title: Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study.
abstract: OBJECTIVE
  Many patients with thyroid nodules are presently referred to surgery for not only therapeutic but also diagnostic purposes. The aim of noninvasive diagnostic methods is to optimize the selection of patients for surgery. Strain elastography (SE) enables the ultrasound-based determination of tissue elasticity. The aim of the present study was to evaluate the value of SE for the differentiation of thyroid nodules in a prospective multicenter study.
  
  
  METHODS
  The study was registered at clinicaltrials.gov and was approved by the local ethics committees of all participating centers. All patients received an ultrasound (US) of the thyroid gland including color Doppler US. In addition, all nodules were evaluated by SE (Hitachi Medical Systems) using qualitative image interpretation of color distribution (SE-ES), strain value and strain ratio.
  
  
  RESULTS
  Overall, 602 patients with 657 thyroid nodules (567 benign, 90 malignant) from 7 centers were included in the final analysis. The sensitivity, specificity, NPV, PPV, +LR were 21 %, 73 %, 86 %, 11 %, 0.8, respectively, for color Doppler US; 69 %, 75 %, 94 %, 30 %, 2.9, respectively, for SE-ES; 56 %, 81 %, 92 %, 32 %, 2.9, respectively, for SE-strain value; and 58 %, 78 %, 92 %, 30 %, 2.6, respectively, for SE-strain ratio. The diagnostic accuracy was 71 % for both strain value and strain ratio of nodules.
  
  
  CONCLUSIONS
  SE as an additional ultrasound tool improves the value of ultrasound for the work-up of thyroid nodules. It might reduce diagnostic surgery of thyroid nodules in the future.
authors.affiliation: Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Friedrich-Rust
authors.affiliation: Department of General Surgery, Buergerhospital Frankfurt, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Vorlaender
authors.affiliation: Innere Medizin 2, Caritas Hospital, Bad Mergentheim, Germany.
authors.forename: C F
authors.initials: CF
authors.lastname: Dietrich
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Kratzer
authors.affiliation: Medizinische Klinik 1, Hospital am Steinenberg, Reutlingen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Blank
authors.affiliation: Department of Internal Medicine, Helfenstein Hospital, Geislingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schuler
authors.affiliation: Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Broja
authors.affiliation: Innere Medizin 2, Caritas Hospital, Bad Mergentheim, Germany.
authors.forename: X W
authors.initials: XW
authors.lastname: Cui
authors.affiliation: Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J.W. Goethe-University, Frankfurt, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Bojunga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005858:Germany; D006044:Goiter, Nodular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D013961:Thyroid Gland / Q000000981:diagnostic imaging / Q000473:pathology; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult