title: Intra- and interobserver variability of thyroid volume measurements in healthy adults by 2D versus 3D ultrasound.
abstract: Thyroid volume measurement by ultrasonography (US) is essential in numerous clinical diagnostic and therapeutic fields. While known to be limited, the accuracy and precision of two-dimensional (2D) US thyroid volume measurement have not been thoroughly characterized.
  
  
  OBJECTIVE
  We sought to assess the intra- and interobserver variability, accuracy and precision of thyroid volume determination by conventional 2D US in healthy adults using reference volumes determined by three-dimensional (3D) US. Design,
  
  
  METHODS
  In a prospective blinded trial, thyroid volumes of ten volunteers were determined repeatedly by nine experienced sonographers using conventional 2D US (ellipsoid model). The values obtained were statistically compared to the so-called true volumes determined by 3D US (multiplanar approximation), the so-called gold standard, to estimate systematic errors and relative deviations of individual observers.
  
  
  RESULTS
  The standard error of measurement (SEM) for one observer and successive measurements (intraobserver variability), was 14%, and for different observers and repeated measurements (interobserver variability), 17%. The minimum relative thyroid volume change significantly different at the 95% level was 39% for the same observer and 46% for different observers. Regarding accuracy, the mean value of the differences showed a significant thyroid volume overestimation (17%, p < 0.01) by 2D relative to 3D US.
  
  
  CONCLUSIONS
  2D US is appropriate for routine thyroid volumetry. Nevertheless, the so-called human factor (random error) should be kept in mind and correction is needed for methodical bias (systematic error). Further efforts are required to improve the accuracy and precision of 2D US thyroid volumetry by optimizing the underlying geometrical modeling or by the application of 3D US.
authors.affiliation: Department of Nuclear Medicine, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany. andermann_p@klinik.uni-wuerzburg.de
authors.forename: P
authors.initials: P
authors.lastname: Andermann
authors.forename: S
authors.initials: S
authors.lastname: Schlögl
authors.forename: U
authors.initials: U
authors.lastname: Mäder
authors.forename: M
authors.initials: M
authors.lastname: Luster
authors.forename: M
authors.initials: M
authors.lastname: Lassmann
authors.forename: Chr
authors.initials: C
authors.lastname: Reiners
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012016:Reference Values; D013961:Thyroid Gland / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods*