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Zhang Z, Xu Y, Hao Z, Wang H. Water immersion ultrasound can improve the repeatability of ultrasonic measurement of dorsalis pedis artery diameter and hemodynamic parameters. Ir J Med Sci 2024; 193:987-991. [PMID: 37707689 DOI: 10.1007/s11845-023-03522-3] [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: 08/28/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE In comparing the repeatability of the internal diameter and hemodynamic parameters of the dorsalis pedis artery measured by immersion ultrasound and contact ultrasound, the factors affecting the accuracy and repeatability of measurement were analyzed. This study aimed to provide a better method for ultrasound evaluation of the dorsalis pedis artery before flap transplantation. METHODS Two senior sonographers measured the diameter of the dorsalis pedis artery (D) of 56 healthy volunteers, measuring at the same location and at different time points using water immersion and contact ultrasound. Color Doppler ultrasound was used to measure the hemodynamics of the dorsalis pedis artery, including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI). The interclass correlation coefficient (ICC) was used to evaluate the intraobserver and interobserver repeatability for each group's measurements. RESULTS The intraobserver and interobserver reproducibility of D, PSV, EDV, and RI measurements by water immersion ultrasound was very good. The intraobserver and interobserver reproducibility of the contact ultrasound measurements of D, PSV, EDV, and RI was good. CONCLUSION The repeatability of water immersion ultrasound is better than that of contact ultrasound in the measurement of the dorsalis pedis artery. Water immersion ultrasound can improve the near-field resolution of superficial tissues and increase the display of the lengths of blood vessels in images, thereby suggesting its superiority in ultrasound examination of dorsalis pedis arteries.
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Affiliation(s)
- Zhijun Zhang
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Yuxi Xu
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Zhaoyang Hao
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Hui Wang
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China.
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Yi AJ, Yang WW, Cui XW, Dietrich CF, Wang B. The value of quantitative and a new qualitative color pattern shear wave elastography for the differentiation of ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm. Front Endocrinol (Lausanne) 2024; 14:1275256. [PMID: 38260152 PMCID: PMC10800972 DOI: 10.3389/fendo.2023.1275256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Objective This study aims to evaluate the diagnostic performance of quantitative shear wave elastography (SWE) and a new qualitative color pattern SWE for the differentiation of benign and malignant American College of Radiology Thyroid Imaging, Reporting, and Data System (ACR TI-RADS) 4 or 5 category thyroid nodules measuring ≤10 mm. Materials and methods From May 2020 to July 2022, a total of 237 patients with 270 thyroid nodules were enrolled, and conventional ultrasound and SWE examinations were performed for each patient. Each ACR TI-RADS 4 or 5 category thyroid nodule measuring ≤10 mm was evaluated by quantitative SWE and a new qualitative color pattern SWE. The diagnostic performance of quantitative SWE parameters, the new qualitative color pattern SWE, and the combination of SWE with ACR TI-RADS, respectively, for the differentiation of benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm was evaluated and compared. Results Among 270 thyroid nodules in 237 patients, 72 (26.67%) thyroid nodules were benign and 198 (73.33%) thyroid nodules were malignant. The qualitative color pattern SWE showed better diagnostic performance than the quantitative SWE parameters. When combining the qualitative color pattern SWE with ACR TI-RADS scores, with the optimal cutoff value of the total points ≥8, the thyroid nodules were considered malignant. The sensitivity, specificity, accuracy, and AUC were 89.90%, 56.94%, 81.11%, and 0.820 (95% CI: 0.768-0.864), respectively. Compared with using qualitative color pattern SWE alone, the combination of qualitative color pattern SWE and ACR TI-RADS had better diagnostic performance, which was significantly different (p < 0.05). Conclusion The combination of qualitative SWE color patterns and ACR TI-RADS had high sensitivity and accuracy, which might be a convenient and useful method to differentiate benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm. It would be helpful for the management of thyroid nodules and improving prognosis.
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Affiliation(s)
- Ai-jiao Yi
- Department of medical ultrasound, Yueyang Central Hospital, Yueyang, China
| | - Wei-Wei Yang
- Department of medical ultrasound, Yueyang Central Hospital, Yueyang, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Bin Wang
- Department of medical ultrasound, Yueyang Central Hospital, Yueyang, China
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Qi WH, Jin K, Cao LL, Peng M, He NA, Zhan XL, Yang Y, Guo YY, Cui XW, Jiang F. Diagnostic performance of a new two-dimensional shear wave elastography expression using siemens ultrasound system combined with ACR TI-RADS for classification of benign and malignant thyroid nodules: A prospective multi-center study. Heliyon 2023; 9:e20472. [PMID: 37790965 PMCID: PMC10543209 DOI: 10.1016/j.heliyon.2023.e20472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/05/2023] Open
Abstract
Objective The present study aimed to evaluate the efficacy of a new two-dimensional shear wave elastography (2D-SWE) method using a Siemens ultrasound system and its combination with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for the differential diagnosis of benign and malignant thyroid nodules. Methods Conventional ultrasound images and 2D-SWE (E-whole-mean and E-stiffest-mean) were prospectively analyzed in 593 thyroid nodules from 543 patients. Nodules were divided into diameter (D) ≤10 mm and D > 10 mm groups and graded using ACR TI-RADS. The receiver operating characteristic curve was plotted using pathological findings as the gold standard. Diagnostic performance was compared among 2D-SWE, ACR TI-RADS, and their combination. Results The area under the curve (AUC) for E-whole-mean was higher than that for E-stiffest-mean (0.858 vs. 0.790, P < 0.001), which indicated that it was the better 2D-SWE parameter for differentiating malignant nodules from benign nodules with an optimal cut-off point of 11.36 kPa. In the all-sizes group, the AUC for E-whole-mean was higher than that for ACR TI-RADS (0.858 vs. 0.808, P < 0.001). The combination of E-whole-mean and ACR TI-RADS resulted in a higher AUC (0.929 vs. 0.858 vs. 0.808, P < 0.001), sensitivity (87.0% vs. 80.3% vs. 85.2%), specificity (85.1% vs. 74.0% vs. 73.6%), accuracy (86.3% vs. 78.1% vs. 81.1%), positive predictive value (91.5% vs. 85.1% vs. 85.6%), and negative predictive value (78.0% vs. 67.0% vs. 72.9%) compared to E-whole-mean or ACR TI-RADS alone. The AUC for the combination of 2D-SWE and ACR TI-RADS was superior to that for E-whole-mean or ACR TI-RADS alone in both D ≤ 10 mm and D > 10 mm groups (P < 0.001). Conclusion As the better 2D-SWE parameter, E-whole-mean had a higher diagnostic power than ACR TI-RADS and enhanced the diagnostic performance of ACR TI-RADS when identifying benign and malignant thyroid nodules. The combination of E-whole-mean and ACR TI-RADS improved the diagnostic performance compared to using ACR TI-RADS alone, providing a new and reliable method for the clinical diagnosis of thyroid nodules.
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Affiliation(s)
- Wei-Hong Qi
- Department of Medical Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Kun Jin
- Department of Medical Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Liu-Liu Cao
- Department of Medical Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Mei Peng
- Department of Medical Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Nian-An He
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, PR China
| | - Xiao-Lin Zhan
- Department of Medical Ultrasound, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230012, PR China
| | - Yang Yang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, PR China
| | - Yun-Yun Guo
- Department of Medical Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China
| | - Fan Jiang
- Department of Medical Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, PR China
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Qiu Y, Xing Z, Yang Q, Luo Y, Ma B. Diagnostic performance of shear wave elastography in thyroid nodules with indeterminate cytology: A systematic review and meta-analysis. Heliyon 2023; 9:e20654. [PMID: 37842563 PMCID: PMC10570586 DOI: 10.1016/j.heliyon.2023.e20654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose Thyroid nodules classified as indeterminate in previous fine-needle aspiration cytology often necessitate additional evaluation to determine their histology, while shear wave elastography (SWE) offers an alternative option in this regard. The objective of this study was to assess the diagnostic effectiveness of SWE in evaluating indeterminate nodules. Methods The PubMed, EMBASE, and Web of Science databases were searched from 1st January 1970 to 1st March 2023. The studies were reviewed and the data was extracted by two separate reviewers. A Bayesian bivariate model was utilized to quantitatively synthesize the diagnostic accuracy and yield of the studies in R. Results A total of seven studies, involving indeterminate thyroid nodules undergoing SWE were included, and the overall malignancy rate was 34.1% (307/900). The summarized estimates of sensitivity and specificity were 0.792 (95% credible interval [CI], 0.727-0.850) and 0.845 (95% CI, 0.797-0.887), respectively. The summarized estimate for the diagnostic odds ratio (DOR) was 17.8 (95% CI, 14.0-22.6). Summarized receiver operating characteristic (SROC) plots indicated a trade-off between sensitivity and specificity, and the estimate of AUC was 0.866 (95% CI, 0.834-0.895). The summary estimates for positive and negative likelihood ratios were 4.67 (95% CI, 3.98-5.85) and 0.26 (95% CI, 0.23-0.28), respectively. Conclusions The overall accuracy of SWE remains satisfactory in indeterminate thyroid nodules. However, it should be noted that the available data are still extremely limited, and more studies or guidelines are required to provide further insights.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Xing
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qianru Yang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Buyun Ma
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
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Zhang Z, Wang H, Ding X, He S. Immersion ultrasound improves the repeatability of shear-wave elastography for measuring median nerve elasticity. J Orthop Surg Res 2023; 18:618. [PMID: 37612692 PMCID: PMC10464027 DOI: 10.1186/s13018-023-04097-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To study the factors that influence the measurement of median nerve elasticity, to provide a more reproducible test for the assessment of median nerve elasticity using shear wave elasticity (SWE), and to reduce operator empirical dependence. To compare the repeatability of the median nerve elasticity measurement using immersion SWE with that using contact SWE, analyze the factors affecting SWE measurement, and provide a more repeatable method for doctors without SWE operation experience. METHODS Two doctors without SWE operation experience measured the median nerve mean elastic modulus (Emean) at the same position and at different time points on the right wrist of 58 healthy volunteers using immersion and contact ultrasound methods. The intraobserver and interobserver repeatability of measurements was assessed using the interclass correlation coefficient (ICC), while the repeatability was assessed using the Bland-Altman diagram. RESULTS The intraobserver and interobserver repeatability of the median nerve elasticity measured via contact SWE by inexperienced operators were classified as good, with ICCs of 0.633 (95% CI 0.380-0.783) and 0.552 (95% CI 0.243-0.735), respectively. The intraobserver and interobserver repeatability of the median nerve elasticity measured by immersion SWE were very good, with ICCs of 0.975 (95% CI 0.958-0.985) and 0.942 (95% CI 0.902-0.966), respectively. The intraobserver and interobserver Bland-Altman diagram of median nerve elasticity measured by immersion SWE showed that 98% of the points fell within the 95% limits of agreement. The intraobserver and interobserver Bland-Altman diagram of median nerve elasticity measured by contact SWE showed that 94% of the points fell within the 95% limits of agreement. CONCLUSION Immersion ultrasound can improve the repeatability of median nerve elasticity measurements by inexperienced operators.
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Affiliation(s)
- Zhijun Zhang
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Hui Wang
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Xiaoya Ding
- Department of Ultrasound, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Shu He
- Medical Affairs Department, The Fifth People's Hospital of Chongqing, Chongqing, 400030, China.
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Zhang Y, Huang QY, Wu CJ, Chen Q, Xia CJ, Liu BJ, Liu YY, Zhang YF, Xu HX. Predicting malignancy in thyroid nodules based on conventional ultrasound and elastography: the value of predictive models in a multi-center study. Endocrine 2023; 80:111-123. [PMID: 36495391 DOI: 10.1007/s12020-022-03271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study aimed to establish predictive models based on features of Conventional Ultrasound (CUS) and elastography in a multi-center study to determine appropriate preoperative diagnosis of malignancy in thyroid nodules with different risk stratification based on 2017 Thyroid Imaging Reporting and Data System by the American College of Radiology (ACR TI-RADS) guidelines. METHODS Five hundred forty-eight thyroid nodules from three centers pathologically confirmed by the cytology or histology were retrospectively enrolled in the study, which were examined by CUS and elastography before fine needle aspiration (FNA) and surgery. Characteristics of CUS of thyroid nodules were reviewed according to 2017 ACR TI-RADS. Binary logistic regression analysis was used to develop the prediction models based on the different risk stratification of CUS features and elastography which were statistically significant. Values of predictive models were evaluated regarding the discrimination and calibration. RESULTS Binary logistic regression showed that patients' age, taller-than-wider, lobulated or irregular boundary, extra-thyroid extension, microcalcification and the elastic parameter of Virtual touch tissue imaging quantification (VTIQ) max were independent predictors for thyroid malignancy (p < 0.05) in the ACR model and showed the area under the curve (AUC) in training (0.912) and validation cohort (internal and external: 0.877 vs 0.935). Predictive models showed predictors in ACR TR4 and TR5 for malignancy and diagnostic performance of AUC in training, internal and external validation cohort respectively: the VTIQ max (p < 0.001) with AUC of 0.809 vs 0.842 vs 0.705 and the age, taller than wide, VTIQ max variables with AUC of 0.859 vs 0.830 vs 0.906 in validation cohort. All predictive models have better calibration capabilities (p > 0.05). CONCLUSIONS Predictive models combined CUS and elastography features would aid clinicians to make appropriate preoperative diagnosis of thyroid nodules among different risk stratification. The elastography parameter of VTIQ max has the priority in distinguishing thyroid malignancy with moderately suspicious (ACR TR4).
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Affiliation(s)
- Ying Zhang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, 200072, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Qiong-Yi Huang
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 200072, Shanghai, China
| | - Chang-Jun Wu
- Department of Ultrasound, The first Affifiliated Hospital of Harbin Medical University, 150007, Harbin, China
| | - Qi Chen
- Department of Ultrasound, The first Affifiliated Hospital of Harbin Medical University, 150007, Harbin, China
| | - Chun-Juan Xia
- Department of Ultrasound, The second Affifiliated Hospital of Kunming Medical University, 650106, Kunming, China
| | - Bo-Ji Liu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, 200072, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yun-Yun Liu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, 200072, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yi-Feng Zhang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, 200072, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Hui-Xiong Xu
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, 200072, Shanghai, China
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
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de Oliveira J, de Souza MA, Assef AA, Maia JM. Multi-Sensing Techniques with Ultrasound for Musculoskeletal Assessment: A Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:9232. [PMID: 36501933 PMCID: PMC9740760 DOI: 10.3390/s22239232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 06/17/2023]
Abstract
The study of muscle contractions generated by the muscle-tendon unit (MTU) plays a critical role in medical diagnoses, monitoring, rehabilitation, and functional assessments, including the potential for movement prediction modeling used for prosthetic control. Over the last decade, the use of combined traditional techniques to quantify information about the muscle condition that is correlated to neuromuscular electrical activation and the generation of muscle force and vibration has grown. The purpose of this review is to guide the reader to relevant works in different applications of ultrasound imaging in combination with other techniques for the characterization of biological signals. Several research groups have been using multi-sensing systems to carry out specific studies in the health area. We can divide these studies into two categories: human-machine interface (HMI), in which sensors are used to capture critical information to control computerized prostheses and/or robotic actuators, and physiological study, where sensors are used to investigate a hypothesis and/or a clinical diagnosis. In addition, the relevance, challenges, and expectations for future work are discussed.
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Affiliation(s)
- Jonathan de Oliveira
- Graduate Program in Health Technology (PPGTS), Pontifical Catholic University of Paraná, Curitiba 80215-901, Brazil
| | - Mauren Abreu de Souza
- Graduate Program in Health Technology (PPGTS), Pontifical Catholic University of Paraná, Curitiba 80215-901, Brazil
| | - Amauri Amorin Assef
- Graduate Program in Electrical and Computer Engineering (CPGEI), Federal University of Technology of Paraná (UTFPR), Curitiba 80230-901, Brazil
| | - Joaquim Miguel Maia
- Graduate Program in Electrical and Computer Engineering (CPGEI), Federal University of Technology of Paraná (UTFPR), Curitiba 80230-901, Brazil
- Electronics Engineering Department (DAELN), Federal University of Technology of Paraná (UTFPR), Curitiba 80230-901, Brazil
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Muacevic A, Adler JR. Variability, Validity and Operator Reliability of Three Ultrasound Systems for Measuring Tissue Stiffness: A Phantom Study. Cureus 2022; 14:e31731. [PMCID: PMC9678015 DOI: 10.7759/cureus.31731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Ultrasound elastography is a method of measuring soft tissue stiffness to detect the presence of pathology. There are several ultrasound elastography devices on the market. The aim of this study was twofold. Firstly, to determine the validity of three different ultrasound systems used to measure tissue stiffness. Secondly, to determine the operator reliability and repeatability when using these three systems. Materials and methods Two observers undertook multiple stiffness measurements from a phantom model using three different ultrasound systems; the LOGIQ E9, the Aixplorer, and the Acuson S2000. The phantom model had four cylindrical-shaped inclusions (Type 1-4) of increasing stiffness values and diameter embedded within. The background phantom stiffness was fixed. The mean, standard deviation, and coefficient of variation (CV) were calculated from measured stiffness readings per diameter per inclusion. Intra-observer variability was assessed. The validity of the measured stiffness value was assessed by calculating the difference between the measured elasticities and actual phantom elasticities. Bland-Altman plots with limits of agreement were used to display the inter-observer agreement. The intraclass correlation coefficients (ICC) were used to measure intra-observer, inter-observer, and inter-system reliability. Results Each observer undertook 1020 measurements. All three systems generally underestimated the stiffness values for the inclusions; the higher the actual stiffness value, the more significant the underestimation. The percentage difference between measured stiffness and actual stiffness varied from -79.1% to 12.7%. The intra-observer variability was generally less than 5% for observers using the LOGIQ E9 and the Aixplorer systems but more than 10% over the stiffer inclusions (Types 3 and 4) for the Acuson system. There was 'almost perfect' intra-observer reliability and repeatability for both the LOGIQ E9 and the Aixplorer systems; this was 'moderate' for the Acuson system over specific inclusions. For all systems, there was 'almost perfect' inter-observer reliability and repeatability between Observer A and Observer B. The inter-system reliability and repeatability were 'almost perfect' between the LOGIQ E9 system and the Aixplorer system but 'poor' and 'moderate' when the Acuson system was matched with the LOGIQ E9 system and the Aixplorer system, respectively. Conclusion This study has demonstrated that the Acuson, LOGIQ E9, and Aixplorer ultrasound systems have low variability, high reproducibility, and good intra-observer and inter-observer reliability when used to measure tissue stiffness. However, they all underestimated the stiffness values during this in vitro study. This study also revealed that not all ultrasound systems are comparable when measuring tissue stiffness, with some having better inter-system reliability than others. Ongoing standardization of technology is required at the manufacturer level.
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Combined Shear Wave Elastography and EU TIRADS in Differentiating Malignant and Benign Thyroid Nodules. Cancers (Basel) 2022; 14:cancers14225521. [PMID: 36428614 PMCID: PMC9688054 DOI: 10.3390/cancers14225521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Although multimodal ultrasound approaches have been suggested to potentially improve the diagnosis of thyroid cancer; the diagnostic utility of the combination of SWE and malignancy-risk stratification systems remains vague due to the lack of standardized criteria. The purpose of the study was to assess the diagnostic value of the combination of grey scale ultrasound assessment using EU TIRADS and shear wave elastography. 121 patients (126 nodules−81 benign; 45 malignant) underwent grey scale ultrasound and SWE imaging of nodules between 0.5 cm and 5 cm prior to biopsy and/or surgery. Nodules were analyzed based on size stratifications: <1 cm (n = 43); 1−2 cm (n = 52) and >2 cm (n = 31) and equivocal cytology status (n = 52), and diagnostic performance assessments were conducted. The combination of EU TIRADS with SWE using the SD parameter; maintained a high sensitivity and significantly improved the specificity of sole EU TIRADS for nodules 1−2 cm (SEN: 72.2% vs. 88.9%, p > 0.05; SPEC: 76.5% vs. 55.9%, p < 0.01) and >2 cm (SEN: 71.4% vs. 85.7%, p > 0.05; SPEC: 95.8% vs. 62.5%, p < 0.01). For cytologically-equivocal nodules; the combination with the SWE minimum parameter resulted in a significant reduction in sensitivity with increased specificity (SEN: 60% vs. 80%; SPEC: 83.4% vs. 37.8%; all p < 0.05). SWE in combination with EU TIRADS is diagnostically efficient in discriminating nodules > 1 cm but is not ideal for discriminating cytologically-equivocal nodules.
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Chen Y, Dong B, Jiang Z, Cai Q, Huang L, Huang H. SuperSonic shear imaging for the differentiation between benign and malignant thyroid nodules: a meta-analysis. J Endocrinol Invest 2022; 45:1327-1339. [PMID: 35229278 DOI: 10.1007/s40618-022-01765-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/09/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE To assess the diagnostic value of SuperSonic shear imaging (SSI) for the differentiation between benign and malignant thyroid nodules through meta-analysis. METHODS Online database searches were performed on PubMed, EMBASE, the Cochrane Library, and the Web of Science until 31 July 2021. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the quality of the included studies. Three measures of diagnostic test performance were used to examine the value of SSI, including the summary area under the receiver operating characteristic curve (AUROC), the summary diagnostic odds ratio (DOR), and the summary sensitivity and specificity. Heterogeneity was explored using meta-regression and subgroup analyses. RESULTS Finally, 21 studies with 3376 patients were included in this study. There were a total of 4296 thyroid nodules, in which 1806 malignant nodules and 2490 benign ones were involved. Thyroid nodules exhibited a malignancy rate of 42.0% (range 5.6-79.8%), 95.1% of which were of papillary variant. SSI showed a summary sensitivity of 74% [95% confidence interval (CI) 67-79%], specificity of 82% (95% CI 77-87%) and AUROC of 0.85 (95% CI 0.82-0.88) for the differentiation between benign and malignant thyroid nodules. The summary positive likelihood ratio (LR), negative LR, and DOR were 4.2 (95% CI 3.3-5.3), 0.32 (95% CI 0.26-0.40), and 13 (95% CI 9-18), respectively. CONCLUSIONS SSI showed high accuracy in the diagnostic differentiation between benign and malignant thyroid nodules and can be served as a noninvasive and important adjunct for thyroid nodule evaluation.
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Affiliation(s)
- Y Chen
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China
| | - B Dong
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Z Jiang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China
| | - Q Cai
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China
| | - L Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China
| | - H Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Quanzhou, 362000, Fujian, China.
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11
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Marcy PY, Russ G, Saba L, Sanglier J, Ghanassia E, Sharara H, Thariat J, Morvan JB, Bizeau A. Opinion: leading position of ultrasound in decision algorithm for small papillary thyroid carcinoma. Insights Imaging 2022; 13:101. [PMID: 35670930 PMCID: PMC9174402 DOI: 10.1186/s13244-022-01240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/22/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Pierre Yves Marcy
- Department of Radiodiagnostics and Interventional Imaging, Polyclinics ELSAN Group, PolyClinics Les Fleurs, Quartier Quiez, 83189, Ollioules, France.
