: EUS elastography is potentially capable of further defining the tissue characteristics of benign and malignant lesions but specifity has to be improved. It can be used to guide biopsy sampling for diagnosis.     

超声弹性面积比值法与Itoh评分法鉴别诊断甲状腺结节的价值

目的探讨超声弹性面积比值法与Itoh评分法在甲状腺结节鉴别诊断中的价值。方法应用超声弹性面积比值法与Itoh评分法对23例患者31个甲状腺结节进行检查,以手术组织病理结果为金标准,比较超声弹性面积比值法与Itoh评分法诊断甲状腺结节良、恶性的准确性、特异性、敏感性。结果手术组织病理证实良性结节22个,恶性结节9个;超声弹性成像Itoh评分法诊断良性结节的符合率为63.6%（14/22）,诊断恶性结节的符合率为55.6%（5/9）;超声弹性成像面积比值法诊断良性结节的符合率为77.3%（17/22）,诊断恶性结节的符合率为77.8%（7/9）,面积比值法诊断甲状腺良性和恶性结节的符合率均高于Itoh评分法（P〈0.05）。结论超声弹性成像面积比值法在判定甲状腺结节性质上优于Itoh评分法。     

Combination of Sonoelastography and TIRADS for the Diagnostic Assessment of Thyroid Nodules

To evaluate the diagnostic performance of elastography alone and combined with Thyroid Imaging Reporting And Data System (TIRADS) for the assessment of non-autonomous thyroid nodules. We included 244 thyroid nodules and analyzed the visual elasticity scores, strain value (SV) and TIRADS classification. Histologic examination revealed 38 malignant (16%) and 206 benign nodules. The SV was lower in malignant nodules than in benign with an optimal cutoff ≤0.225. The visual elasticity scores showed a better diagnostic performance than the SV measurement. The risk for malignancy increased with higher TIRADS category. The sensitivity, specificity, positive predictive value and negative predictive value of TIRADS were superior to sonoelastography. The combination of TIRADS ≥4C and SV ≤0.225 showed the highest odds ratio to predict malignancy. Kwak-TIRADS classification is superior to elastography for the differentiation of benign and malignant thyroid nodules. Our data demonstrate that a high TIRADS class alone is predictive for thyroid carcinoma and the clinical relevance of sonoelastography is negligible.     

Characterization of solid breast masses: use of the sonographic breast imaging reporting and data system lexicon.

OBJECTIVE: The purpose of this study was to determine the reliability of sonographic American College of Radiology Breast Imaging Reporting And Data System (BI-RADS) classification in differentiating benign from malignant breast masses. METHODS: One hundred seventy-eight breast masses studied by sonography with a known diagnosis were reviewed. All lesions were classified according to the sonographic BI-RADS lexicon. Pathologic results were compared with sonographic features. Sensitivity, specificity, accuracy, and positive predictive value (PPV) and negative predictive value (NPV) for the sonographic BI-RADS lexicon were calculated. RESULTS: Twenty-six cases were assigned to class 3, 73 to class 4, and 79 to class 5. Pathologic results revealed 105 malignant and 73 benign lesions. The sonographic BI-RADS lexicon showed 71.3% accuracy, 98.1% sensitivity, 32.9% specificity, 67.8% PPV, and 92.3% NPV. The NPV for class 3 was 92.3%. The PPVs for classes 4 and 5 were 46.6% and 87.3%. Typical signs of malignancy were irregular shape, antiparallel orientation, noncircumscribed margin, echogenic halo, and decreased sound transmission. Typical signs of benignity were oval shape and circumscribed margin. CONCLUSIONS: The sonographic BI-RADS lexicon is an important system for describing and classifying breast lesions.     

