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Stoian D, Borlea A, Sporea I, Popa A, Moisa-Luca L, Popescu A. Assessment of Thyroid Stiffness and Viscosity in Autoimmune Thyroiditis Using Novel Ultrasound-Based Techniques. Biomedicines 2023; 11:biomedicines11030938. [PMID: 36979917 PMCID: PMC10046469 DOI: 10.3390/biomedicines11030938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
The estimation of viscosity by measuring the shear-wave dispersion (SWD) using ultrasound 2D shear-wave elastography (SWE) is becoming more and more popular. Recent research suggests that SWD can be used in addition to 2D-SWE (shear-wave speed) to diagnose diffuse liver disease. Viscosity was studied for the assessment of normal thyroid tissue. This study aims to evaluate the use of viscosity measurements in patients with chronic autoimmune thyroiditis using the SuperSonic MACH®30 ultrasound machine (Hologic SuperSonic Imagine, Aix-en-Provence, France) which provides the Vi PLUS mode for viscosity and the 2D SWE PLUS mode for shear-wave speed measurements. Valid measurements were obtained in 308 cases, 153 with chronic autoimmune thyroiditis (CAT) and 155 with no thyroid pathology (95.95% feasibility of the methods). The differences between the healthy group and the CAT group were statistically significant both for Vi PLUS (2.5 ± 0.4 vs. 2.8 ± 0.5, p < 0.0001) and for 2D-SWE PLUS (13.5 ± 3.3 vs. 23.1 ± 8.3, p < 0.0001). The diagnostic performance was poor for Vi PLUS alone (AUC = 0.69; cut-off > 2.5 Pa·s, se = 68.6%; sp = 64.52%) and good for 2D-SWE PLUS alone (AUC = 0.861; cut-off > 18.4 kPa, se = 69.9%; sp = 92.2%). Vi PLUS correlated with 2D-SWE PLUS, with the presence of CAT, the thyroid volume, levothyroxine replacement therapy and age. Statistically significant differences were found between the CAT subgroup receiving thyroid replacement therapy and the subgroup without therapy: 24.74 ± 8.33 vs. 21.93 ± 8.12 kPa for 2D-SWE (p = 0.0380) and 3 ± 0.5 vs. 2.7 ± 0.4 Pa·s for Vi PLUS (p = 0.0193). Elastography-based methods improve the classic ultrasound evaluation: 2D-SWE PLUS performed somewhat better in distinguishing CAT from normal thyroid tissue, while Vi PLUS made a slightly better assessment regarding the functional status.
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Affiliation(s)
- Dana Stoian
- Division of Endocrinology, Department of Internal Medicine II, "Victor Babeș" University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- DrD Ultrasound Center, M. Cristea Nr. 9, 300029 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andreea Borlea
- Division of Endocrinology, Department of Internal Medicine II, "Victor Babeș" University of Medicine and Pharmacy, E. Murgu Square, Nr. 2, 300041 Timisoara, Romania
- DrD Ultrasound Center, M. Cristea Nr. 9, 300029 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioan Sporea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Popa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | | | - Alina Popescu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Koca SB, Seber T. Can thyroid elastography with ultrasound be used to stage children with Hashimoto's thyroiditis? J Pediatr Endocrinol Metab 2023; 36:346-352. [PMID: 36843220 DOI: 10.1515/jpem-2022-0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVES We aimed to evaluate the stiffness of the thyroid parenchyma with Shear wave elastography (SWE) in children with Hashimoto's thyroiditis (HT) and healthy controls. METHODS A total of 130 children with HT and 46 healthy controls were included in this study. The clinical and laboratory characteristics of the groups, thyroiditis stages in thyroid ultrasonography, and SWE scores which was obtained as kilopascal (kPa), were analysed. RESULTS We observed that SWE scores were significantly higher in children with HT compared to healthy controls, and SWE scores increased significantly in HT group, as the thyroiditis stage increased (p<0.001). Median, 1st (Q1) and 3rd (Q3) quartiles of SWE scores were as follows; healthy control: 7.4 kPa (6-10.6), stage 1 HT: 9.6 kPa (7.4-11.2), stage 2 HT: 15.2 kPa (10.8-19.9), stage 3 HT: 17.9 kPa (13.7-25.8), (p<0.001). Children with HT were divided into subgroups according to serum TSH and free T4 levels as euthyroid (103; 79.2% of children), euthyroid but subclinical TSH elevation (7; 5.4% of children), hypothyroidism (11; 8.5% of children) and hyperthyroidism (9; 6.9% of children). The SWE scores were significantly higher in children with hypothyroidism with HT compared to healthy controls 17.9 kPa (13.6-27.5) vs. 7.4 kPa (6-10.6), and in euthyroid children with HT compared to healthy controls 11.5 kPa (9.2-15.6) vs. 7.4 kPa (6-10.6), (p=0.006 and p<0.001, respectively). CONCLUSIONS The SWE scores increase as the thyroiditis stage increases in children with HT. There was no significant difference in SWE scores between stage 2 and stage 3 thyroiditis.
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Affiliation(s)
- Serkan Bilge Koca
- Department of Pediatrics, Division of Pediatric Endocrinology, Health Sciences University, Kayseri City Hospital, Kayseri, Türkiye
| | - Turgut Seber
- Department of Radiology, Division of Pediatric Radiology, Health Sciences University, Kayseri City Hospital, Kayseri, Türkiye
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Elastographic Evaluation of Thyroid Nodules in Children and Adolescents with Hashimoto’s Thyroiditis and Nodular Goiter with Reference to Cytological and/or Histopathological Diagnosis. J Clin Med 2022; 11:jcm11216339. [DOI: 10.3390/jcm11216339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/10/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
There are data indicating the coexistence of papillary thyroid carcinoma and autoimmune thyroiditis (AIT) in children. The aim of the study was elastographic evaluation of thyroid nodules in children and adolescents with AIT and nodular goiter in relation to cytological and/or histopathological diagnosis. We examined 215 children (57 boys and 158 girls) with 261 thyroid nodules (143 non-AIT and 118 AIT). All study participants underwent a conventional ultrasound examination with elastography followed by fine needle aspiration biopsy (FNAB). Abnormal Strain Ratio (SR ≥ 5) was observed in 36 non-AIT nodules and 15 AIT nodules. Papillary thyroid carcinoma was diagnosed in 5 patients (2% of all investigated nodules). SR of malignant thyroid nodules was statistically higher in comparison to SR of benign nodules both in the group of non-AIT (6 ± 4 vs. 3.67 ± 2.62, p = 0.024) and AIT nodules (6.3 ± 0.01 vs. 2.92 ± 1.89, p = 0.047). Comparison of non-AIT and AIT benign nodules revealed that SR was higher in non-AIT nodules (3.67 ± 2.62 vs. 2.92 ± 1.89, p = 0.01). We observed a strong positive correlation (R = 1) between TSH concentration and SR ratio in the group of all malignant thyroid nodules. Autoimmune inflammatory process of the thyroid gland does not limit the use of elastography in the diagnosis of thyroid nodules in children.
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Kamel SM, ElKhashab KM, Bhagat S, Elzayat WA. Shear wave elastography as a quantitative method for thyroid gland elasticity assessment in pediatrics patients with autoimmune-related thyroid disease, diagnostic utility and laboratory correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Autoimmune thyroiditis (AIT) is the most common thyroid pathology in pediatric patients among which Hashimoto’s thyroiditis has the highest prevalence. Along with size, measuring mechano-acoustic tissue elasticity is evolving as an important parameter in the evaluation of diffuse thyroid pathology. This study aims to investigate the role of shear wave elastography (SWE) in the diagnosis of autoimmune thyroid disease (AITD) in the pediatric population and also compare the elasticity between them and healthy individuals.
Results
This case–control analytical study was carried out on 64 pediatric subjects ranging in age from 7 to 17 years. All the cases were diagnosed as AIT by anti-thyroid antibodies, and their thyroid function was evaluated by thyroid hormones. We performed thyroid Ultrasonography and Shear wave elastography. Patients with AIT had significantly higher elasticity values (35.6 kPa, IQR 8.43–103.7 kPa) than the control group (9.35 kPa, IQR 5.73–13.21 kPa). There was no correlation of elasticity values of thyroid gland in patients with AIT with autoantibodies and thyroid function test, respectively. The cutoff value for elasticity was 12.317 kPa with sensitivity and specificity of 96.9% and 100%, respectively.
Conclusions
SWE is a highly sensitive imaging method integrating routine ultrasonography in the diagnosis of AITD which estimates the extent of fibrosis in numerical value.
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The Old and the New in Subacute Thyroiditis: An Integrative Review. ENDOCRINES 2022. [DOI: 10.3390/endocrines3030031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Subacute thyroiditis (SAT) is the most common cause of neck pain and thyrotoxicosis. Although this disease was recognized already by the end of the 18th century, new concepts regarding pathogenesis have emerged in recent years. Moreover, in the last two years, literature on SAT has increased significantly due to articles describing the possible connection with coronavirus disease 2019 (COVID-19). This integrative review depicts old and new concepts of this disease, proposing a detailed overview of pathogenesis, a practical approach to diagnosis and treatment, and a thorough description of the latest discoveries regarding the association of SAT with COVID-19.
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Abdulwahid HM, Hussien LA, Kamal AM. The Value of Ultrasound Elastography in Diffuse Thyroid Disease among a Sample of Iraqi Population. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background: Early detection of many thyroid disorders is essential in the management. Ultrasound elastography is beneficial in the assessment of diffuse thyroid diseases.
Aim of study: To assess the role of ultrasound strain elastography in the diagnosis of diffuse non nodular thyroid disease in comparison to healthy controls and in the characterization and differentiation of the types of diffuse thyroid diseases.
Patients and methods: It is a prospective analytic study performed in the Radiology Department of Oncology Teaching Hospital/Medical city Complex in Baghdad during the period from 1st of December 2019 to 30th of June, 2020 on convenient sample of 25 patients with diffuse thyroid disease, in addition to a sample of 25 healthy control persons. The diagnosis of diffuse thyroid diseases was made by combination of clinical symptoms, laboratory investigations and thyroid ultrasound.
Results: The mean elastography strain ratio (1.36) of patients with diffuse thyroid disease was significantly higher than (0.82) mean of elastography strain ratio for healthy control persons (p<0.001). The acceptable cutoff elastography strain ratio in the diagnosis of diffuse thyroid disease was 0.89 with validity results (80% sensitivity, 70% specificity and 75% accuracy). The mean elastography strain ratio for patients with Hashimotos thyroiditis was significantly higher than the strain ratio of patients with Graves disease (p=0.002).
Conclusions: The ultrasound elastography is useful in the assessment and characterization of diffuse thyroid disease. The ultrasound elastography strain ratio value is helpful in differentiation between different diffuse thyroid diseases especially between Hashimotos thyroiditis and Graves's disease
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Hazem M, Al Jabr IK, AlYahya AA, Hassanein AG, Algahlan HAE. Reliability of shear wave elastography in the evaluation of diffuse thyroid diseases in children and adolescents. Eur J Radiol 2021; 143:109942. [PMID: 34479126 DOI: 10.1016/j.ejrad.2021.109942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/28/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Thyroid diseases are common yet serious in children that lead to many metabolic and growth disorders; the most common among these are diffuse thyroid diseases (DTD). This study aimed to evaluate the reliability of shear wave elastography (SWE) to differentiate and diagnose DTD from normal thyroid tissue. METHOD This prospective study included normal participants and patients with DTD. The subjects were assessed by clinical evaluation, laboratory investigation, conventional ultrasound, and Doppler examination, followed by SWE assessments. Statistical analysis was performed using the t-test and one-way ANOVA test, as appropriate. Receiver operating characteristic (ROC) curves were used to determine the best cutoff values to differentiate healthy participants from those with DTD and to differentiate between different types of DTD. RESULTS The study included 74 patients with DTD and 20 healthy participants. The mean SWE values were 10.9 ± 1.78, 12.8 ± 2.1, 15.31 ± 2.95, and 17.26 ± 4.2 kPa for the normal participants and for patients with simple goiter, Hashimoto's thyroiditis (HT), or Grave's disease (GD), respectively. Statistically significant differences were noted between the mean SWE of the normal participants and that of patients with DTD, as well as between the mean SWE of patients with different types of DTD (P < 0.05). The best SWE cutoff values to differentiate a normal thyroid from DTD, HT from GD, HT from simple goiter, and GD from simple goiter were 12.8, 17.8, 13.4, and 13.9 kPa, respectively. CONCLUSIONS SWE is a reliable diagnostic tool for differentiating normal thyroid tissue from DTD, as well as for differentiating between different types of DTD.
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Affiliation(s)
- Mohammed Hazem
- Department of Surgery, Collage of Medicine, King Faisal University, P.O. Box: 400, Al-Ahsa 31982, Saudi Arabia; Department of Radiology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
| | - Ibrahim Khalid Al Jabr
- Department of Surgery, Collage of Medicine, King Faisal University, P.O. Box: 400, Al-Ahsa 31982, Saudi Arabia.
| | - Abdulwahab A AlYahya
- Department of Surgery, Collage of Medicine, King Faisal University, P.O. Box: 400, Al-Ahsa 31982, Saudi Arabia; Radiology Department, Polyclinic Center, King Faisal University, P.O. Box: 400, Al-Ahsa 31982, Saudi Arabia
| | - Ahmed Gaber Hassanein
- Maxillofacial Surgery Unit, Surgery Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt; Albaha University Medical Center, Albaha, Saudi Arabia
| | - Hisham A Elghany Algahlan
- Department of Radiology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt; Sohag University Hospital, Sohag, Egypt
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Liang S, Gao N, Bian D, Zhai Q, Yang P, Huang K. Clinical value of contrast-enhanced ultrasonography in focal hypoechogenic lesions of thyroid. Eur Arch Otorhinolaryngol 2021; 279:2077-2082. [PMID: 34274997 DOI: 10.1007/s00405-021-06982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objectives of this study were to analyze the accuracy of contrast-enhanced ultrasonography (CE-US) in diagnosing focal hypoechogenic lesions of the thyroid (FHLT), and to explore the clinical value of CE-US in the diagnosis of FHLT. METHODS Patients undergoing CE-US and ultrasound-guided fine needle aspiration (US-FNA) of FHLT at First Hospital of China Medical University between January 2017 and December 2018 were selected for the study; this included patients with papillary thyroid carcinoma (PTC), subacute thyroiditis (SAT) and focal Hashimoto thyroiditis (FHT). All patients underwent color Doppler ultrasonography (CD-US) after which thyroid image reporting and data system (TI-RADS) grading were done. Then, each patient underwent CE-US and US-FNA. The results of the CE-US were analyzed using descriptive statistics. The cytopathological results from the US-FNAs were the gold standard used to confirm the diagnoses. RESULTS A total of 56 patients were selected for the study. In the PTC group (n = 16), grading was as follows: TI-RADS4a, n = 3; TI-RADS4b, n = 12; and TI-RADS4c, n = 1. More patients with PTC showed heterogeneous hypoenhancement (n = 15) than heterogeneous isoenhancement (n = 1) on CE-US. In the SAT group (n = 24), grading was as follows: TI-RADS3, n = 1; TI-RADS4a, n = 18; TI-RADS4b, n = 5. Fewer patients with SAT showed heterogeneous hypoenhancement (n = 2) than heterogeneous isoenhancement (n = 22) on CE-US. In the FHT group (n = 16), grading was as follows: TI-RADS3, n = 1; TI-RADS4a, n = 11; TI-RADS4b, n = 4. Of those in the FHT group, one patient showed heterogeneous isoenhancement, one patient showed heterogeneous hypoenhancement, and 14 showed uniform isoenhancement on CE-US. The diagnostic accuracy of CD-US alone differed significantly from that of CD-US + CE-US (p < 0.05). CONCLUSION CE-US has a high diagnostic accuracy for FHLT and can be used to identify PTC, SAT, and FHT.
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Affiliation(s)
- Songnian Liang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Ningning Gao
- Department of Ultrasonic Diagnosis, Liaoning Province Cancer Hospital and Institute, Shenyang, Liaoning, People's Republic of China
| | - Donglin Bian
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Nanjingbei Street 155#, Shenyang, Liaoning, People's Republic of China
| | - Qixi Zhai
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Nanjingbei Street 155#, Shenyang, Liaoning, People's Republic of China
| | - Puxu Yang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Nanjingbei Street 155#, Shenyang, Liaoning, People's Republic of China
| | - Kun Huang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Nanjingbei Street 155#, Shenyang, Liaoning, People's Republic of China.
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Li L, Chen X, Li P, Liu Y, Ma X, Ye YQ. The Value of Ultrasound-Guided Fine-Needle Aspiration Cytology Combined with Puncture Feeling in the Diagnosis of Thyroid Nodules. Acta Cytol 2021; 65:368-376. [PMID: 34350849 DOI: 10.1159/000517168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are few studies on the role of puncture feeling in thyroid nodules during ultrasound-guided fine-needle aspiration cytology (US-FNAC), although it is expected to become a new predictive technique. We aimed to analyze the importance of puncture feeling in combination with US-FNAC and investigate whether it can be used as an indicator to predict the nature of thyroid nodules. MATERIALS AND METHODS From January 1, 2018, to October 31, 2020, a total of 623 thyroid nodules were included. Puncture feeling was classified as "soft," "hard," or "hard with grittiness." The correlation between puncture feeling and postoperative pathology and the diagnostic value of FNAC combined with puncture feeling were analyzed, and the influence of thyroid nodule size on puncture feeling, FNAC, and FNAC combined with puncture feeling was studied. We further explored the correlation between puncture feeling and histopathology in Bethesda III and IV thyroid nodules. RESULTS There was a significant correlation between puncture feeling and postoperative pathology (p < 0.001). The sensitivity, negative predictive value, and total coincidence rate of US-FNAC combined with puncture feeling for the diagnosis of thyroid nodules were higher than those of US-FNAC alone (96.1, 83.6, and 94.7% vs. 89.0, 65.5, and 89.7%, respectively). Thyroid nodule size was the influencing factor for puncture feeling, FNAC, and FNAC combined with puncture feeling (p < 0.05 for all). The area under the curve for puncture feeling, FNAC, and FNAC combined with puncture feeling for thyroid nodules of size ≤1 cm was greater than for modules of size >1 cm. Puncture feeling was of great value in diagnosing Bethesda III thyroid nodules (p < 0.001), and all Bethesda IV thyroid nodules had puncture feeling of soft. CONCLUSION Puncture feeling is of great value during US-FNAC. "Hard" and "hard with grittiness" were indicators for malignancy, while "soft" indicated that the thyroid nodule was likely to be benign. The diagnostic value of US-FNAC combined with puncture feeling for thyroid nodules is higher than US-FNAC alone, especially when nodule size is ≤1 cm. Puncture feeling is of great value in predicting the nature of Bethesda III thyroid nodules.
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Affiliation(s)
- Li Li
- School of Graduate, Hebei Medical University, Shijiazhuang, China
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China
| | - Xiao Chen
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China
| | - Peipei Li
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China
| | - Yibo Liu
- School of Graduate, Hebei Medical University, Shijiazhuang, China
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China
| | - Xiaoli Ma
- Department of Pathology, Hebei General Hospital, Shijiazhuang, China
| | - Yu-Quan Ye
- School of Graduate, Hebei Medical University, Shijiazhuang, China
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China
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Schenke SA, Görges R, Seifert P, Zimny M, Kreissl MC. Update on diagnosis and treatment of hyperthyroidism: ultrasonography and functional imaging. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:102-112. [PMID: 33494588 DOI: 10.23736/s1824-4785.21.03333-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Ultrasonography and radionuclide imaging using [99mTc]Pertechnetate or radioactive iodine isotopes are essential tools used during the diagnostic workup of hyperthyroidism with or without structural alterations of the thyroid. Color duplex sonography and ultrasound elastography may add important information to find the cause of the hormone excess. During the last few years, hybrid imaging using SPECT/-(CT) or PET-based methods, such as [124]Iodine-PET/CT or [124]Iodine-PET/ultrasound have been increasingly used, playing a role in the context of localizing ectopic thyroid tissue or in multinodular goiter. Recently, promising data has been published on the use of [99mTc]MIBI imaging in amiodarone induced hyperthyroidism.
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Affiliation(s)
- Simone A Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany -
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Philipp Seifert
- Clinic for Nuclear Medicine, University Hospital of Jena, Jena, Germany
| | | | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
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The Association of Subacute Thyroiditis with COVID-19: a Systematic Review. ACTA ACUST UNITED AC 2021; 3:1515-1527. [PMID: 33942028 PMCID: PMC8082479 DOI: 10.1007/s42399-021-00912-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 12/22/2022]
Abstract
The multisystem effects of SARS-CoV-2 encompass the thyroid gland as well. Emerging evidence suggests that SARS-CoV-2 can act as a trigger for subacute thyroiditis (SAT). We conducted a systematic literature search using PubMed/Medline and Google Scholar to identify cases of subacute thyroiditis associated with COVID-19 and evaluated patient-level demographics, major clinical features, laboratory findings and outcomes. In the 21 cases that we reviewed, the mean age of patients was 40.0 ± 11.3 years with a greater female preponderance (71.4%). Mean number days between the start of COVID-19 illness and the appearance of SAT symptoms were 25.2 ± 10.1. Five patients were confirmed to have ongoing COVID-19, whereas the infection had resolved in 16 patients before onset of SAT symptoms. Fever and neck pain were the most common presenting complaints (81%). Ninety-four percent of patients reported some type of hyperthyroid symptoms, while the labs in all 21 patients (100%) confirmed this with low TSH and high T3 or T4. Inflammatory markers were elevated in all cases that reported ESR and CRP. All 21 cases (100%) had ultrasound findings suggestive of SAT. Steroids and anti-inflammatory drugs were the mainstay of treatment, and all patients reported resolution of symptoms; however, 5 patients (23.8%) were reported to have a hypothyroid illness on follow-up. Large-scale studies are needed for a better understanding of the underlying pathogenic mechanisms, but current evidence suggests that clinicians need to recognize the possibility of SAT both in ongoing and resolved COVID-19 infection to optimize patient care.
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Troshina EA, Panfilova EA, Mikhina MS, Kim IV, Senyushkina ES, Glibka AA, Shifman BM, Larina AA, Sheremeta MS, Degtyarev MV, Rumyanstsev PO, Kuznetzov NS, Melnichenko GA, Dedov II. [Clinical practice guidelines for acute and chronic thyroiditis (excluding autoimmune thyroiditis)]. ACTA ACUST UNITED AC 2021; 67:57-83. [PMID: 34004104 PMCID: PMC8926135 DOI: 10.14341/probl12747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 01/25/2023]
Abstract
Острые и хронические заболевания щитовидной железы занимают второе место по выявляемости после сахарного диабета. Всемирная организация здравоохранения отмечает ежегодную тенденцию к увеличению числа заболеваний щитовидной железы. В настоящих клинических рекомендациях будут рассмотрены вопросы этиологии, клинического течения, диагностики и лечения острых и хронических (за исключением аутоиммунного) воспалительных заболеваний щитовидной железы.Клинические рекомендации — это основной рабочий инструмент практикующего врача, как специалиста, так и врача узкой практики. Лаконичность, структурированность сведений об определенной нозологии, методов ее диагностики и лечения, базирующихся на принципах доказательной медицины, позволяют в короткий срок дать тот или иной ответ на интересующий вопрос специалисту, добиваться максимальной эффективности и персонализации лечения.Клинические рекомендации составлены профессиональным сообществом узких специалистов, одобрены экспертным советом Министерства здравоохранения РФ. Представленные рекомендации содержат максимально полную информацию, которая требуется на этапе диагностики острых и хронических тиреоидитов, этапе выбора тактики ведения пациентов с тиреоидитом, а также на этапе лечения пациента.Рабочая группа представляет этот проект в профессиональном журнале, посвященном актуальным проблемам эндокринологии, с целью повышения качества оказываемой медицинской помощи, повышения эффективности лечения острых и хронических тиреоидитов путем ознакомления с полным тестом клинических рекомендаций по острым и хроническим тиреоидитам (исключая аутоиммунный тиреоидит) максимально возможного количества специалистов в области не только эндокринологии, но и медицины общей (семейной) практики.
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Affiliation(s)
| | | | | | - I V Kim
- Endocrinology Research Centre
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13
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Pieczewska B, Glińska-Suchocka K, Niżański W, Dzięcioł M. Decreased Size of Mammary Tumors Caused by Preoperative Treatment with Aglepristone in Female Domestic Dogs ( Canis familiaris) Do Not Influence the Density of the Benign Neoplastic Tissue Measured Using Shear Wave Elastography Technique. Animals (Basel) 2021; 11:ani11020527. [PMID: 33670676 PMCID: PMC7922823 DOI: 10.3390/ani11020527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/17/2022] Open
Abstract
Shear wave elastography (SWE) can be useful to discriminate between malignant and benign mammary tumors. In dogs with elevated progesterone levels compared to the baseline and fast-growing tumors, treatment with the use of aglepristone allows for tumor size reduction, which facilitates surgery. This study aimed to evaluate the influence of the preoperative treatment of benign mammary tumors (BMTs), performed with the use of aglepristone, on the density of the tumor tissue measured by SWE. Twelve female dogs with diagnosed BMTs and increased levels of progesterone were treated with aglepristone (Alizine, Virbac, France) at 10 mg/kg s.c. (Subcutaneous injection). twice, with a 24 h interval. The density of the tumor was evaluated by SWE before and after the treatment. The type of tumor was evaluated by fine needle aspiration cytology before treatment, and a histopathological examination was made after surgical removal, performed after the aglepristone treatment. In all the cases, a significant reduction in the mammary tumor's size was observed following treatment, with no influence on the density of the tumor's tissue measured by SWE. Similar studies on malignant mammary tumors are warranted to verify if in these cases, density will also be a constant parameter that is not dependent on the tumor size.
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Affiliation(s)
- Barbara Pieczewska
- Department of Reproduction and Clinic of Farm Animals, Wroclaw University of Environmental and Life Sciences, 50-366 Wrocław, Poland; (B.P.); (W.N.)
| | - Kamila Glińska-Suchocka
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, Wrocław University of Environmental and Life Sciences, 50-366 Wrocław, Poland;
| | - Wojciech Niżański
- Department of Reproduction and Clinic of Farm Animals, Wroclaw University of Environmental and Life Sciences, 50-366 Wrocław, Poland; (B.P.); (W.N.)
| | - Michał Dzięcioł
- Department of Reproduction and Clinic of Farm Animals, Wroclaw University of Environmental and Life Sciences, 50-366 Wrocław, Poland; (B.P.); (W.N.)
- Correspondence: ; Tel.: +48-691394742
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Shear-Wave Elastography-Diagnostic Value in Children with Chronic Autoimmune Thyroiditis. Diagnostics (Basel) 2021; 11:diagnostics11020248. [PMID: 33562689 PMCID: PMC7915688 DOI: 10.3390/diagnostics11020248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic autoimmune thyroiditis (CAT) is the most common thyroid disorder in the pediatric population. Ultrasound evaluation may suggest the diagnosis. Additionally, shear-wave elastography (SWE) proved to be a valuable additional diagnosis tool in adults with CAT by assessing thyroid stiffness (TS). This study aims to assess its use also in detecting children with CAT. The study group consisted of 50 children with confirmed diagnosis of CAT, who were compared to the control group, consisting of 50 children with no thyroid pathology and with an adult group of 50 subjects with CAT. The evaluation included, besides bioimmunochemical evaluation, also thyroid ultrasound evaluation and elastography measurements in the same session (Aixplorer Mach 30, Supersonic imagine, France). The mean TS values were significantly lower for children in the CAT group compared to adults with CAT (15.51 ± 4.76 kPa vs. 20.96 ± 6.31 kPa; p < 0.0001) and higher compared to the healthy aged matched controls (15.51 ± 4.76 kPa vs. 10.41 ± 2.01 kPa; p < 0.0001). SWE elastography definitely seems a promising technique in the evaluation of children with autoimmune thyroid pathology.
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15
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Abstract
The present study aimed to evaluate the reproducibility and accuracy of the optimized algorithm of shear-wave elastography (SWE) in diagnosing solid thyroid nodules. Two hundred and sixty-three solid thyroid nodules in 248 patients who underwent conventional ultrasound and SWE, respectively, by two operators were scheduled for fine-needle aspiration or surgery. Elasticity indices of the mean, minimum and maximum of nodules (EI) and thyroid parenchyma (EInorm) were measured respectively in the same frame of elastographic images for three times by both operators. The intraobserver and interobserver reproducibility of the optimized algorithm were assessed by intraclass correlation coefficients (ICC). Diagnostic performance of the optimized algorithm was compared with that of conventional SWE measurements by receiver-operating characteristic (ROC) curves. Among a total of 243 nodules included, 121 were benign nodules and 122 were papillary thyroid carcinoma (PTC). Intraobserver reliability for EId and EIr was nearly perfect (ICC>0.80). Interobserver agreement for MEANd, MAXd, MEANr and MAXr was nearly perfect (ICC>0.80). MAXd had the largest areas under the ROC curve which was 0.82. Compared with conventional SWE, the optimized algorithm of SWE shows better reproducibility and performance in diagnosing solid thyroid nodules.
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Sedlackova Z, Herman J, Furst T, Salzman R, Vachutka J, Herman M. Shear wave elastography in diffuse thyroid disease. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:152-156. [PMID: 32394978 DOI: 10.5507/bp.2020.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/20/2020] [Indexed: 11/23/2022] Open
Abstract
AIM Our aim was to examine the contribution of shear wave elastography to ultrasonographic assessment in diffuse thyroid disease, specifically to evaluate the stiffness of the thyroid gland in diffuse thyroid disease and compare it with healthy controls. METHODS A total of 46 patients with diffuse thyroid disease were examined clinically, by conventional ultrasound, and shear wave elastography. The conventional ultrasound parameters followed were: volume, margin quality, presence of nodules, and vascularisation. We measured the mean, minimum, and maximum stiffnesses by shear wave elastography. Results were correlated with values in 128 healthy subjects. RESULTS Patients with diffuse thyroid disease had significantly higher mean and maximal stiffnesses of the thyroid gland: 12.5 ± 5 kPa and 35.3 ± 12.8 kPa, respectively, and lower minimal stiffness: 0.5 ± 0.6 kPa than the healthy control group with mean, maximal, and minimal values of 9.5 ± 3.6 kPa, 22.5 ± 7.3 kPa, and 2.2 ± 2.1 kPa (P<0.001). Stiffness values were positively correlated with BMI and volume of the thyroid; they did not correlate with margin quality, presence of nodules nor vascularisation. Compared with healthy volunteers, thyroid glands of patients with diffuse thyroid disease had a blurred margin more frequently and the amount of nodules and vascularisation were higher. Patients with Graves-Basedow disease did not have significantly different mean, maximal, nor minimal stiffnesses than those with thyroiditis. CONCLUSION Both mean and maximal stiffness of the thyroid gland are significantly higher in diffuse thyroid disease than in the healthy population, while minimal stiffness is lower.
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Affiliation(s)
- Zuzana Sedlackova
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Jan Herman
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Tomas Furst
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Richard Salzman
- Department of Otorhinolaryngology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Jaromir Vachutka
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Miroslav Herman
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
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Arslan S, Durmaz MS, Erdogan H, Esmen SE, Turgut B, Iyisoy MS. Two-Dimensional Shear Wave Elastography in the Assessment of Salivary Gland Involvement in Primary Sjögren's Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:949-956. [PMID: 31763717 DOI: 10.1002/jum.15179] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the diagnostic performance of two-dimensional (2D) shear wave elastography (SWE) in the assessment of salivary gland involvement in primary Sjögren's syndrome (pSS). METHODS Fifty-three patients with pSS and 30 healthy volunteers were included. The echogenicity of all submandibular and parotid glands was evaluated with B-mode ultrasound, and their elasticity was assessed with 2D SWE. The mean and standard deviation of the shear wave speed and elasticity modes on 2D SWE were calculated. RESULTS The mean shear wave speed and elasticity mode values for the submandibular and parotid glands were significantly higher in the patients with pSS (P < .05). The mean elasticity of the shear wave speed mode was best able to differentiate the parotid glands of patients with pSS from those of healthy volunteers at a cutoff value of 2.48 m/s, whereas the mean elasticity of the elasticity mode was best able to differentiate the submandibular glands of patients with pSS from those of healthy volunteers at a cutoff value of 21 kPa. CONCLUSIONS Two-dimensional SWE is an effective technique for assessment of the parenchyma of the salivary glands in patients with pSS and predicts interstitial fibrosis and the severity of histologic damage.
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Affiliation(s)
- Serdar Arslan
- Department of Radiology, Division of Neuroradiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey (S.A.)
| | - Mehmet Sedat Durmaz
- Department of Radiology, Selcuk University School of Medicine, Konya, Turkey (M.S.D.)
| | - Hasan Erdogan
- Department of Radiology, Aksaray University Training and Research Hospital, Aksaray, Turkey (H.E.)
| | - Serpil Ergulu Esmen
- Departments of Rheumatology, University of Health Science, Konya Training and Research Hospital, Konya, Turkey (S.E.E)
| | - Bekir Turgut
- Department of Radiology, University of Health Science, Konya Training and Research Hospital, Konya, Turkey (B.T.)
| | - Mehmet Sinan Iyisoy
- and Department of Medical Education and Informatics, Necmettin Erbakan University School of Medicine, Konya, Turkey (M.S.I.)
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Assessment of thyroid gland elasticity with shear-wave elastography in Hashimoto's thyroiditis patients. J Ultrasound 2020; 23:543-551. [PMID: 32185701 DOI: 10.1007/s40477-020-00437-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/15/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We aimed to investigate the use and effectiveness of Shear-Wave Elastography (SWE) in Hashimoto's Thyroiditis (HT) diagnosis and compare the SWE values in HT patients with asymptomatic volunteers. METHODS The thyroid gland parenchyma of 74 patients whose clinical and laboratory findings and ultrasonography (US) features were indicative of HT and 75 healthy, asymptomatic participants with normal laboratory values were examined using SWE. Their thyroid parenchymal echoes and thyroid gland volume were measured using B-mode US examination. Elastographic measurements were made by plotting the boundaries of thyroid gland by hand, using Free Region of Interest (ROI). The quantitative SWE values [meters/second (m/s) and kilopascal (kPa)] were compared betweent the patients and the controls. The correlation analyses between the SWE measurements and the autoantibodies [Anti-thyroid peroxidase antibody (TPOAbs) and anti-thyroglobulin antibodies (TgAbs)], thyroid-stimulating hormone (TSH), freetriiodothyronine (fT3), free-thyroxine (fT4), and thyroglobulin levels were performed. RESULTS The mean thyroid SWE measurement values of HT group were significantly higher than the asymptomatic group (p < 0.001). This study proposes 29.45 kPa or 2.77 m/s as a sensitive-spesific cut-off value for HT. We revealed significant positive association between SWE values and TgAb levels, gland volume, TgAb, TPOAb levels, and a significant negative association between SWE and echogenicity (p < 0.001). CONCLUSION In the assessment of HT, SWE is a highly sensitive imaging method to estimate the degree of fibrosis and to provide objective numerical values.
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Hefeda MM. Value of the New Elastography Technique using Acoustic Radiation Force Impulse in Differentiation between Hashimoto's Thyroiditis and Graves' Disease. J Clin Imaging Sci 2019; 9:17. [PMID: 31448168 PMCID: PMC6702860 DOI: 10.25259/jcis-22-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/27/2019] [Indexed: 01/05/2023] Open
Abstract
Background and Aim: This study was performed to evaluate the role and accuracy of shear wave elastography in the differentiation between Graves’ disease (GD) and Hashimoto’s thyroiditis (HT), in comparison with the B-mode ultrasound and color Doppler ultrasound. Materials and Methods: This study was non-randomized prospective study. The study included 30 patients with GD, 65 patients with HT, and 35 patients with normal thyroid glands. Assessment of ultrasonographic criteria, color Doppler flow pattern, and shear patterns differed significantly between the control group and the group of diffuse thyroid disease (P < 0.001). The most specific sign for diagnosing HT was nodularity (97.87%), and the most sensitive sign was coarse echotexture (81.54%). Color Doppler flow (CDF) showed sensitivity of 91.8%, specificity of 56.92%, positive predictive value of 52.54%, negative predictive value of 92.5%, and diagnostic accuracy of 68.69% in the differentiation between GD and HT. The mean shear wave velocity (SWV) was 2.61 ± 0.32 m/s in the GD group (range: 2.1–3.21 m/s), 2.85 ± 0.52 m/s in the HT group (range: 2.31–3.82 m/s), and 1.75 ± 0.37 m/s in the control group (range: 1.24–2.36 m/s). The mean SWVs in the GD and HT groups were significantly higher than that in the control group (P < 0.001). The mean SWV in the HT group was higher than that in the GD group (P = 0.03). Conclusion: Quantitative and qualitative SWE is useful for diagnosing diffuse thyroid disease and evaluating the degree of fibrosis in autoimmune thyroiditis. However, acoustic radiation force impulse techniques cannot differentiate between HT and GD reliably.
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Bakırtaş Palabıyık F, İnci E, Papatya Çakır ED, Hocaoğlu E. Evaluation of Normal Thyroid Tissue and Autoimmune Thyroiditis in Children Using Shear Wave Elastography. J Clin Res Pediatr Endocrinol 2019; 11:132-139. [PMID: 30362325 PMCID: PMC6571532 DOI: 10.4274/jcrpe.galenos.2018.2018.0137] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Shear wave elastography (SWE) is a user-independent ultrasonographic technique that evaluates tissue elasticity. It is used especially in the evaluation of thyroiditis and thyroid nodules when it is capable of distinguishing malignant from benign thyroiditis in adults. To date, no studies have evaluated SWE in pediatric thyroid patients. The aim of this study was to measure the elasticity of normal thyroid tissue in children and adolescents using SWE and to investigate its role in the diagnosis of pediatric autoimmune thyroiditis. METHODS In total, 113 healthy children of whom 66 (58.4%) were girls and 57 children with autoimmune thyroiditis of whom 45 (78.9%) were girls were evaluated by SWE after B-mode ultrasound. The quantitative evaluation of normal thyroid tissue in healthy children and those with autoimmune thyroiditis was performed using shear wave velocity (SWV) values (m/s). Thyroid antibodies were consistent with autoimmune thyroiditis. Data were compared using descriptive and analytical statistics and receiver-operating characteristic curves. RESULTS The mean ± standard deviation (range) of SWV value in thyroid parenchyma of the healthy children was 1.82±0.3 m/s (1.32-2.37) m/s. There was a significant positive correlation between age and SWV values which increased with age. The average SWV value of thyroid parenchyma in children with autoimmune thyroiditis was 3.7±1.2 (2.59-6.25) m/s which was statistically significantly greater than in healthy children (p=0.00). The cut-off value for elasticity with the highest diagnostic accuracy was 2.39 m/s; sensitivity and specificity were 97.4% and 100% respectively. There was no correlation between elasticity, thyroid function tests and autoantibody concentrations (p>0.05). CONCLUSION SWE is a useful imaging method that can be used with routine ultrasonography in evaluation of the thyroid in children.
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Affiliation(s)
- Figen Bakırtaş Palabıyık
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Radiology, İstanbul, Turkey
| | - Ercan İnci
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Radiology, İstanbul, Turkey
| | - Esra Deniz Papatya Çakır
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Radiology, Division of Pediatrics, İstanbul, Turkey
| | - Elif Hocaoğlu
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Radiology, İstanbul, Turkey
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Hepcidin and Iron Homeostasis in Patients with Subacute Thyroiditis and Healthy Subjects. Mediators Inflamm 2019; 2019:5764061. [PMID: 30936776 PMCID: PMC6415316 DOI: 10.1155/2019/5764061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/16/2019] [Indexed: 12/30/2022] Open
Abstract
Purpose Hepcidin is an acute-phase protein involved also in regulation of iron homeostasis. The aim of the study was to prospectively assess for the first time the hepcidinEL concentration in patients with subacute thyroiditis (SAT), to identify biochemical determinants of hepcidinEL concentration and evaluate the potential role of hepcidin in SAT diagnosis and monitoring. Methods Out of 40 patients with SAT initially recruited, restrictive inclusion criteria fulfilled 21 subjects aged 45 ± 10 years and 21 healthy control subjects (CS). HepcidinEL concentration, thyroid status, and iron homeostasis were evaluated at SAT diagnosis and following therapy and compared with CS. Results The median hepcidinEL concentration at SAT diagnosis is higher than that in CS (48.8 (15.9-74.5) ng/mL vs. 18.2 (10.2-23.3) ng/mL, p = 0.009) and is significantly lower after treatment (4.0 (1.2-10.0) ng/mL, p = 0.007) compared with CS. The ROC analysis for hepcidinEL at SAT diagnosis revealed that area under the curve (AUC) is 0.735 (p = 0.009), and the cut-off for hepcidinEL concentration is 48.8 ng/mL (sensitivity 0.52 and specificity 0.95). HepcidinEL in SAT patients correlated with CRP (r = 0.614, p = 0.003), ferritin (r = 0.815, p < 0.001), and aTPO (r = -0.491, p = 0.024). On multiple regression, the correlation between hepcidinEL and ferritin was confirmed (p < 0.001). Conclusions SAT is accompanied by a significant increase in hepcidin, which reflects an acute-phase inflammatory process. Parameters of iron homeostasis improved significantly while inflammatory indices got lower following recovery. The potential role of hepcidin as a predictive factor of the risk of SAT relapse needs to be assessed in studies on larger groups of SAT patients.
