title: Comparison of color-Doppler and qualitative and quantitative strain-elastography for differentiation of thyroid nodules in daily practice.
abstract: OBJECTIVE
  Strain-elastography provides a new ultrasound-based method that can offer information about the stiffness of thyroid nodules as an indicator of malignancy. The aim of our study was to compare the utility of color-Doppler and strain-elastography in differentiating between benign and malignant nodules.
  
  
  METHODS
  77 thyroid nodules (70 benign and 7 malignant) from 70 unselected patients (48 female/22 male, mean age 49.7±14.3 years) were evaluated with color-Doppler and elastography based on a five-scale elastogram score for qualitative elastography and strain ratio for quantitative elastography. As reference tissue we chose normal thyroid tissue [strain ratio a (SR a)] and cervical muscles [strain ratio b (SR b)]. The cytological or histological results were used as a reference standard. Diagnostic performances of qualitative and quantitative elastography were compared using ROC curves.
  
  
  RESULTS
  Vascularization score 3 or 4 was associated with malignancy (p=0.024) as well as elastogram score 4 or 5 (p=0.070, n.s.s.). SR a was indicatively higher and SR b lower in the group of malignant nodules (p=0.065 and p=0.246, n.s.s.). The best cut-off points predicting malignancy were 3.32 for SR a (66.7% sensitivity, 83.3% specificity) and 0.10 for SR b (71.4% sensitivity, 67.1% specificity).
  
  
  CONCLUSIONS
  In our study, the accuracy of elastography did not surpass other sonographic parameters in differentiating thyroid nodules. The technique can play a role as a supplementary parameter in assessment of malignancy to improve diagnostic efficacy. The best parameter is SR a, but SR b can serve as an alternative if SR a is not assessable.
authors.affiliation: Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munchen, Germany. goetzbergerm@klinikum-freising.de.
authors.forename: Manuela
authors.initials: M
authors.lastname: Götzberger
authors.affiliation: Klinikum Bogenhausen, Klinikum der Universität München, Munchen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Krueger
authors.affiliation: Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munchen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Gärtner
authors.affiliation: Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munchen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.affiliation: Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munchen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pichler
authors.affiliation: Pathologisches Institut, Klinikum der Universität München, Munchen, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Assmann
authors.affiliation: Klinik für Viszeral- und Endokrine Chirurgie - Campus Innenstadt, Klinikum der Universität München, Munchen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mussack
authors.affiliation: Maria-Theresia-Klinik, Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zimmermann
authors.affiliation: Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munchen, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Gülberg
mesh_terms: D000328:Adult; D019540:Area Under Curve; D054459:Elasticity Imaging Techniques / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012015:Reference Standards; D015203:Reproducibility of Results; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D016606:Thyroid Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D018615:Ultrasonography, Doppler, Color / Q000592:standards