彩色多普勒超声对甲状腺乳头状癌颈部淋巴结囊性转移的诊断价值

目的探讨甲状腺乳头状癌颈部淋巴结囊性转移的超声表现。方法对经病理证实为甲状腺乳头状癌颈部淋巴结囊性转移的18例患者,44枚囊性转移性淋巴结进行高频彩色多普勒超声检查,观察其二维声像图,结节、分隔内部的血流情况。结果囊性转移性淋巴结二维声像图表现为完全囊性变和部分囊性变两种类型,42枚为部分囊性变,2枚为完全囊性变。其中38枚囊性变区透声差,39枚囊壁较厚且毛糙,23枚有壁结节,18枚内部有粗细不均分隔,19枚内部见点状高回声,40枚囊性转移性淋巴结实性成分内见点状、条状血流信号。结论彩色多普勒超声是诊断甲状腺乳头状癌颈部淋巴结囊性转移的一项重要检查方法,颈部淋巴结囊性变对于甲状腺乳头状癌转移的诊断有较高的特异性。     

Sonographic diagnosis of thyroid nodules: correlation with the results of sonographically guided fine-needle aspiration biopsy

PURPOSE: To assess the reliability of sonography in differentiating benign from malignant thyroid nodules and selecting lesions for fine-needle aspiration (FNA). METHODS: During a 2-year period, the following 7 sonographic parameters were assessed in 129 patients with thyroid nodules: size, number, echogenicity, echotexure, margin regularity, presence of calcifications, and presence of a hypoechoic rim. Sonographically guided FNA was performed on thyroid nodules 5 mm in diameter. Out of 184 FNAs, we obtained 168 specimens adequate for cytologic analysis and 16 (9%) nondiagnostic specimens. RESULTS: FNA diagnoses included 150 (89%) benign and 18 (11%) malignant nodules. Among 53 solitary nodules, 11 were carcinomas and 42 were benign (p < 0.01). The mean size of the carcinomas was 28 +/- 12 mm versus 18 +/- 10 mm for benign nodules (p < 0.01). The following sonographic features were significantly associated with malignancy: hypoechogenicity, irregular margins, calcifications, and absence of a hypoechoic rim. Differences in echotexure between malignant and benign nodules were not statistically significant. CONCLUSION: Sonographically guided FNA should be performed on thyroid nodules 5 mm in diameter with sonographic characteristics that suggest malignancy.     

Sonoelastographic Evaluation of Recurrent Thyroid Nodules in Patients with Operated Recurrent Nodular Goiters

Alterations in neck anatomy after thyroid surgery and post-operative fibrosis may be misleading by causing sonoelastographic changes in recurrent tissues in patients with recurrent nodular goiter and so may result in unnecessary biopsies or surgical procedures. Here, the aim was to examine thyroid sonoelastography values in patients developing a recurrence and presenting with recurrent nodular goiter with benign cytology after total or near-total thyroidectomy (T/N-TT). Twenty-nine nodules from 22 patients with a recurrence after T/N-TT whose biopsies were found to be benign constituted the patients, and 23 nodules from 23 participants among the non-operated patients having solitary or multiple thyroid nodules and with age, gender and body mass index values similar to those of the patients constituted our controls. Shear-wave velocity (SWV) values were measured. Average elapsed time after T/N-TT was 11.82 (4:25) y. No difference was detected between the groups in terms of localization and sonographic structures of the nodules. Nodule SWV values were higher in the operated recurrent nodular goiter group than in the controls (2.93 ± 0.87 m/s vs. 2.43 ± 0.33 m/s, respectively, p = 0.011). Because SWV values are high in operated recurrent nodular goiter patients, the utilization of reference sonoelastography values in those with unoperated goiter may yield misleading results in the differentiation of benign and malignant lesions.     

Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer.

OBJECTIVE: The aim of this study was to determine whether ultrasonography itself was able to distinguish benign from malignant lymphadenopathy in patients with thyroid cancer. METHODS: We evaluated lymph nodes in a group of patients with thyroid cancer. Nodes were detected and measured by ultrasonography, and their shape, echogenicity, size, and location were noted. Ultrasonographically guided fine-needle aspiration biopsy (FNAB) was performed, and smears were analyzed cytologically. RESULTS: Ultrasonographically guided FNAB was performed in 578 neck nodes in a group of 631 patients with thyroid cancer. In most cases, metastases had a round shape and various echo structures, with a predomination of hypoechoic nodes without a hilum. There were statistical differences in size between metastatic and benign nodes in terms of maximum diameter, minimum diameter, and volume. Among these, minimum diameter and the shape of the nodes seemed to be the most reliable in suggesting malignancy. A round shape with a longitudinal/transverse ratio of less than 2 of hypoechoic nodes indicated the presence of metastases, and we then performed FNAB. The absence of an echogenic hilum and the presence of cystic portions and calcifications were significantly greater in malignancies than in benign lesions (P<.001). In most cases, metastatic nodules were situated in the lower third of the neck. Reactively enlarged nodes occurred more frequently in the upper part of the neck. CONCLUSIONS: Ultrasonography itself cannot distinguish benign from malignant lesions, but an echographic appearance suggests malignancy and helps in the selection of the node to aspirate with ultrasonographically guided FNAB, which is crucial for a final diagnosis.     