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Stasiak M, Tymoniuk B, Adamczewski Z, Stasiak B, Lewiński A. Sonographic Pattern of Subacute Thyroiditis Is HLA-Dependent. Front Endocrinol (Lausanne) 2019; 10:3. [PMID: 30728805 PMCID: PMC6351437 DOI: 10.3389/fendo.2019.00003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/07/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Since 1977 the susceptibility to SAT has been known to be HLA-B*35-related in ~70% of patients. Recently it has been demonstrated that SAT is associated with the presence of HLA-B*18:01 and DRB1*01, as well as with HLA-C*04:01. The association between the type of genetic SAT background and sonographic pattern of the disease has never been analyzed. The aim of the study was to evaluate the potential correlation between the presence of individual HLA haplotypes and the sonographic SAT pattern, and to provide the US characteristics of the analyzed SAT cases. Methods: HLA-A, -B, -C, -DQB1, and -DRB1 were genotyped using a next-generation sequencing method in 46 SAT patients. All patients were divided into the following groups according to the HLA haplotype: 1. HLA-B*35 and/or HLA-C*04, but without any other of the analyzed antigens; 2. HLA-DRB1*01, regardless of the co-presence of HLA-B*35 or C*04:01, but without HLA-B*18:01; 3. HLA-B*18:01 only, without any other of the analyzed antigens; 4. HLA-B*18:01 plus B*35, regardless of the presence of any other analyzed antigens. The US patterns of SAT thyroid lesions were compared among the groups. Results: The US image of SAT lesions in Groups 1 and 2 were similar. The typical SAT features for these groups were as follows: hypoechoic, strongly heterogeneous, bilateral, multiple areas, with decreased vascularization, usually oval with blurred margins, infrequently affecting the whole lobe, or having nodule-like pattern. Several features of Group 3 were different from the other groups. In 60% of cases lesions were rather homogeneous, and in 100%-hypoechoic, in 80% of patients there was only one unilateral single SAT area filling the whole affected lobe. On the contrary to the other groups, in Group 4 no lesion was oval in shape. Conclusions: Our results provide for the first time the evidence that the US pattern of SAT lesions depends on HLA, and the determining factor is the presence of HLA-B*18:01. The deviations from the typical SAT US image are mostly pronounced in patients with the presence of only HLA-B*18:01, without any other analyzed haplotype. Further research is necessary to explain this phenomenon.
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Affiliation(s)
- Magdalena Stasiak
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Bogusław Tymoniuk
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
| | - Bartłomiej Stasiak
- Institute of Information Technology, Lodz University of Technology, Lodz, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
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Zhao CK, Xu HX. Ultrasound elastography of the thyroid: principles and current status. Ultrasonography 2018; 38:106-124. [PMID: 30690960 PMCID: PMC6443591 DOI: 10.14366/usg.18037] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/01/2018] [Indexed: 12/31/2022] Open
Abstract
Ultrasound (US) elastography has been introduced as a non-invasive technique for evaluating thyroid diseases. This paper presents a detailed description of the technical principles, peculiarities, and limitations of US elastography techniques, including strain elastography and shear-wave elastography. This review was conducted from a clinical perspective, and aimed to assess the usefulness of US elastography for thyroid diseases in specific clinical scenarios. Although its main focus is on thyroid nodules, the applications of US elastography for other thyroid diseases, such as diffuse thyroid diseases and thyroiditis, are also presented. Furthermore, unresolved questions and directions for future research are also discussed.
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Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
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Yucel S, Ceyhan Bilgici M, Kara C, Can Yilmaz G, Aydin HM, Elmali M, Tomak L, Saglam D. Acoustic Radiation Force Impulse Quantification in the Evaluation of Thyroid Elasticity in Pediatric Patients With Hashimoto Thyroiditis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1143-1149. [PMID: 29064111 DOI: 10.1002/jum.14459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the parenchymal elasticity of the thyroid gland with acoustic radiation force impulse imaging in pediatric patients with Hashimoto thyroiditis and to compare it with healthy volunteers. METHODS Twenty-six patients with Hashimoto thyroiditis and 26 healthy volunteers between 6 and 17 years were included. The shear wave velocity (SWV) values of both thyroid lobes in both groups were evaluated. RESULTS The age and sex characteristics of the controls and patients with Hashimoto thyroiditis were similar. The SWV of the thyroid gland in patients with Hashimoto thyroiditis (mean ± SD, 1.67 ± 0.63 m/s) was significantly higher than that in the control group (1.30 ± 0.13 m/s; P < .001). There was no significant difference between the thyroid lobes in both groups. A receiver operating characteristic curve analyses showed an optimal cutoff value of 1.41 m/s, with 73.1% sensitivity, 80.8% specificity, a 79.2 % positive predictive value, and a 75.0% negative predictive value (area under the curve, 0.806; P < .001). In patients with Hashimoto thyroiditis, there was a positive correlation between the SWV values versus anti-thyroperoxidase (Pearson r = 0.46; P = .038). There were no correlations between age, body mass index, thyroid function test results, and anti-thyroglobulin values and versus SWV values. Also, no significant differences were seen between the groups for gland size, gland vascularity, and l-thyroxine treatment. CONCLUSIONS Acoustic radiation force impulse elastography showed a significant difference in the stiffness of the thyroid gland between children with Hashimoto thyroiditis and the healthy group. Using acoustic radiation force impulse elastography immediately after a standard ultrasound evaluation may predict chronic autoimmune thyroiditis.
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Affiliation(s)
- Serap Yucel
- Departments of Radiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Meltem Ceyhan Bilgici
- Departments of Radiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Cengiz Kara
- Departments of Pediatric Endocrinology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Gulay Can Yilmaz
- Departments of Pediatric Endocrinology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - H Murat Aydin
- Departments of Pediatric Endocrinology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Muzaffer Elmali
- Departments of Radiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Leman Tomak
- Departments of Medical Biostatistics, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Dilek Saglam
- Departments of Radiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
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Stangierski A, Wolinski K, Ruchala M. Shear wave elastography in the diagnostics of parathyroid adenomas-new application of the method. Endocrine 2018; 60:240-245. [PMID: 29468557 PMCID: PMC5893658 DOI: 10.1007/s12020-018-1553-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/30/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Shear wave elastography (SWE) was described as valuable tool in the diagnostics of distinct types of thyroid lesions, thyroiditis and several other non-thyroidal conditions, such as liver inflammation and fibrosis or diagnostics of breast lesions. The aim of the current study was to assess the appearance of parathyroid adenomas in SWE and to check prospectively if SWE can be valuable additional tool in the diagnostics of pathologically enlarged parathyroids. METHODS Patients with parathyroid adenomas confirmed by histopathology were included. Subjects with benign thyroid lesions were enrolled to the control group. Elasticity of parathyroid adenomas and benign thyroid nodules was measured and compared. RESULTS Sixty five patients with parathyroid adenomas and 35 patients with 51 benign thyroid nodules were included. Parathyroid adenomas where significantly more elastic than benign thyroid nodules-mean elasticity of the lesion was 5.2 ± 7.2 vs. 24.3 ± 33.8 kPa, respectively. Relative mean elasticity (in comparison with surrounding thyroid tissue) was 0.30 ± 0.36 and 2.8 ± 3.9, respectively. CONCLUSIONS SWE can be useful tool in the diagnostics of parathyroid adenomas. Enlarged parathyroids are significantly more elastic than benign thyroid lesions. Low elasticity of the lesion constitutes feature with high negative prognostic value, allowing for reliable exclusion of suspicion of parathyroid adenomas.
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Affiliation(s)
- Adam Stangierski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Kosma Wolinski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Quantitative assessment of thyroid gland elasticity with shear-wave elastography in pediatric patients with Hashimoto’s thyroiditis. J Med Ultrason (2001) 2018; 45:417-423. [DOI: 10.1007/s10396-018-0859-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 12/12/2017] [Indexed: 12/21/2022]
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Value of Real-Time and Strain Ratio Elastography in Differential Diagnosis of Graves’ Disease and Subacute and Hashimoto’s Thyroiditis. IRANIAN JOURNAL OF RADIOLOGY 2017. [DOI: 10.5812/iranjradiol.22019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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McQueen AS, Bhatia KS. Head and neck ultrasound: technical advances, novel applications and the role of elastography. Clin Radiol 2017; 73:81-93. [PMID: 28985885 DOI: 10.1016/j.crad.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/25/2023]
Abstract
High-resolution ultrasound (US) provides superb anatomical detail in the superficial anatomy of the neck and has become the first-line imaging investigation for neck lumps and a crucial component of clinical pathways. In this article, a wide range of advances in neck US are described with a focus on the emerging role of ultrasound elastography. Selected examples of clinical utility are presented across a spectrum of scenarios with discussion of newer applications, service delivery, and training issues. The changing role of the neck ultrasound practitioner and the future of the technique in the head and neck are considered.