| | - Gilles Russ
- Centre de Pathologie et d'Imagerie Paris 14ème, Unité Thyroïde et Tumeurs Endocrines. Hôpital La Pitie Salpetriere, 83 Bd de l'Hopital, Sorbonne Université, Paris, France
| | - Luca Saba
- Department of Radiology, Humanitas Mater Domini, Castellanza, VA, Italy
| | - Julie Sanglier
- Department of Ultrasound, Antoine Lacassagne Cancer Research Institute, Sophia Antipolis University, 33 Avenue Valombrose, Nice Cedex, France
| | - Edouard Ghanassia
- American Hospital of Paris, 63 bd Victor Hugo, Neuilly sur Seine, France
| | - Haithem Sharara
- Department of Radiology, University Hospital, Place du Pr R. Debré, Nîmes Cedex 9, France
| | - Juliette Thariat
- Department of Radiation Oncology, Cancer Research Institute Francois Baclesse, 3 Avenue Général Harris, Caen, France
| | - Jean Baptiste Morvan
- Department of Head and Neck Surgery, University Military Hospital Sainte-Anne, 2, Boulevard Sainte Anne, BP 600, Toulon, France
| | - Alain Bizeau
- Department of Head and Neck Surgery, Sainte Musse Hospital, 54, Rue Henri Sainte Claire Deville, Toulon, France
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12
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Zhou Q, Xu P, Ding H, Wang Y, Fu L, Wang B, Liu D. Application value of gray-scale ultrasound and shear wave elastography in differential diagnosis of thyroid nodules. Technol Health Care 2022; 30:1043-1054. [PMID: 35342061 DOI: 10.3233/thc-213137] [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] [Indexed: 12/07/2022]
Abstract
BACKGROUND The global prevalence of thyroid cancer has increased significantly in recent years. Ultrasonography is the preferred method for differentiating benign and malignant thyroid nodules preoperatively and is recommended by guidelines. OBJECTIVE To assess the application value of gray-scale ultrasound and shear wave elastography in distinguishing small thyroid nodules. METHODS A retrospective analysis of 228 thyroid nodules, all of which were confirmed by pathology after surgery or FNA from January 2019 to January 2020, was carried out. All nodules were divided into a ⩽ 5 mm group and a > 5 mm group according to their maximum size. We compared the differences in the gray scale and elastography of the nodules between the two groups and the accuracy of different diagnostic methods. RESULTS The accuracies of gray-scale ultrasound and shear wave elastography in the ⩽ 5 mm group were found to be lower than those in the > 5 mm group, and the gray-scale accuracy was slightly higher than that of shear wave elastography in both groups (p< 0.05). The largest AUC (area under the curve) of elastic parameters in the ⩽ 5 mm and > 5 mm groups was found for Emax and Esd, respectively. Based on a combination of these two parameters, the accuracies of the two groups were significantly higher than those of the parameters or gray scale alone (p< 0.05) and were 84.62% and 85.48%, respectively. CONCLUSION Shear wave elastography is valuable in the diagnosis of benign and malignant thyroid nodules using ultrasonography. When combining gray-scale ultrasound and shear wave elastography, the diagnostic accuracy is obviously improved, especially for ⩽ 5 mm small thyroid nodules.
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13
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Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis. Acad Radiol 2022; 29 Suppl 3:S114-S121. [PMID: 29054676 DOI: 10.1016/j.acra.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/03/2017] [Accepted: 09/03/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVE This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. METHODS PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively. CONCLUSION Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.
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14
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Alhyari A, Görg C, Dietrich CF, Kawohl S, Safai Zadeh E. Diagnostic Performance of Point Shear Wave Elastography (pSWE) Using Acoustic Radiation Force Impulse (ARFI) Technology in Mesenteric Masses: A Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12020523. [PMID: 35204612 PMCID: PMC8870845 DOI: 10.3390/diagnostics12020523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose: To evaluate the diagnostic performance of ultrasound point shear wave elastography (pSWE) using acoustic radiation force impulse (ARFI) technology in different benign and malignant mesenteric masses (MMs). Methods: A total of 69 patients with MMs diagnosed from September 2018 to November 2021 were included retrospectively in the study. The inclusion criteria were (1) an MM over 1 cm; (2) valid ARFI measurements; and (3) confirmation of the diagnosis of an MM by histological examination and/or clinical and radiological follow-up. To examine the mean ARFI velocities (MAVs) for potential cut-off values between benign and malignant MMs, a receiver operating characteristics analysis was implemented. Results: In total, 37/69 of the MMs were benign (53.6%) and 32/69 malignant (46.4%). Benign MMs demonstrated significantly lower MAVs than mMMs (1.59 ± 0.93 vs. 2.76 ± 1.01 m/s; p < 0.001). Selecting 2.05 m/s as a cut-off value yielded a sensitivity and specificity of 75.0% and 70.3%, respectively, in diagnosing malignant MMs (area under the curve = 0.802, 95% confidence interval 0.699–0.904). Conclusion: ARFI elastography may represent an additional non-invasive tool for differentiating benign from malignant MMs. However, to validate the results of this study, further prospective randomized studies are required.
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Affiliation(s)
- Amjad Alhyari
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
- Correspondence: ; Tel.: +49-6421-58-61538; Fax: +49-6421-58-62825
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland;
| | - Svenja Kawohl
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
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15
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Zhang Y, Lu F, Zhang YF, Xu HX, Shi H, Guo LH, Wei Q. Predicting malignancy in thyroid nodules with benign cytology results: The role of Conventional Ultrasound, Shear Wave Elastography and BRAF V600E. Clin Hemorheol Microcirc 2021; 81:33-45. [PMID: 34958011 DOI: 10.3233/ch-211337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND: Ultrasound-guided fine-needle aspiration (US-FNA) is the most accurate method for preoperative diagnosis of thyroid nodules, but how to deal with false negative results. OBJECTIVE: This study aimed to find preoperative diagnosis methods including Conventional Ultrasound (CUS), Shear Wave Elastography (SWE) and BRAF V600E testing to differentiate false negative nodules. METHODS: Forty-nine nodules in 49 patients with benign FNA results and pathological diagnoses were included. CUS and SWE features were evaluated. BRAF V600E analysis was performed after FNA. Diagnostic performances of three methods were analyzed in predicting malignancy in benign FNA results. RESULTS: Twenty-seven of 49 nodules were malignant, and 22 nodules were benign. Hypoechogenicity, taller-than-wider, irregular boundary, microcalcification, SWE max, SWE mean and BRAF V600E mutation were risk factors for malignancy. All 7 malignant nodules with BRAF V600E mutations and 18 of 20 malignant nodules without BRAF V600E mutations have two or more suspicious CUS features. Six of 7 malignant nodules with BRAF V600E mutations and 16 of 20 malignant nodules without BRAF V600E mutations had SWE mean value greater than the cut-off value. CONCLUSIONS: CUS, SWE and BRAF V600E were diagnostic tools for malignancy in FNA benign nodules. Further clinical decisions should be considered for nodules with 2 or more suspicious CUS features and SWE parameters greater than cut-off values whether BRAF V600E is mutational or not.