原发性甲状腺淋巴瘤的超声表现及病理特征

目的探讨原发甲状腺淋巴瘤(PTL)的超声表现及病理特征。方法回顾性分析28例经穿刺或手术病理证实的PTL患者的声像图表现,对病变的超声分型、形态特点、边界、回声及周围组织侵犯情况进行分析,并分析上述超声表现与其病理特征的关系。结果 28例PTL病例均为非霍奇金淋巴瘤,其中弥漫大B细胞淋巴瘤19例,结外边缘带B细胞淋巴瘤/低度恶性黏膜相关组织淋巴瘤6例,结外边缘带B细胞淋巴瘤伴大细胞转化3例。7例合并桥本甲状腺炎。超声示甲状腺弥漫性肿大,累及单侧或双侧,多呈不均匀极低回声,可有条索状强回声,后方回声增强,可伴数目不等的低回声结节,边界欠清,易侵犯颈部淋巴结,还可累及周围软组织、压迫气管。结论充分认识不同病理类型的PTL超声表现特点、结合病史及临床资料,有助于提高PTL的超声诊断准确率。     

超声鉴别甲状腺峡部结节良恶性的研究

目的研究通过甲状腺峡部结节的超声特征鉴别其良恶性。 方法回顾分析2016年1月至12月于上海交通大学医学院附属瑞金医院行甲状腺全切术及颈部中央组淋巴结清扫术,且有病灶位于峡部的196个甲状腺结节的超声特征,根据手术石蜡病理将结节分为良恶性2组,对2组结节的超声特征进行分析比较。回顾分析同期于本院行甲状腺全切术及颈部中央组淋巴结清扫术,且位于甲状腺侧叶的239个甲状腺恶性结节的超声特征,比较分析峡部与侧叶甲状腺恶性结节各超声特征的差异。验证2种甲状腺影像报告和数据系统（TI-RADS）对甲状腺峡部结节的诊断效能。用独立样本t检验比较良恶性结节患者年龄及结节大小有无显著差异;用χ²检验比较良恶性结节各超声特征及患者性别有无显著差异;用χ²检验,必要时用Fisher确切概率法比较峡部与侧叶恶性结节各超声特征有无显著差异。 结果低回声、实性结构、边缘不光整、微钙化、周围型血供、低血供等超声特征为甲状腺峡部结节恶性风险的独立危险因素（P均<0.05）。峡部恶性甲状腺结节比侧叶恶性甲状腺结节更易表现为纵横比≤1、甲状腺外侵犯、与包膜接触面积>25%、周围型血供、低血供（P均<0.05）,且更易发生颈部中央组淋巴转移（P=0.041）。本组4A、4B类甲状腺峡部结节的实际恶性率皆明显高于2种TI-RADS的推荐恶性率。 结论纵横比>1并非鉴别甲状腺峡部结节良恶性的良好超声指标,周围型血供、低血供等非灰阶超声特征可协助峡部结节的良恶性鉴别;与侧叶结节不同,当甲状腺峡部结节为低回声时,就应提高警惕;当对峡部结节进行风险分层时,应适当升级。     

