title: Acoustic Radiation Force Impulse Elastography in the Diagnosis of Thyroid Nodules: Useful or Not Useful?
abstract: The goal of this study is to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) elastography for differentiating benign from malignant thyroid nodules. One hundred and seventy-four pathologically proven thyroid nodules (139 benign, 35 malignant) in 154 patients (mean age: 49.2 ± 12.1 y; range: 16-72 y) were included in this study. Conventional ultrasound (US) and ARFI elastography using virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ) were performed to examine the thyroid nodules. Two blinded readers with different amounts of experience independently scored the likelihood of malignancy on the basis of a five-point scale in three different image-reading sets. The diagnostic performances among different image-reading sets and between the two readers were compared. The diagnostic specificity of both readers improved significantly after reading the VTI images or both VTI and VTQ images (all p < 0.05). After review of the results of both VTI and VTQ, the numbers of correctly diagnosed nodules increased in nodules <1.0 cm for both readers and in both nodular goiter and papillary thyroid carcinoma for the junior reader (p < 0.05). The nodules with definite diagnoses (i.e., confidence levels including definite benign and definite malignant cases) increased after review of VTI and VTQ images versus conventional US for the senior reader (p < 0.05). In conclusion, adding ARFI elastography improves the specificity in diagnosing malignant thyroid nodules compared with conventional US on its own. ARFI elastography particularly facilitates the specific diagnosis for thyroid nodules smaller than 1.0 cm. ARFI elastography is also able to increase the diagnostic confidence of the readers.
authors.affiliation: Department of Medical Ultrasound, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Zhang
authors.affiliation: Department of Medical Ultrasound, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Ultrasound, Guangdong Medical College Affiliated Hospital, Zhanjiang, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China. Electronic address: xuhuixiong@hotmail.com.
authors.forename: Hui-Xiong
authors.initials: HX
authors.lastname: Xu
authors.affiliation: Department of Medical Ultrasound, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jun-Mei
authors.initials: JM
authors.lastname: Xu
authors.affiliation: Department of Medical Ultrasound, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Medical Ultrasound, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
authors.forename: Le-Hang
authors.initials: LH
authors.lastname: Guo
authors.affiliation: Department of Medical Ultrasound, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
authors.forename: Lin-Na
authors.initials: LN
authors.lastname: Liu
authors.affiliation: Department of Medical Ultrasound, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China; Thyroid Institute, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Ultrasound, Guangdong Medical College Affiliated Hospital, Zhanjiang, China.
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Xu
authors.affiliation: Thyroid Institute, Tongji University School of Medicine, Shanghai, China; Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Shen
authors.initials: S
authors.lastname: Qu
authors.affiliation: Thyroid Institute, Tongji University School of Medicine, Shanghai, China; Department of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mingzhao
authors.initials: M
authors.lastname: Xing
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Acoustic radiation force impulse; Elastography; Thyroid nodule; Ultrasound