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Affiliation(s)
- A S McQueen
- Department of Radiology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK.
| | - K S Bhatia
- Department of Radiology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Borysewicz-Sanczyk H, Dzieciol J, Sawicka B, Bossowski A. Practical Application of Elastography in the Diagnosis of Thyroid Nodules in Children and Adolescents. Horm Res Paediatr 2017; 86:39-44. [PMID: 27372081 DOI: 10.1159/000447490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrasound elastography is a noninvasive method of imaging based on the estimation of the mechanical properties of tissue. Data in adults indicate that decreased flexibility in comparison to the surrounding healthy tissue is characteristic of malignancy (in most thyroid carcinomas, except for follicular thyroid carcinoma). The purpose of our study was to assess the deformation of thyroid nodules and to evaluate the usefulness of elastography in predicting malignant thyroid nodules in adolescent patients. METHODS We examined 47 children with 62 thyroid nodules. All patients underwent elastography and fine needle aspiration cytology (FNAC). RESULTS Thirty-seven girls (79%) and 10 boys (21%) were included in the study. A strain ratio <2 was observed in 17 nodules (27% of the study group), a strain ratio between 2 and 4.9 in 34 nodules (55%) and a strain ratio >5 in 11 nodules (18%). According to cytological examination, 3 nodules (4.8% of the study group) were malignant. Two of them were hard (strain ratio ≥5), and 1 nodule had a strain ratio of 2. CONCLUSIONS Our results suggest that elastography can be complementary to conventional ultrasonography and useful while making a decision about FNAC. At the same time, it should not replace the cytological assessment of thyroid nodules in children and adolescents.
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Affiliation(s)
- Hanna Borysewicz-Sanczyk
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Division, Medical University of Biax0142;ystok, Biax0142;ystok, Poland
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Cosgrove D, Barr R, Bojunga J, Cantisani V, Chammas MC, Dighe M, Vinayak S, Xu JM, Dietrich CF. WFUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography: Part 4. Thyroid. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:4-26. [PMID: 27570210 DOI: 10.1016/j.ultrasmedbio.2016.06.022] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The World Federation for Ultrasound in Medicine and Biology (WFUMB) has produced guidelines for the use of elastography techniques including basic science, breast and liver. Here we present elastography in thyroid diseases. For each available technique, procedure, reproducibility, results and limitations are analyzed and recommendations are given. Finally, recommendations are given based on the level of evidence of the published literature and on the WFUMB expert group's consensus. The document has a clinical perspective and is aimed at assessing the usefulness of elastography in the management of thyroid diseases.
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Affiliation(s)
- David Cosgrove
- Division of Radiology, Imperial and Kings Colleges, London, UK
| | - Richard Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Joerg Bojunga
- Department of Internal Medicine 1, Endocrinology and Diabetology, Goethe University Hospital, Frankfurt am Main, Germany
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, University Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Ultrasound Division, Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Sudhir Vinayak
- Department of Imaging and Diagnostic Radiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, China
| | - Christoph F Dietrich
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Talreja SM, Tomar V, Yadav SS, Jaipal U, Priyadarshi S, Agarwal N, Vyas N. Comparison of sonoelastography with sonourethrography and retrograde urethrography in the evaluation of male anterior urethral strictures. Turk J Urol 2016; 42:84-91. [PMID: 27274893 DOI: 10.5152/tud.2016.99223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Retrograde urethrography (RUG) is the most common and preferred imaging modality for imaging of the anterior urethral strictures despite its well-known limitations and disadvantages. Sonourethrography (SUG) was introduced in 1988 to overcome the limitations of RUG and to provide more accurate results. As proper selection of imaging modality is very important for planning the treatment, various advances in this area are required. One of the major factors for recurrence of stricture disease is spongiofibrosis. Sonoelastography (SE) is a newer technique, tried in various other pathologies. In this study, we have used this technique for the first time to assess its efficacy in the evaluation of anterior urethral stricture disease by comparison with RUG and SUG. MATERIAL AND METHODS Between August 2014 and May 2015, 77 patients with clinical features of anterior urethral stricture disease were included in the study and evaluated by RUG followed by SUG and SE for stricture location, length, depth of spongiofibrosis and periurethral pathologies. The results were then correlated with operative and histopathological findings. RESULTS Overall diagnostic accuracy of SE, SUG, and RGU for the estimation of stricture location, and length were estimated 92.68% vs. 91.54%, 79% vs. 78.87% and 80.48% vs. 43.66%, respectively, while for depth of spongiofibrosis SE, and SUG had accuracy rates of 87.3%, 48%, respectively. The mean length measured on SE was nearest to the mean intra-operative stricture length (21.34+11.8 mm). SE findings significantly correlated with the colour of bladder mucosa on cystoscopic examination (p=0.003) whereas the association was non-significant (p=0.127) for difficulty in incision. While a nonsignificant correlation existed between SUG findings related both to the colour of the bladder mucosa and difficulty in incision on cystoscopy, SE findings had a significant association (p<0.001) with histopathology findings for severe degree of fibrosis. CONCLUSION Sonoelastography estimates stricture site and length better in comparison with RUG and SUG. It estimates degree of spongiofibrosis which serves as an important prognostic factor for stricture recurrence more accurately than SUG.
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Affiliation(s)
| | - Vinay Tomar
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sher Singh Yadav
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Usha Jaipal
- Department of Radiology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Shivam Priyadarshi
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Neeraj Agarwal
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Nachiket Vyas
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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Reliability of Shear-Wave Elastography Estimates of the Young Modulus of Tissue in Follicular Thyroid Neoplasms. AJR Am J Roentgenol 2016; 206:609-16. [PMID: 26901019 DOI: 10.2214/ajr.15.14676] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study is to determine the reliability of shear-wave elastographic estimates of the Young modulus in thyroid follicular neoplasms. SUBJECTS AND METHODS In this study, 35 adults with follicular nodules diagnosed by fine-needle aspiration (FNA) biopsy were enrolled. A single sonographer examined all nodules in three planes (sagittal, transverse, and transverse center). Two raters independently placed ROIs in each nodule. Intra- and interrater reliability were computed as intraclass correlation coefficients (ICCs) and were reported using the Guidelines for Reporting Reliability and Agreement Studies. RESULTS Thirty-five subjects with 35 follicular pattern nodules diagnosed by FNA biopsy were enrolled; 23 (65.7%) patients were female, with a mean age of 55.1 years (range, 23-85 years). For rater 1, intrarater agreement showed ICCs for single measurements of 0.87, 0.87, and 0.90 in the sagittal, transverse, and transverse center plans, respectively; ICCs for the median of multiple measurements were 0.97, 0.94, and 0.96 in the sagittal, transverse, and transverse center planes, respectively. For rater 2, intrarater agreement showed ICCs for single measurements of 0.94, 0.86, and 0.92 in the sagittal, transverse, and transverse center planes, respectively; ICCs for the median of multiple measurements were 0.97, 0.92, and 0.96 in the sagittal, transverse, and transverse center planes, respectively. Interrater agreement between measurements performed for the same subject showed ICCs for single measurements of 0.87, 0.87, and 0.80 in the sagittal, transverse, and transverse center planes, respectively; ICCs for the median of multiple measurements were 0.96, 0.93, and 0.92 in the sagittal, transverse, and transverse center planes, respectively. CONCLUSION ROI placement is a reliable method for estimating the Young modulus of tissue in follicular thyroid nodules.
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Lee MYW, Lam WWC, Wong WY. Subacute Thyroiditis-An Often Overlooked Sonographic Diagnosis: Report of 3 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1095-1100. [PMID: 27022173 DOI: 10.7863/ultra.15.05052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
The characteristic sonographic finding of subacute thyroiditis of a heterogeneous poorly defined hypoechoic area in the thyroid gland may mimic that of thyroid malignancy. This finding needs to be interpreted in the correct clinical context to avoid an unnecessary biopsy. We describe 3 patients who underwent thyroid biopsy on the basis of suspicious sonographic findings but who subsequently had a diagnosis of subacute thyroiditis.
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Affiliation(s)
- Margaret Yee Wah Lee
- Department of Nuclear Medicine and Positron Emission Tomography, Singapore General Hospital, Singapore.
| | - Winnie Wing Chuen Lam
- Department of Nuclear Medicine and Positron Emission Tomography, Singapore General Hospital, Singapore
| | - Wai Yin Wong
- Department of Nuclear Medicine and Positron Emission Tomography, Singapore General Hospital, Singapore
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Zhang S, Zhu J, Zhang X, He J, Li J. Assessment of the Stiffness of Major Salivary Glands in Primary Sjögren's Syndrome through Quantitative Acoustic Radiation Force Impulse Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:645-653. [PMID: 26715188 DOI: 10.1016/j.ultrasmedbio.2015.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/03/2015] [Accepted: 11/09/2015] [Indexed: 06/05/2023]
Abstract
The purpose of the study described here was to evaluate salivary gland stiffness in primary Sjögren's syndrome (pSS) via acoustic radiation force impulse imaging, including Virtual Touch tissue quantification (VTQ) and Virtual Touch tissue imaging quantification (VTIQ). Twenty-one patients with pSS and 11 healthy patients were included, and the paired parotid and submandibular glands of all of the patients were examined using VTQ and VTIQ. Differences between the two groups were compared with independent and paired t-tests. The VTQ value for the parotid in the pSS group was significantly higher than that obtained for the control group (1.33 ± 0.22 and 1.18 ± 0.04 m/s, respectively, p < 0.01). The VTIQ values for the parotid and submandibular gland were both significantly higher in the pSS group than in the control group (p < 0.05). In the pSS group, a positive correlation was observed between the VTQ and VTIQ results for the parotid and submandibular glands. In summary, the stiffness of the major salivary glands in patients with pSS was increased compared with that of patients with normal glands. This finding indicates that VTQ and VTIQ imaging may be valuable adjuncts to gray-scale ultrasonography for the clinical diagnosis of pSS.
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Affiliation(s)
- Shanshan Zhang
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China.
| | - Xia Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Jianguo Li
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
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Zandieh S, Bernt R, Zwerina J, Haller J, Knoll P, Seyeddain O, Mirzaei S. Acoustic Structure Quantification Analysis of the Thyroid in Patients with Diffuse Autoimmune Thyroid Disease. ULTRASONIC IMAGING 2016; 38:137-147. [PMID: 25855160 DOI: 10.1177/0161734615580766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to assess whether acoustic structure quantification (ASQ) can differentiate normal from pathological thyroid parenchyma in patients with diffuse autoimmune thyroid disease (AITD). We evaluated 83 subjects (72 [87%] women and 11 [13%] men) aged 19 to 94 years with a mean age of 53 years. We performed a prospective study (from March 2011 to November 2014) that included 43 (52%) patients with chronic autoimmune thyroiditis (CAT), 22 (26%) patients with Graves' disease (GD), and 18 (22%) healthy volunteers. The ASQ values were significantly lower in normal subjects than in subjects with CAT and GD (p < 0.001). In contrast, the differences between the GD and the CAT patients (p = 0.23) were not statistically significant. The optimal cutoff ASQ value for which the sum of sensitivity and specificity was the highest for the prediction of diffuse thyroid pathology was 103 (95% confidence interval = [0.79, 0.95]). At this cutoff value, the sensitivity was 83% and the specificity was 89%. Our findings suggest that ASQ is a useful method for the assessment of the thyroid in patients with AITD.