剪切波弹性成像与实时组织弹性成像技术在甲状腺结节良恶性鉴别诊断中的应用价值

目的比较剪切波弹性成像（SWE）技术与实时组织弹性成像技术在甲状腺结节良恶性鉴别诊断中的应用价值。方法选择2012年2月至2012年12月于中山大学附属第一医院接受甲状腺手术的49例患者共59个甲状腺结节,于术前同一时间分别接受SWE和实时组织弹性成像检查。所有患者均经手术病理证实。59个甲状腺结节中,41个结节为良性,18个结节为恶性。对于SWE技术,绘制受试者操作特性（ROC）曲线得出鉴别诊断甲状腺结节良恶性的最佳阈值并进行诊断;对于实时组织弹性成像技术,采取Rago 5分法对甲状腺结节良恶性进行鉴别诊断。以手术病理结果作为金标准,分别计算SWE技术和实时组织弹性成像技术鉴别诊断甲状腺良恶性结节的敏感度、特异度、准确性、阳性预测值、阴性预测值。结果 ROC曲线显示,SWE技术鉴别诊断甲状腺结节良恶性的最佳阈值为38.3 k Pa。SWE和实时组织弹性成像技术鉴别诊断甲状腺结节良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为72.2%（13/18）、85.4%（35/41）、81.4%（48/59）、68.4%（13/19）、87.5%（35/40）和77.8%（14/18）、87.8%（36/41）、84.8%（50/59）、73.7%（14/19）和90.0%（36/40）。实时组织弹性成像技术鉴别诊断直径≤1 cm的甲状腺小结节良恶性的敏感度为87.5%（7/8）,高于SWE技术鉴别诊断直径≤1 cm的甲状腺小结节良恶性的敏感度50.0%（5/5）。SWE技术鉴别诊断直径〉3 cm的甲状腺大结节良恶性的准确性为100%（5/5）,高于实时组织弹性成像技术鉴别诊断直径〉3 cm的甲状腺大结节良恶性的准确性80.0%（4/5）。结论无论是SWE技术还是实时组织弹性成像技术对甲状腺结节良恶性的鉴别诊断都有很好的应用价值。但SWE技术对于直径〉3 cm的甲状腺大结节良恶性的鉴别诊断有一定的优势,而实时组织弹性成像技术对直径≤1 cm的甲状腺小结     

Nodule or pseudonodule? Differentiation in Hashimoto's thyroiditis with sonoelastography

Fine needle aspiration biopsy (FNAB) is the gold standard for the diagnosis of lymphoma in Hashimoto's thyroiditis and is able to differentiate between benign, inflammatory or malignant nodules, classifying them as either true nodules or pseudonodules. This technique is, however, invasive. The present study aimed to differentiate pseudonodules from true nodules by sonoelastography, a non-invasive technique, in 54 patients with Hashimoto's thyroiditis. The accuracy of sonoelastography to differentiate between true or pseudonodules was compared with the gold standard FNAB and with grey scale ultrasonography. The nodules were categorized into three groups: non-demarcated hypoechogenic, demarcated hyperecho genic, and demarcated hypoechogenic. Sono elastography findings were concordant with the cytopathological results and demonstrated that sono elastography was able to detect true thyroid nodules often misdiagnosed by conventional grey scale ultrasonography. Sonoelastography was found to have increased sensitivity for true nodule diagnosis compared with conventional grey scale ultrasonography and may eliminate unnecessary FNABs being carried out.     

术前超声检查评估甲状腺微小乳头状癌颈部淋巴结转移的临床价值

目的探讨术前超声检查评估甲状腺微小乳头状癌颈部淋巴结转移的临床价值。方法回顾性分析2009年1月至2012年7月在上海交通大学医学院附属瑞金医院行超声检查并进行甲状腺手术的315例甲状腺微小乳头状癌患者。以术后石蜡切片病理检查结果作为金标准,计算术前超声评估颈部淋巴结有无转移、中央组淋巴结有无转移、颈侧组淋巴结有无转移的敏感度、特异度、阳性预测值及阴性预测值。结果共308例患者行淋巴结清扫,7例患者未行淋巴结清扫。术前超声检查评估颈部淋巴结有无转移的敏感度为38.8%（50/129）,特异度为96.1%（172/179）,阳性预测值为87.7%（50/57）,阴性预测值为68.5%（172/251）;术前超声检查评估中央组淋巴结有无转移的敏感度为31.4%（38/121）,特异度为96.7%（181/187）,阳性预测值为86.4%（38/44）,阴性预测值为68.5%（181/264）;术前超声检查评估颈侧组淋巴结有无转移的敏感度为80.9%（34/42）,特异度为98.4%（262/266）,阳性预测值为89.5%（34/38）,阴性预测值为97.0%（262/270）。以术前超声检查评估中央组淋巴结有无转移作为一项评估手段预测颈侧组有无转移,其敏感度为59.5%（25/42）,特异度为92.8%（247/266）。6.4%（17/264）的术前超声检查判断中央组淋巴结无转移患者中术后颈侧组淋巴结有转移。4.3%（8/187）的术中冰冻切片病理检查结果显示中央组淋巴结无转移患者中术后颈侧组淋巴结有转移。结论术前超声检查评估中央组淋巴结有无转移的敏感度较低,因此常规的中央组淋巴结清扫是必要的;术前超声检查评估颈侧组淋巴结有无转移的敏感度及特异度均较高,术前超声怀疑颈侧组淋巴结有转移的患者行颈侧区淋巴结的清扫是必要的。     