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Affiliation(s)
- Ying Zhang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Lu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yi-Feng Zhang
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hui Shi
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Le-Hang Guo
- Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Ultrasound Research and Education Institute, Clinical Research Center for interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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16
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Zhou Y, Chen H, Qiang J, Wang D. Systematic review and meta-analysis of ultrasonic elastography in the diagnosis of benign and malignant thyroid nodules. Gland Surg 2021; 10:2734-2744. [PMID: 34733723 DOI: 10.21037/gs-21-492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
Background In recent years, ultrasound elastography (USE) has been the main diagnostic technique for benign and malignant thyroid nodules. However, it cannot display the blood flow signals of nodules with smaller diameters clearly, which decreases its diagnostic accuracy. Methods Chinese and English databases were searched using "ultrasonic elastography", "benign and malignant thyroid nodules", and "diagnose" as the search terms. RevMan 5.3 software was used for meta-analysis. Results A total of 11 randomized controlled trials (RCTs) were included. Eight articles analyzed clinical symptoms, and the heterogeneity test results were Chi2 =7.46, df=7, I2=6%, and P=0.38; and Z=11.44, OR =14.58, 95% confidential interval (CI): 9.21-23.07, and P<0.01. The diagnostic efficacy of USE was analyzed in 8 articles, and the heterogeneity test results were Chi2 =3.03, df=7, I2=0%, and P=0.88; and Z=6.33, OR =7.47, 95% CI: 4.01-13.93, and P<0.01. The pathological diagnosis results of randomized controlled trials were analyzed in 10 literatures, and the heterogeneity test results were Tau2 =0.78, Chi2 =20.97, df=9, I2=57%, and P=0.01; and Z=7.27, OR =14.67, 95% CI: 7.11-30.27, and P<0.01. After meta-analysis, the combined sensitivity was 72.26% (95% CI: 0.625-0.764) and the combined specificity was 95.35% (95% CI: 0.815-0.943). The area under the receiver operating characteristic curve (AUC) was 0.857. Conclusions This meta-analysis confirmed that USE shows high sensitivity and specificity in diagnosing benign and malignant thyroid nodules, which could reduce the false negative rate (FNR) and false positive rate (FPR), showing high clinical diagnostic value.
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Affiliation(s)
- Ying Zhou
- Ultrasonography Department, Zhejiang Quhua Hospital, Quzhou, China
| | - Huali Chen
- Ultrasonography Department, Zhejiang Quhua Hospital, Quzhou, China
| | - Jialin Qiang
- Ultrasonography Department, Zhejiang Quhua Hospital, Quzhou, China
| | - Dandan Wang
- Ultrasonography Department, The Second Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
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17
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Li H, Kang C, Xue J, Jing L, Miao J. Influence of lesion size on shear wave elastography in the diagnosis of benign and malignant thyroid nodules. Sci Rep 2021; 11:21616. [PMID: 34732826 PMCID: PMC8566553 DOI: 10.1038/s41598-021-01114-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/21/2021] [Indexed: 12/07/2022] Open
Abstract
In shear wave elastography (SWE) studies, the optimal cutoff value of Young's modulus for the diagnosis of benign and malignant thyroid nodules varies greatly, which affects the clinical application of the method. The objective of this study was to evaluate the influence of thyroid nodule size on the clinical diagnostic efficacy of SWE. A total of 356 thyroid nodules of 280 patients were divided into three groups according to size (Group A: ≤ 1 cm; Group B: 1-2 cm; Group C: ≥ 2 cm). SWE was used to measure the maximum Young's modulus (Emax) values of all thyroid nodules. Receiver operating characteristic (ROC) curves were drawn with pathological results as the gold standard. For all nodules, the optimal cutoff value of Emax in SWE for diagnosing malignant thyroid nodules was 36.2 kPa. The sensitivity and specificity were 76.5% and 78.4%, respectively. Groups A, B, and C had different optimal Emax cutoff values of 33.7 kPa, 37.7 kPa, and 55.1 kPa, respectively. The area under the ROC curve (AUC) values of Groups A, B, and C (0.844, 0.886, and 0.935, respectively) were all greater than the values for all lesions (0.830). The specificity values of Groups A, B, and C (86.4%, 82.6%, and 88.2%, respectively) were all increased, and the sensitivity values of Groups B and C (89.7% and 96.4%, respectively) were also increased compared with the values for all lesions. Thyroid nodule size affects the optimal Emax cutoff value of SWE. We suggest that different cutoff values be used to diagnose benign and malignant thyroid nodules according to lesion size.
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Affiliation(s)
- Huizhan Li
- Department of Ultrasonography, Bethune Hospital Affiliated to Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
| | - Chunsong Kang
- Department of Ultrasonography, Bethune Hospital Affiliated to Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China.
| | - Jiping Xue
- Department of Ultrasonography, Bethune Hospital Affiliated to Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
| | - Liwei Jing
- Department of Health Statistics, Shanxi Medical University, 56 XinJian South Road, Taiyuan City, 030001, Shanxi Province, China
| | - Junwang Miao
- Department of Ultrasonography, Bethune Hospital Affiliated to Shanxi Medical University, 99 Longcheng Street, Taiyuan City, 030032, Shanxi Province, China
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18
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Swan KZ, Nielsen VE, Bonnema SJ. Evaluation of thyroid nodules by shear wave elastography: a review of current knowledge. J Endocrinol Invest 2021; 44:2043-2056. [PMID: 33864241 DOI: 10.1007/s40618-021-01570-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Shear wave elastography (SWE), as a tool for diagnosing thyroid malignancy, has gathered considerable attention during the past decade. Diverging results exist regarding the diagnostic performance of thyroid SWE. METHODS A comprehensive literature review of thyroid SWE was conducted using the terms "Thyroid" and "shear wave elastography" in PubMed. RESULTS The majority of studies found SWE promising for differentiating malignant and benign thyroid nodules on a group level, whereas results are less convincing on the individual level due to huge overlap in elasticity indices. Further, there is lack of consensus on the optimum outcome reflecting nodule elasticity and the cut-off point predicting thyroid malignancy. While heterogeneity between studies hinders a clinically meaningful meta-analysis, the results are discussed in a clinical perspective with regard to applicability in clinical practice as well as methodological advantages and pitfalls of this technology. CONCLUSION Technological as well as biological hindrances seem to exist for SWE to be clinically reliable in assessing benign and malignant thyroid nodules. Structural heterogeneity of thyroid nodules in combination with operator-dependent factors such as pre-compression and selection of scanning plane are likely explanations for these findings. Standardization and consensus on the SWE acquisition process applied in future studies are needed for SWE to be considered a clinically reliable diagnostic tool for detection of thyroid cancer.