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Affiliation(s)
- Shahin Zandieh
- Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Reinhard Bernt
- Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK; Department of Internal Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Joerg Haller
- Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Austria
| | - Peter Knoll
- Institute of Nuclear Medicine with PET-Center, Wilhelminen Hospital, Teaching Hospital of Medical University of Vienna, Austria, Austria
| | - Orang Seyeddain
- Department of Ophthalmology, Paracelsus Medical University of Salzburg, Austria
| | - Siroos Mirzaei
- Institute of Nuclear Medicine with PET-Center, Wilhelminen Hospital, Teaching Hospital of Medical University of Vienna, Austria, Austria
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Anvari A, Barr RG, Dhyani M, Samir AE. Clinical application of sonoelastography in thyroid, prostate, kidney, pancreas, and deep venous thrombosis. ACTA ACUST UNITED AC 2015; 40:709-22. [PMID: 25750099 DOI: 10.1007/s00261-015-0383-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article reviews the clinical applications of current ultrasound elastography methods in non-hepatic conditions including thyroid nodules, prostate cancer, chronic kidney disease, solid renal lesions, pancreatic lesions, and deep vein thrombosis. Pathophysiology alters tissue mechanical properties via ultrastructural changes including fibrosis, increased cellularity, bleeding, and necrosis, creating a target biomarker, which can be imaged qualitatively or quantitatively with US elastography. US elastography methods can add information to conventional US methods and improve the diagnostic performance of conventional US in a range of disease processes.
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Affiliation(s)
- Arash Anvari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Shao J, Shen Y, Lü J, Wang J. Ultrasound scoring in combination with ultrasound elastography for differentiating benign and malignant thyroid nodules. Clin Endocrinol (Oxf) 2015; 83:254-60. [PMID: 25138622 DOI: 10.1111/cen.12589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 06/25/2014] [Accepted: 08/11/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the value of ultrasound scores obtained by conventional ultrasonography and ultrasound elastography in the differentiation of benign and malignant thyroid nodules in Chinese patients. METHODS This study included 297 patients who were referred for surgery for compressive symptoms or suspicion of malignancy. Five hundred and twelve thyroid nodules were examined by ultrasonography. The final diagnosis was based on histological findings. A seven-point ultrasound scoring system based on conventional ultrasonography and a five-point scoring system based on ultrasound elastography were applied independently or in combination. The receiver operating characteristic (ROC) curves were graphed, and the areas under the curves (AUCs) were compared using the χ(2) -test. RESULTS Solid composition, hypo-echoic appearance, an irregular or blurred margin, an aspect ratio ≥1, intranodular blood flow and presence of microcalcifications were significant predictors of malignant thyroid nodules. The AUC (95% CI) was 0·9067 (0·8817-0·9318) for the ultrasound scores based on conventional ultrasonography and 0·9080 (0·8842-0·9317) for the elasticity scores. The combination of these two scoring systems provided good accuracy with an AUC (95% CI) of 0·9415 (0·9223-0·9606), which was significantly higher than that obtained with the conventional ultrasound scores (χ(2) = 36·03, P < 0·001) or the elasticity scores (χ(2) = 12·80, P < 0·001) individually. When we set the cut-point to ≥5, the sensitivity and specificity were 85·22% and 87·38%, respectively. CONCLUSIONS Elastography in combination with conventional ultrasonography is a promising imaging-based approach that can assist in the differential diagnosis of thyroid cancer.
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Affiliation(s)
- Jun Shao
- Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Suzhou, China
| | - Ye Shen
- Department of Gastrointestinal Surgery, Aoyoung Hospital, Zhangjiagang, Suzhou, China
| | - Jieqiong Lü
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jianming Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
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Utility of Shear Wave Elastography for Diagnosing Chronic Autoimmune Thyroiditis. J Thyroid Res 2015; 2015:164548. [PMID: 26257979 PMCID: PMC4519543 DOI: 10.1155/2015/164548] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/02/2015] [Accepted: 06/29/2015] [Indexed: 12/03/2022] Open
Abstract
The aims of this study were to evaluate the utility of shear wave elastography (SWE) using acoustic radiation force impulse (ARFI) for diagnosing chronic autoimmune thyroiditis (CAT) and to verify the effect of fibrotic thyroid tissue on shear wave velocity (SWV). The subjects were 229 patients with 253 normal thyroid lobes (controls) and 150 CAT lobes. The SWV for CAT (2.47 ± 0.57 m/s) was significantly higher than that for controls (1.59 ± 0.41 m/s) (P < 0.001). The area under the receiver operating characteristics (ROC) curve for CAT was 0.899, and the SWV cut-off value was 1.96 m/s. The sensitivity, specificity, and diagnostic accuracy were 87.4%, 78.7%, and 85.1%, respectively. Levels of anti-thyroperoxidase antibodies and thyroid isthmus thickness were correlated with tissue stiffness in CAT. However, there was no correlation between levels of anti-thyroglobulin antibodies and tissue stiffness. Quantitative SWE is useful for diagnosing CAT, and it is possible that SWE can be used to evaluate the degree of fibrosis in patients with CAT.
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Lee G, Jeon S, Lee SK, Kim H, Yu D, Choi J. STRAIN ELASTOGRAPHY USING DOBUTAMINE-INDUCED CAROTID ARTERY PULSATION IN CANINE THYROID GLAND. Vet Radiol Ultrasound 2015; 56:549-53. [DOI: 10.1111/vru.12268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 04/05/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gahyun Lee
- College of Veterinary Medicine; Chonnam National University; Gwangju 500-757 Republic of Korea
| | - Sunghoon Jeon
- College of Veterinary Medicine; Chonnam National University; Gwangju 500-757 Republic of Korea
| | - Sang-Kwon Lee
- College of Veterinary Medicine; Chonnam National University; Gwangju 500-757 Republic of Korea
| | - Hyunwoo Kim
- College of Veterinary Medicine; Chonnam National University; Gwangju 500-757 Republic of Korea
| | - Dohyeon Yu
- College of Veterinary Medicine; Chonnam National University; Gwangju 500-757 Republic of Korea
| | - Jihye Choi
- College of Veterinary Medicine; Chonnam National University; Gwangju 500-757 Republic of Korea
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Thyroid nodule ultrasound: technical advances and future horizons. Insights Imaging 2015; 6:173-88. [PMID: 25736837 PMCID: PMC4376820 DOI: 10.1007/s13244-015-0398-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/28/2015] [Accepted: 02/04/2015] [Indexed: 01/19/2023] Open
Abstract
UNLABELLED Thyroid nodules are extremely common and the vast majority are non-malignant; therefore the accurate discrimination of a benign lesion from malignancy is challenging. Ultrasound (US) characterisation has become the key component of many thyroid nodule guidelines and is primarily based on the detection of key features by high-resolution US. The thyroid imager should be familiar with the strengths and limitations of this modality and understand the technical factors that create and alter the imaging characteristics. Specific advances in high-resolution US are discussed with reference to individual features of thyroid cancer and benign disease. Potential roles for three-dimensional thyroid ultrasound and computer-aided diagnosis are also considered. The second section provides an overview of current evidence regarding thyroid ultrasound elastography (USE). USE is a novel imaging technique that quantifies tissue elasticity (stiffness) non-invasively and has potential utility because cancers cause tissue stiffening. In recent years, there has been much research into the value of thyroid USE for distinguishing benign and malignant nodules. Preliminary findings from multiple pilot studies and meta-analyses are promising and suggest that USE can augment the anatomical detail provided by high-resolution US. However, a definite role remains controversial and is discussed. TEACHING POINTS • High-resolution US characterises thyroid nodules by demonstration of specific anatomical features • Technical advances heavily influence the key US features of thyroid nodules • Most papillary carcinomas appear stiffer than benign thyroid nodules on US elastography (USE) • Thyroid USE is controversial because of variation in the reported accuracies for malignancy • Combined grey-scale US/USE may lower the FNAC rate in benign nodules.
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Szczepanek-Parulska E, Woliński K, Stangierski A, Gurgul E, Ruchała M. Biochemical and ultrasonographic parameters influencing thyroid nodules elasticity. Endocrine 2014; 47:519-27. [PMID: 24535467 DOI: 10.1007/s12020-014-0197-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/29/2014] [Indexed: 10/25/2022]
Abstract
Elastography is a method of tissue stiffness assessment. It has already been demonstrated that thyroid cancers are less elastic than benign lesions. However, little is known about other factors, which might influence the stiffness of thyroid nodules and disrupt the prediction of malignancy using this technique. The aim of this study was to conduct the first systematic assessment of factors potentially affecting the elasticity of thyroid lesions. One hundred and twenty-two patients with thyroid nodular disease admitted for thyroidectomy underwent preoperative ultrasonography and sonoelastography. The definite diagnosis of thyroid lesions was based on histological examination. What was evaluated in the study was the influence of composition, size, localization, nodularity, and selected laboratory parameters on thyroid nodule elasticity. Firstly, association between the above-mentioned factors and elasticity was assessed in benign lesions. Secondly, all nodules (benign and malignant) were divided into subgroups according to the presence or absence of particular features, which turned out to be an important disturbing factor increasing the stiffness of the lesion in the first step of analysis. There were 22 malignant and 371 benign lesions. The analysis of benign lesions revealed that the presence calcifications (p < 0.0001) significantly increased nodule stiffness. Partially, cystic nodules were significantly less elastic than solid ones (p = 0.03). There was also positive correlation between nodule size and stiffness (p < 0.0001). Lesions localized in the isthmus were significantly less elastic than nodules in other localizations. (p = 0.0001). Solitary nodules were less elastic than lesions in multinodular goiter (p = 0.006). Correlation between Tg concentration and stiffness was significant (p < 0.0001, r = 0.24). The concentration of anti-thyroid autoantibodies was associated with stiffness at the border of significance. However, there was no significant difference between benign lesions in patients with diagnosed chronic autoimmune thyroiditis and patients without the disease. The analysis of the entire group of nodules revealed that shear wave elastography is a valuable modality of thyroid nodule assessment, with sensitivity of over 95 % and specificity of about 70 %. However, the stiffness value of the lesion might be increased in the case of nodules containing calcifications, cystic component, and those of size above 20 mm. Certain clinical conditions or attributes of the lesions influence the stiffness values of thyroid nodules. Identifying these variables is the basis for a credible interpretation of the results of a sonoelastographic examination and makes it possible to estimate the risk of thyroid nodule malignancy adequately.