超声引导下粗针穿刺活检对甲状腺结节诊断价值的临床研究

目的回顾性分析大样本甲状腺结节超声引导下粗针穿刺活检（CNB）的结果,并评价其诊断价值。 方法2009年4月到2011年4月在解放军总医院超声诊断科行CNB的355个患者的369个结节纳入本研究。恶性结节以手术切除后组织病理学结果为诊断金标准。良性结节以手术切除后组织病理学结果或者粗针穿刺活检良性且随访至少3年无明显变化为标准。采用甲状腺针吸细胞学检查Bethesda分级标准,得出CNB诊断不明确的比率。计算CNB诊断的敏感度、特异度、阳性预测值、阴性预测值和准确性,计算受试者工作特性（ROC）曲线下面积。分析CNB诊断效果与结节声像图特征的相关性。 结果CNB结果中22（6.0%）个结节诊断不明确。CNB诊断的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为97.7%,98.5%,99.1%,96.3%和98.0%。ROC曲线下面积为0.981±0.009（95%可信区间：0.964~0.998）。 结论超声引导下CNB对甲状腺结节诊断的准确性高,安全性好,可减少重复穿刺、诊断性手术和不必要的随访。CNB的诊断效果不受结节声像图表现的影响。因此,具有可疑恶性征象的甲状腺结节,超声引导下CNB可作为穿刺活检的方法。     

The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules

Purpose

This study aimed at evaluating the diagnostic performance of quantitative shear wave elastography (SWE) in differentiating metastatic cervical lymph nodes from benign nodes in patients with thyroid nodules.

Methods

One hundred and forty-one cervical lymph nodes from 39 patients with thyroid nodules that were diagnosed as papillary thyroid cancer had been imaged with SWE. The shear elasticity modulus, which indicates the stiffness of the lymph nodes, was measured in terms of maximum shear elasticity modulus (maxSM), minimum shear elasticity modulus (minSM), mean shear elasticity modulus (meanSM), and standard deviation (SD) of the shear elasticity modulus.

Results

All the patients underwent thyroid surgery, 50 of the suspicious lymph nodes were resected, and 91 lymph nodes were followed up for 6 months. The maxSM value, minSM value, meanSM value, and SD value of the metastatic lymph nodes were significantly higher than those of the benign nodes. The area under the curve of the maxSM value, minSM value, meanSM value, and SD value were 0.918, 0.606, 0.865, and 0.915, respectively.

Conclusions

SWE can differentiate metastasis from benign cervical lymph nodes in patients with thyroid nodules, and the maxSM, meanSM, and SD may be valuable quantitative indicators for characterizing cervical lymph nodes.

     

甲状腺实性结节超声诊断的Logistic回归分析

目的 应用二分类Logistic回归模型分析甲状腺实性结节超声检查各指标对良恶性结节鉴别诊断的意义.方法 总结经手术病理证实的118个甲状腺结节术前的二维灰阶、彩色多普勒及弹性成像的各项超声诊断指标,采用多因素回归分析方法,建立Logistic回归模型.结果 共有3个变量进入回归方程,分别为弹性评分、弹性应变率和结节形态,该Logistic模型对甲状腺结节良恶性预报的正确率为86.4%(102/118),ROC曲线下面积为0.931.结论 二分类Logistic回归模型分析能筛选出对甲状腺实性结节有鉴别诊断意义的特征变量及弹性成像方法所反应出来的硬度信息,在良恶性结节的鉴别诊断中具有较高的临床应用价值.     

