title: Comparative effectiveness of elastographic and B-mode ultrasound criteria for diagnostic discrimination of thyroid nodules: a meta-analysis.
abstract: OBJECTIVE
  The purpose of this article is to present, through systematic review of recent literature, a comparative effectiveness analysis of ultrasound elastography versus B-mode ultrasound features for differentiating thyroid nodules.
  
  
  METHODS
  We conducted an extensive literature search of PubMed and other medical and general purpose databases from January 1966 through March 2012. Eligible studies were published in English, reported diagnostic performance of elastography (using elasticity score or strain ratio) with or without B-mode ultrasound in differentiation of thyroid nodules, and used histology or cytology as the reference standard. Summary diagnostic performance measures were assessed for each of the elasticity measuring methods and ultrasound features by means of a bivariate random effects model.
  
  
  RESULTS
  Twenty-four studies provided relevant information on more than 2624 patients and 3531 thyroid nodules (927 malignant and 2604 benign). Six ultrasound features (echogenicity, calcifications, margins, halo sign, shape, and color Doppler flow pattern) were compared with elasticity score and strain ratio. The respective sensitivities and specificities were as follows: elasticity score, 82% and 82%; strain ratio, 89% and 82%; hypoechogenicity, 78% and 55%; microcalcifications, 50% and 80%; irregular margins, 66% and 81%; absent halo sign, 56% and 57%; nodule vertical development, 46% and 77%; and intranodular vascularization, 40% and 61%.
  
  
  CONCLUSIONS
  Evaluation of thyroid nodules with ultrasound elastography appears to be both more sensitive and specific than each of the ultrasound features. The former is a safe and effective technique that warrants further rigorous investigation or use in the clinical diagnosis of thyroid nodules.
authors.affiliation: Department of Radiology, University of Michigan, 1500 E Medical Center Dr, B1 132H Taubman Center, Ann Arbor, MI 48109-5302, USA.
authors.forename: Seyed Amirhossein
authors.initials: SA
authors.lastname: Razavi
authors.forename: Tyson A
authors.initials: TA
authors.lastname: Hadduck
authors.forename: Gelareh
authors.initials: G
authors.lastname: Sadigh
authors.forename: Ben A
authors.initials: BA
authors.lastname: Dwamena
mesh_terms: D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*