Abstract
BackgroundAcoustic Radiation Force Impulse (ARFI)-Imaging is an ultrasound-based elastography method enabling quantitative measurement of tissue stiffness. The aim of the present study was to evaluate sensitivity and specificity of ARFI-imaging for differentiation of thyroid nodules and to compare it to the well evaluated qualitative real-time elastography (RTE).MethodsARFI-imaging involves the mechanical excitation of tissue using acoustic pulses to generate localized displacements resulting in shear-wave propagation which is tracked using correlation-based methods and recorded in m/s. Inclusion criteria were: nodules ≥5 mm, and cytological/histological assessment. All patients received conventional ultrasound, real-time elastography (RTE) and ARFI-imaging.ResultsOne-hundred-fifty-eight nodules in 138 patients were available for analysis. One-hundred-thirty-seven nodules were benign on cytology/histology, and twenty-one nodules were malignant. The median velocity of ARFI-imaging in the healthy thyroid tissue, as well as in benign and malignant thyroid nodules was 1.76 m/s, 1.90 m/s, and 2.69 m/s, respectively. While no significant difference in median velocity was found between healthy thyroid tissue and benign thyroid nodules, a significant difference was found between malignant thyroid nodules on the one hand and healthy thyroid tissue (p = 0.0019) or benign thyroid nodules (p = 0.0039) on the other hand. No significant difference of diagnostic accuracy for the diagnosis of malignant thyroid nodules was found between RTE and ARFI-imaging (0.74 vs. 0.69, p = 0.54). The combination of RTE with ARFI did not improve diagnostic accuracy.ConclusionsARFI can be used as an additional tool in the diagnostic work up of thyroid nodules with high negative predictive value and comparable results to RTE.
Highlights
Thyroid nodules are a common finding in regions with inadequate iodine supply and are reported in 33% of unselected adults between the age of 18–65 years [1]
Ultrasound is an accurate method for the detection of thyroid nodules, but it has a low accuracy for the differentiation between benign and malignant thyroid nodules [2]
Inclusion criteria were the presence of a thyroid nodule $5 mm, normal values of thyroidstimulating hormone, and FNAB of this nodule performed within the last 6-months or FNAB and/or surgery planned at the time of ultrasound examination and performed within the study period
Summary
Thyroid nodules are a common finding in regions with inadequate iodine supply and are reported in 33% of unselected adults between the age of 18–65 years [1]. Ultrasound is an accurate method for the detection of thyroid nodules, but it has a low accuracy for the differentiation between benign and malignant thyroid nodules [2]. In patients with normal thyroid stimulating hormone fine-needle-aspiration-biopsy (FNAB) is presently recommended as supplementary diagnostic methods in the evaluation of thyroid nodules with a size of $10 mm. FNAB is known to have a high specificity (60–98%) but varying sensitivity (54–90%) for the diagnosis of malignant thyroid nodules [7,8,9,10]. A relevant number of patients with the final diagnosis of benign thyroid nodules receive thyroid surgery more for diagnostic than for therapeutic purposes. The aim of the present study was to evaluate sensitivity and specificity of ARFIimaging for differentiation of thyroid nodules and to compare it to the well evaluated qualitative real-time elastography (RTE)
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