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Affiliation(s)
- K Z Swan
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Faculty of Health, Aarhus University , Aarhus, Denmark.
| | - V E Nielsen
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - S J Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Quarato CMI, Venuti M, Dimitri L, Lacedonia D, Simeone A, Mirijello A, Cosmo SD, Maiello E, Taurchini M, Scioscia G, Barbaro MPF, Copetti M, Sperandeo M. Transthoracic ultrasound shear wave elastography for the study of subpleural lung lesions. Ultrasonography 2021; 41:93-105. [PMID: 34218607 PMCID: PMC8696150 DOI: 10.14366/usg.21021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/15/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The aim of this study was to assess whether new-generation shear wave elastography (SWE) is suitable for the characterization of lung subpleural lesions. METHODS In total, 190 consecutive patients with subpleural lung lesions received ultrasonography and SWE. Patients with suspected malignancy underwent ultrasound-guided transthoracic needle biopsy. Final diagnoses were made on the basis of patients' clinical course, microbiological studies, and histological results. SWE was also performed in 25 healthy volunteers. RESULTS We found no statistically significant differences in stiffness between lung carcinomas, lung metastases, and pneumonia (P=0.296) or between different histological types of lung cancer (P=0.393). Necrosis was associated with reduced stiffness in pneumonia. Excluding necrotic lesions, pneumonia showed higher stiffness than lung carcinomas (2.95±0.68 m/s vs. 2.60±0.54 m/s, P=0.006). Chronic pneumonia showed increased stiffness (3.03±0.63 m/s), probably due to the presence of fibrotic tissue on histology. Pleural effusion was associated with a statistically significant reduction in stiffness, both in lung carcinomas (P=0.004) and lung metastases (P=0.002). The presence of air in healthy lung tissue may lead to incorrect speed estimates due to shear wave reflection (very high values, 14.64±2.19 m/s). CONCLUSION Transthoracic SWE could not distinguish lung malignancy from pneumonia, or between different histological types of lung carcinomas. In particular, SWE seems unable to resolve the clinical dilemma of chronic subpleural consolidations.
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Affiliation(s)
- Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Mariapia Venuti
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Lucia Dimitri
- Unit of Pathology, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Anna Simeone
- Department of Radiology, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Mirijello
- Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Salvatore De Cosmo
- Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Evaristo Maiello
- Unit of Oncology, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Marco Taurchini
- Unit of Thoracic Surgery, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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20
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Kılınçer A, Durmaz MS, Baldane S, Kıraç CO, Cebeci H, Koplay M. Evaluation of the Stiffness of Thyroid Parenchyma With Shear Wave Elastography Using a Free-Region of Interest Technique in Graves Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:471-480. [PMID: 32767605 DOI: 10.1002/jum.15422] [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: 03/18/2020] [Revised: 05/31/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The first aim was to evaluate the stiffness of thyroid parenchyma with shear wave elastography (SWE) in patients with Graves disease (GD) and compare the elastographic values with those of asymptomatic volunteers. The second aim was to evaluate whether there was a correlation between SWE values and grayscale ultrasound (US) and laboratory parameters. METHODS In this prospective study, the thyroid gland parenchyma of 50 patients whose clinical and laboratory findings were indicative for GD and 54 asymptomatic participants with normal laboratory values was examined by SWE. Grayscale US images of the thyroid and submandibular gland were recorded. The volume of the thyroid gland was measured. Elastographic measurements were performed with a free region of interest. The quantitative SWE values (meters per second and kilopascals) of the patient and control groups were compared. A correlation analysis between the SWE values and grayscale US and laboratory parameters was performed. RESULTS The median (range) SWE values of the thyroid gland in patients with GD were significantly higher than those of the control group [17.34 (12.58-56.15) versus 12.05 (7.72-23.67) kPa and 2.28 (1.83-4.12) versus 1.92 (1.55-2.61) m/s; P < .001 for both comparisons]. When 14.5 kPa or 2.115 m/s was designated as the cutoff value, GD could be diagnosed with a high sensitivity and specificity. We showed a negative weak correlation between the SWE values and parenchymal echogenicity in the GD group. CONCLUSIONS Shear wave elastography can be used as an effective imaging method with high sensitivity and specificity rates in the diagnosis of GD.
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Affiliation(s)
- Abidin Kılınçer
- Department of Radiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Mehmet Sedat Durmaz
- Department of Radiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Süleyman Baldane
- Department of Internal Medicine, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Cem Onur Kıraç
- Department of Internal Medicine, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Hakan Cebeci
- Department of Radiology, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Mustafa Koplay
- Department of Radiology, Selçuk University Faculty of Medicine, Konya, Turkey
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Xu J, Wang P, Yue W, Luo Y, Li Z. Application of ultrasonic shear wave elastography and contrast-enhanced ultrasound in the differential diagnosis of patients with benign and malignant thyroid lesions. Gland Surg 2020; 9:2136-2143. [PMID: 33447564 DOI: 10.21037/gs-20-819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Thyroid nodules are a common thyroid disorder. The aim of the present study was to observe the application value of ultrasonic shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of patients with benign and malignant thyroid lesions. Methods Eighty-two patients with thyroid nodules (96 thyroid nodules) at our hospital were enrolled. All patients underwent ultrasonic SWE and CEUS examination. With surgical pathology as the gold standard, the Young's modulus, CEUS imaging features, and quantitative parameters were compared between the benign and malignant groups. The diagnostic efficiency of SWE, CEUS, and their combination was analyzed by receiver-operating characteristic curve (ROC). Results The average of the Young's modulus in the malignant group was significantly higher than that of the benign group (P<0.05). There were significant differences in the CEUS images of nodules between the benign and malignant groups in terms of boundary conditions, morphology, perfusion intensity, homogeneous enhancement, and perfusion defects (P<0.05), while there were no significant difference in initial increase time, peak intensity, time to peak, and area under the curve (P>0.05). The curve sharpness in the benign group was significantly lower than that of the malignant group (P<0.05). ROC analysis found that the diagnostic sensitivity and specificity of SWE, CEUS, and their combination were 90.1% and 81.6%, 67.8% and 75.4%, and 97.3% and 71.5%, respectively. Conclusions Compared with CEUS, the sensitivity and specificity of SWE were relatively higher in the differential diagnosis of benign and malignant thyroid lesions, and a combination of both can improve the diagnostic sensitivity of SWE alone to a certain extent.