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Affiliation(s)
- Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355, Poznan, Poland
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Menzilcioglu MS, Duymus M, Gungor G, Citil S, Sahin T, Boysan SN, Sarica A. The value of real-time ultrasound elastography in chronic autoimmune thyroiditis. Br J Radiol 2014; 87:20140604. [PMID: 25315887 DOI: 10.1259/bjr.20140604] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Chronic autoimmune thyroiditis (CAT) (chronic lymphocytic thyroiditis-Hashimoto's thyroiditis), which is the most common inflammatory disorder of the thyroid gland, causes hypothyroidism. Ultrasound elastography is a newly developed sonographic technique that provides an estimation of tissue elasticity by measuring the degree of tissue displacement under the application of an external force. In this study, our aim was to evaluate the accuracy of strain index ratio with real-time ultrasound elastography and to calculate the cut-off point for the diagnosis of CAT. Our aim was also to lead further studies on other pathological changes such as lymphoma, malign nodules etc. based on CAT by using this cut-off point. The gains from this study and further studies will assist clinical diagnoses and follow-up. METHODS Aplio™ 500 ultrasound machine (Toshiba Medical Systems Co. Ltd, Otawara, Japan) with linear 4.8-11.0 MHz transducers and elastography software was used. Routine B-mode (dimensions and parenchymal echogenicity) ultrasound evaluation was performed prior to the ultrasound elastography. RESULTS A total of 31 randomized patients (3 males, 28 females) with a mean age of 39.13 ± 10.16 years (range, 16-58 years) with CAT and 21 healthy controls (6 males, 15 females) with mean age of 34.67 ± 16.31 years (range, 14-81 years) were prospectively examined. The mean values of thyroid-stimulating hormone (TSH; normal TSH value is 0.27-4.20 IU ml(-1)) and anti-thyroid peroxidase (anti-TPO; normal anti-TPO value is 0-34 IU ml(-1)) were 3.40 ± 2.70 and 373.66 ± 148.94 IU ml(-1), respectively. No correlation was detected between serum TSH and thyroid tissue strain index (Spearman r coefficient of TSH was -0.290). Positive-sided correlation was detected between anti-TPO values and thyroid tissue strain index ratio (Spearman r coefficient of anti-TPO was 0.682). The median strain index ratio of patients with CAT (1.39 ± 0.72) was significantly higher than the mean ratio of the controls (0.76 ± 0.55). The area under the receiver operating characteristic curve was 0.775 (95% confidence interval). The optimal cut-off value (in which the sum of sensitivity and specificity was highest) for the prediction of diffuse thyroid pathology was 0.677. For this cut-off ratio, thyroid stiffness had 96% sensitivity and 67% specificity. A total of 30 of 31 patients (96%) and a total of 7 of 21 healthy controls (33%) exceeded the cut-off points. CONCLUSION The strain index ratio was higher in CAT than in normal thyroid parenchyma in real-time ultrasound elastography. Thus, it seems to be a useful method for the assessment of CAT with real-time ultrasound elastography, and further studies assessing the correlation of sonoelastography findings and histopathological subtypes of CAT would enrich the findings of the present study. ADVANCES IN KNOWLEDGE In our study, we detected the stiffness ratio of the thyroid tissue in patients with CAT. The cut-off value should be helpful for diagnosis or follow-up of the recently developed lesions such as lymphoma, malign nodule, etc. based on CAT. This study should also encourage new studies about CAT and ultrasound elastography.
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Affiliation(s)
- M S Menzilcioglu
- 1 Department of Radiology, Gazi University, Faculty of Medicine, Ankara, Turkey
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Tachibana T, Orita Y, Ogawara Y, Matsuyama Y, Abe I, Nakada M, Sato Y, Nishizaki K. Time-lag between symptom onset and laboratory findings in patients with subacute thyroiditis. Auris Nasus Larynx 2013; 41:369-72. [PMID: 24368199 DOI: 10.1016/j.anl.2013.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to delineate the frequency of delayed diagnosis in cases of subacute thyroiditis (SAT) and intervals between onset of clinical symptoms and appearance of abnormal laboratory findings. METHODS We reviewed the medical records of 27 patients (7 men and 20 women) with SAT who visited our hospital between 2007 and 2013. RESULTS On presentation to the hospital, 5 of 27 SAT cases (18.5%) showed normal laboratory findings. Among these 5 cases, the mean interval between symptom onset and thyrotropin (TSH) suppression was 6.3 weeks, and the mean interval to elevation of fT4 was 6.7 weeks. The longest interval from symptom onset to appearance of an abnormal laboratory finding was 11 weeks. CONCLUSION Sometimes time-lag exists between onset of clinical symptoms and the appearance of abnormal laboratory findings in patients with SAT. The possibility of this disease should not be excluded from the differential diagnoses for patients with clinical symptoms consistent with SAT but showing normal laboratory findings.
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Affiliation(s)
- Tomoyasu Tachibana
- Department of Otolaryngology, Himeji Red Cross Hospital, 12-1 Shimoteno 1-Chome, Himeji City, Hyogo 670-8540, Japan.
| | - Yorihisa Orita
- Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan
| | - Yuya Ogawara
- Department of Otolaryngology, Himeji Red Cross Hospital, 12-1 Shimoteno 1-Chome, Himeji City, Hyogo 670-8540, Japan
| | - Yuko Matsuyama
- Department of Otolaryngology, Himeji Red Cross Hospital, 12-1 Shimoteno 1-Chome, Himeji City, Hyogo 670-8540, Japan
| | - Iku Abe
- Department of Otolaryngology, Himeji Red Cross Hospital, 12-1 Shimoteno 1-Chome, Himeji City, Hyogo 670-8540, Japan
| | - Michihiro Nakada
- Nakada ENT Clinic, 2-2-20 Shirakuni, Himeji City, Hyogo 670-0808, Japan
| | - Yasuharu Sato
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan
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Szczepanek-Parulska E, Woliński K, Stangierski A, Gurgul E, Biczysko M, Majewski P, Rewaj-Łosyk M, Ruchała M. Comparison of diagnostic value of conventional ultrasonography and shear wave elastography in the prediction of thyroid lesions malignancy. PLoS One 2013; 8:e81532. [PMID: 24312313 PMCID: PMC3843667 DOI: 10.1371/journal.pone.0081532] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/14/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Thyroid nodular disease (TND) is a very common disorder. However, since the rate of malignancy is reported to be 3-10%, only a minority of patients require aggressive surgical treatment. As a result, there is a need for diagnostic tools which would allow for a reliable differentiation between benign and malignant nodules. Although a number of conventional ultrasonographic (US) features are proved to be markers of malignancy, Shear Wave Elastography (SWE) is considered to be an improvement of conventional US. The aim of this study was to compare conventional US markers and SWE diagnostic values in the differentiation of benign and malignant thyroid nodules. MATERIALS AND METHODS All patients referred for thyroidectomy, irrespective of the indications, underwent a US thyroid examination prospectively. Patients with TND were included into the study. Results of the US and SWE examinations were compared with post-surgical histopathology. RESULTS One hundred and twenty two patients with 393 thyroid nodules were included into the study. Twenty two patients were diagnosed with cancer. SWE turned out to be a predictor of malignancy superior to any other conventional US markers (OR=54.5 using qualitative scales and 40.8 using quantitative data on maximal stiffness with a threshold of 50 kPa). CONCLUSIONS Although most conventional US markers of malignancy prove to be significant, none of them are characterized by both high sensitivity and specificity. SWE seems to be an important step forward, allowing for a more reliable distinction of benign and malignant thyroid nodules. Our study, assessing SWE properties on the highest number of thyroid lesions at the time of publication, confirms the high diagnostic value of this technique. It also indicates that a quantitative evaluation of thyroid lesions is not superior to simpler qualitative methods.
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Affiliation(s)
- Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Kosma Woliński
- Department of Endocrinology, Metabolism and Internal Medicine, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Adam Stangierski
- Department of Endocrinology, Metabolism and Internal Medicine, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Edyta Gurgul
- Department of Endocrinology, Metabolism and Internal Medicine, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Maciej Biczysko
- Department of General Surgery, Gastroenterological Oncological Surgery and Plastic Surgery, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Przemysław Majewski
- Department of Clinical Pathomorphology, Karol Marcinkowski University of Medical Sciences
| | - Magdalena Rewaj-Łosyk
- Department of Endocrinology, Metabolism and Internal Medicine, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Medicine, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
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Alizad A, Urban MW, Morris JC, Reading CC, Kinnick RR, Greenleaf JF, Fatemi M. In vivo thyroid vibro-acoustography: a pilot study. BMC Med Imaging 2013; 13:12. [PMID: 23530993 PMCID: PMC3618245 DOI: 10.1186/1471-2342-13-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to evaluate the utility of a noninvasive ultrasound-based method, vibro-acoustography (VA), for thyroid imaging and determine the feasibility and challenges of VA in detecting nodules in thyroid. Methods Our study included two parts. First, in an in vitro study, experiments were conducted on a number of excised thyroid specimens randomly taken from autopsy. Three types of images were acquired from most of the specimens: X-ray, B-mode ultrasound, and vibro-acoustography. The second and main part of the study includes results from performing VA and B-mode ultrasound imaging on 24 human subjects with thyroid nodules. The results were evaluated and compared qualitatively. Results In vitro vibro-acoustography images displayed soft tissue structures, microcalcifications, cysts and nodules with high contrast and no speckle. In this group, all of US proven nodules and all of X-ray proven calcifications of thyroid tissues were detected by VA. In vivo results showed 100% of US proven calcifications and 91% of the US detected nodules were identified by VA, however, some artifacts were present in some cases. Conclusions In vitro and in vivo VA images show promising results for delineating the detailed structure of the thyroid, finding nodules and in particular calcifications with greater clarity compare to US. Our findings suggest that, with further development, VA may be a suitable imaging modality for clinical thyroid imaging.
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Affiliation(s)
- Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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