Abstract
ObjectiveVirtual touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) is a new quantitative technique to measure tissue stiffness. The study was aimed to assess the usefulness of VTQ in the diagnosis of thyroid nodules.Methods173 pathologically proven thyroid nodules in 142 patients were included and all were examined by conventional ultrasound (US), conventional elasticity imaging (EI) and VTQ of ARFI. The tissue stiffness for VTQ was expressed as shear wave velocity (SWV) (m/s). Receiver-operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance. Intra- and inter-observer reproducibility of VTQ measurement was assessed.ResultsThe SWVs of benign and malignant thyroid nodules were 2.34±1.17 m/s (range: 0.61–9.00 m/s) and 4.82±2.53 m/s (range: 2.32–9.00 m/s) respectively (P<0.001). The mean SWV ratios between each nodule and the adjacent thyroid tissue were 1.19±0.67 (range: 0.31–6.87) for benign and 2.50±1.54 (range: 0.85–6.69) for malignant nodules (P<0.001). ROC analyses indicated that the area under the curve was 0.861 (95% CI : 0.804, 0.918) (P<0.001) for SWV and 0.831(95% CI : 0.761, 0.900)(P<0.001) for the SWV ratio. The cutoff points for the differential diagnosis were 2.87 m/s for SWV and 1.59 for SWV ratio. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for EI were 65.9%, 66.7%, 66.5%, 40.3%, and 85.1%, respectively, and were 63.6%–75%, 82.2%–88.4%, 80.3%–82.1%, 58.9%–65.1%, and 87.7%–90.5%, respectively, for VTQ. The diagnostic value of VTQ is the highest for nodules >20 mm and lowest for those ≤10 mm. The correlation coefficients were 0.904 for intraobserver measurement and 0.864 for interobserver measurement.ConclusionsVTQ of ARFI provides quantitative and reproducible information about the tissue stiffness, which is useful for the differentiation between benign and malignant thyroid nodules. The diagnostic performance of VTQ is higher than that of conventional EI.
Highlights
The incidence of thyroid nodules is about 33%–68% in general population and 5–15% of these nodules were malignant [1,2]
The US patterns such as hypoechoic nodule, spot microcalcifications, and the absence of halo sign are useful for predicting thyroid malignancy [5,6], whereas conventional US becomes highly predictive of malignancy only when multiple patterns are simultaneously present in a thyroid nodule, and no US features have both a high sensitivity and a high positive predictive value (PPV) for thyroid cancer
Tissue stiffness is another feature that may reflect the nature of the thyroid nodule, with the malignant nodule tends to be hard and the benign nodule be soft [8,9,10]
Summary
The incidence of thyroid nodules is about 33%–68% in general population and 5–15% of these nodules were malignant [1,2]. Fine-needle aspiration (FNA) is the standard method to find out whether a thyroid nodule is malignant or not, and it has been shown to be the most cost-effective way to select patients for surgery with sensitivities of 54%–90% and specificities of 60%–96% for the detection of malignant lesions, whereas there are some suspicious cases in 5%–11% and some non diagnostic aspirates in 17%–22% nodules [4]. The sensitivity of conventional US ranged from 69% to 75% and the PPV ranged from 41.8% to 94.2% [7] Tissue stiffness is another feature that may reflect the nature of the thyroid nodule, with the malignant nodule tends to be hard and the benign nodule be soft [8,9,10]. Elasticity imaging (EI) of US, which provides qualitative or semiquantitative reflection of the tissue stiffness, has emerged into clinical practice in recent years and gained promising results in improving the diagnostic performance of conventional US. Conventional EI is apt to be influenced by several factors such as poor reproducibility and lack of quantitative information, its use is limited in clinic practice
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