title: Acoustic radiation force impulse imaging (ARFI) for differentiation of benign and malignant thyroid nodules--A meta-analysis.
abstract: OBJECTIVE
  Work-up of thyroid nodules remains challenging. Acoustic radiation force impulse imaging (ARFI)-generated shear wave elastography, which can measure quantitatively tissue stiffness (virtual touch tissue quantification) is used as a complement to conventional sonography for improving the diagnosis of thyroid nodules. This meta-analysis was performed to expand on a previous meta-analysis to assess the diagnostic power of ARFI in differentiating benign and malignant thyroid nodules.
  
  
  METHODS
  The MEDLINE, PubMed, SpringerLink databases up to December 31, 2014, were searched. The pooled sensitivity, specificity, and summary receiver operating characteristic curve were obtained from individual studies with a random effects model.
  
  
  RESULTS
  Sixteen studies that included a total of 2436 nodules in 2147 patients for ARFI studies were analyzed. The overall mean sensitivity and specificity of ARFI for differentiation of thyroid nodules were 0.80 (95% confidence interval [CI], 0.73-0.87) and 0.85 (95% CI, 0.80-0.90), respectively. A significant heterogeneity was found for both sensitivity and specificity of the different studies (P<0.001). The area under the curve for the ARFI was 0.91.
  
  
  CONCLUSIONS
  ARFI has high sensitivity and specificity for identification of thyroid. This technique might be useful to select patients with thyroid nodules for surgery.
authors.affiliation: Department of Ultrasound Huadong Hospital, Fudan University, Shanghai, PR China. Electronic address: zhanjia@fudan.sh.
authors.forename: Jia
authors.initials: J
authors.lastname: Zhan
authors.affiliation: Department of Ultrasound Huadong Hospital, Fudan University, Shanghai, PR China. Electronic address: jimjin870531@163.com.
authors.forename: Jia-Mei
authors.initials: JM
authors.lastname: Jin
authors.affiliation: Department of Ultrasound Huadong Hospital, Fudan University, Shanghai, PR China. Electronic address: xuehong_d@126.com.
authors.forename: Xue-Hong
authors.initials: XH
authors.lastname: Diao
authors.affiliation: Department of Ultrasound Huadong Hospital, Fudan University, Shanghai, PR China. Electronic address: ultrasound_drchen@163.com.
authors.forename: Yue
authors.initials: Y
authors.lastname: Chen
mesh_terms: D016208:Databases, Factual; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods; D006801:Humans; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000473:pathology*
keywords: Acoustic radiation force impulse imaging (ARFI); Fine-needle aspiration biopsy (FNAB); Real-time elastography (RTE); Virtual touch tissue quantification (VTQ)