Differentiation of Thyroid Nodules With Macrocalcifications

Objective. The purpose of this study was to determine which types of macrocalcifications are associated with thyroid carcinoma and to assess the role of other suspicious sonographic findings in thyroid nodules with macrocalcifications. Methods. Our Institutional Review Board approved this retrospective study, and informed consent was not required. We reviewed sonographic findings of thyroid nodules in 722 patients that underwent thyroid surgery in our institution between March 2006 and August 2006. Sonographic results were grouped into 3 types of macrocalcifications. Each lesion was evaluated on the basis of other suspicious sonographic criteria, including marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape. Sensitivity and specificity based on sonographic criteria were calculated and compared among the subtypes of macrocalcifications. Results. One hundred seventy‐four nodules showed macrocalcifications; 116 were malignant, and 58 were benign. Among the macrocalcification categories, solitary calcifications were more common in benign thyroid lesions, whereas coarse calcifications not otherwise specified were more common in malignant lesions (P < .05). Although the risk of malignancy was 17.2% in cases with no suspicious sonographic findings, the risk of malignancy was up to 82.8% in cases with at least 1 of the sonographic criteria (P < .05). On the basis of the suspicious sonographic criteria, the overall sensitivity was 82.8%. There was no statistically significant difference in sensitivity among the macrocalcification subtypes (P > .05). Conclusions. Suspicious sonographic features such as marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape can play important roles in differentiating benign and malignant thyroid nodules with macrocalcifications.     

多模态超声检查对甲状腺弥漫性病变合并结节的诊断分析

目的:探讨分析多模态超声检查对甲状腺弥漫性病变合并结节的诊断价值。方法:选取2017年5月-2019年5月我院收治的甲状腺弥漫性病变合并结节患者400例,所有患者均在我院接受超声检查。并且全部患者均通过穿刺活检或者手术病理检查确诊。观察比较与病理诊断结果相比超声检查的准确性;良性结节与恶性结节在不同超声特征方面的差异。结果:所有400例患者的病理诊断结果提示,共检查出甲状腺结节:418个,其中,良性结节:148个,恶性结节:270个;超声检查共检查出甲状腺结节408个,其中,良性结节:144个,恶性结节:264个,与病理诊断相比,超声检查在甲状腺结节方面的检出率并无显著差异(P>0.05)。恶性结节与良性结节在不同超声特征:形态、纵横比、边界、边缘、声晕、内部回声、钙化灶、后方回声、相对运动、血流分布、阻力指数、硬度等方面均存在显著差异(P<0.05)。结论:甲状腺弥漫性病变合并结节使用多模态超声检查诊断的准确率较高,且通过多模态超声检查也能够有效地区分良性结节与恶性结节,值得应用。     

Ultrasound examination using contrast agent and elastosonography in the evaluation of single thyroid nodules: Preliminary results

Aim

To evaluate the usefulness of ultrasound (US) using contrast agent and elastosonography in the characterization of thyroid nodules.

Materials and methods

From November 2006 to July 2007, 23 patients with single thyroid nodules underwent B-mode US and power Doppler, US examination using contrast agent, elastosonography and fine needle aspiration cytology (FNAC). Sixteen patients underwent thyroidectomy.

Results

The 23 nodules included 14 benign and 9 malignant lesions. Analysis of time/intensity curves showed that wash-in (8.8 ± 1.3 vs 12.1 ± 2.6 s; p = 0.002, t-test) and peak enhancement (15.3 ± 4.6 vs 22.2 ± 3.9 s; p = 0.001, t-test) occurred significantly earlier in the malignant nodules than in the benign nodules. Wash-out was monophasic in 70% of benign nodules, but in none of the malignant nodules; polyphasic in 30% of benign nodules and in 100% of malignant nodules. Polyphasic wash-out showed a statistically significant association with malignancy (p = 0.0007, χ²). Polyphasic wash-out yielded a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 69%, negative predictive value (NPV) of 100% and diagnostic accuracy of 83%. In 78% of the benign nodules (11/14) elastosonographic patterns was 1–2 (elevated elasticity); in 88% of the malignant nodules (8/9) elastosonographic patterns was 3–4 (reduced elasticity). Elastosonography yielded a sensitivity of 88%, specificity of 78%, PPV of 72%, NPV of 91% and diagnostic accuracy of 82%. Elastosonographic patterns 3–4 is associated with malignancy (p = 0.001, χ²).

Conclusion

US using contrast agent and elastosonography can be a useful diagnostic tool in the evaluation of single thyroid nodules, particularly when FNAC result is non-diagnostic or suggests a follicular lesion, and in nodules <1 cm.