title: Ultrasound elastography using carotid artery pulsation in the differential diagnosis of sonographically indeterminate thyroid nodules.
abstract: OBJECTIVE. The purpose of this study was to evaluate the diagnostic performance of gray-scale ultrasound and a new method of thyroid ultrasound elastography using carotid artery pulsation in the differential diagnosis of sonographically indeterminate thyroid nodules. MATERIALS AND METHODS. A total of 102 thyroid nodules with indeterminate gray-scale ultrasound features from 102 patients (20 males and 82 females; age range, 16-74 years; mean age, 51 years) were included. The gray-scale ultrasound images of each nodule were reviewed and assigned a score from 1 (low) to 5 (high) according to the possibility of malignancy. Ultrasound elastography was performed using carotid pulsation as the compression source. The elasticity contrast index (ECI), which quantifies local strain contrast within a nodule, was automatically calculated. The radiologist reassessed the scores after concurrently reviewing gray-scale ultrasound and elastography. ROC curve analysis was used to evaluate the diagnostic performances of each dataset and to compare the AUC (Az) values of gray-scale ultrasound score alone, ECI alone, and a combined assessment. RESULTS. Significantly more malignant thyroid nodules were hypoechoic than benign nodules (p = 0.014). The ECI was significantly higher in malignant nodules than in benign thyroid nodules. The Az values of each dataset were 0.755 (95% CI, 0.660-0.835) for gray-scale ultrasound score, 0.835 (0.748-0.901) for ECI, and 0.853 (0.769-0.915) for a combined assessment. The Az value for a combined assessment of the gray-scale ultrasound score and the ECI was significantly higher than that for the gray-scale ultrasound score alone (p = 0.022). CONCLUSION. Combined assessment with gray-scale ultrasound and elastography using carotid artery pulsation is helpful for characterizing sonographically indeterminate thyroid nodules as benign or malignant.
authors.affiliation: 1 Department of Radiology, Hanyang University Hospital, Seoul, Korea.
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Choi
authors.forename: Jeong Seon
authors.initials: JS
authors.lastname: Park
authors.forename: Hye Ryoung
authors.initials: HR
authors.lastname: Koo
authors.forename: Soo-Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Min Sung
authors.initials: MS
authors.lastname: Chung
authors.forename: Kyung
authors.initials: K
authors.lastname: Tae
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002339:Carotid Arteries / Q000503:physiopathology*; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult
keywords: carotid artery pulsation; elastography; thyroid nodule; thyroid ultrasound