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Affiliation(s)
- Jing Xu
- Department of Radiology, East Branch Hospital of Sichuan Provincial People's Hospital, Chengdu, China
| | - Ping Wang
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wensheng Yue
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuqun Luo
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zukun Li
- Department of Ultrasound, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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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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Filho RHC, Pereira FL, Iared W. Diagnostic Accuracy Evaluation of Two-Dimensional Shear Wave Elastography in the Differentiation Between Benign and Malignant Thyroid Nodules: Systematic Review and Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1729-1741. [PMID: 32227500 DOI: 10.1002/jum.15271] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/11/2020] [Accepted: 02/29/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate two-dimensional (2D) shear wave elastography (SWE) performance as an independent predictor of malignancy in the diagnostic differentiation of thyroid nodules (TNs), including subgroup analyses of different manufacturers and respective cutoffs points. METHODS The online databases MEDLINE (PubMed), Embase, and the Cochrane Library were searched for articles using 2D SWE in TN evaluation. After good-quality relevant thyroid-specific articles were selected, the main data, plus their sensitivity and specificity, were tabulated. Summary receiver operating characteristic curves were generated to verify the accuracy of data obtained from 3 manufactures. A meta-analysis was performed to evaluate whether clinical recommendations can be improved by the use of 2D SWE to differentiate TNs. RESULTS The sensitivity and specificity parameters of 2D SWE for the differentiation between benign and malignant TNs according to different instruments were, respectively, as follows: Toshiba SWE (Toshiba Medical Systems, Tochigi, Japan), 0.77 (95% confidence interval [CI], 0.70-0.83) and 0.76 (95% CI, 0.72-0.81); Virtual Touch tissue imaging and quantification (Siemens Medical Solutions, Mountain View, CA), 0.72 (95% CI, 0.67-0.77) and 0.81 (95% CI, 0.78-0.84); and SuperSonic SWE (SuperSonic Imagine, Aix-en-Provence, France), 0.63 (95% CI, 0.59-0.66) and 0.81 (95% CI, 0.79-0.83). The summary receiver operating characteristic curves showed the following area under the curve syntheses: Toshiba SWE, 0.84 (Q* = 0.7707); Virtual Touch tissue imaging and quantification, 0.85 (Q* = 0.7809); and SuperSonic SWE, 0.88 (Q* = 0.8102). Positive and negative predictive values varied, respectively, from 16% to 94% and 29% to 100%, considering all included articles. The overall accuracy ranged from 53% to 93%. CONCLUSIONS Two-dimensional SWE is a relevant and an important tool that supports ultrasound in clinical practice in the diagnostic differentiation between benign and malignant TNs.
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Affiliation(s)
| | | | - Wagner Iared
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Yang JR, Song Y, Xue SS, Ruan LT. Suggested amendment of TI-RADS classification of thyroid nodules by shear wave elastography. Acta Radiol 2020; 61:1026-1033. [PMID: 31825762 DOI: 10.1177/0284185119889567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The application of the ultrasound elastography and Thyroid Imaging Reporting and Data System (TI-RADS) classification further expands the scope of ultrasound differential diagnosis between benign and malignant thyroid nodules. PURPOSE To investigate the value of the quantitative parameter of ultrasonic shear waves in optimizing the TI-RADS classification of thyroid nodules. MATERIAL AND METHODS A total of 168 thyroid nodules, initially classified using TI-RADS and scanned by shear wave elastography (SWE), were retrospectively analyzed. All cases were diagnosed by fine needle aspiration and histology following surgery. RESULTS The benign rate of TI-RADS 3 nodules was 76.5%, while the benign rate of TI-RADS 4a nodules was 71.7%. Furthermore, the malignant rate of TI-RADS 4b nodules was 69.7%, while the malignant rate of TI-RADS 4c nodules was 85.7%. In differentiating benign from malignant nodules, the combination of TI-RADS classification and Emean had the largest area under the receiver operating characteristic curve (AUC). Using an Emean value of 42.25 kpa as the cut-off point, the malignant rate of TI-RADS 4a nodules decreased from 28.3% to 23.5%, while the malignant rate of TI-RADS 4b nodules increased from 69.7% to 79.4%. Compared to conventional ultrasound alone, the sensitivity, negative predictive value, and AUC of conventional ultrasound combined with SWE in the diagnosis of benign and malignant thyroid nodules significantly improved (P=0.012, 0.029, 0.001). CONCLUSION The SWE technique can be used to further determine the benign and malignant nature of TI-RADS 4 lesions, providing further reference for the choice of clinical treatment. The TI-RADS classification system corrected by SWE is more significant in the diagnosis of benign and malignant thyroid nodules.
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Affiliation(s)
- Jin-Ru Yang
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, PR China
| | - Yan Song
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, PR China
| | - Shan-Shan Xue
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, PR China
| | - Li-Tao Ruan
- Department of Ultrasonics, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an, PR China
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Incremental diagnostic value of shear wave elastography combined with contrast-enhanced ultrasound in TI-RADS category 4a and 4b nodules. J Med Ultrason (2001) 2020; 47:453-462. [PMID: 32306192 DOI: 10.1007/s10396-020-01016-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the diagnostic value of shear wave elastography (SWE) combined with contrast-enhanced ultrasonography (CEUS) in diagnosing thyroid imaging reporting and data system (TI-RADS) category 4a and 4b nodules. METHODS TI-RADS, SWE, and CEUS features of 71 thyroid nodules (23 benign, 48 malignant) confirmed by postoperative pathological results were retrospectively analyzed. The diagnostic efficiency of each single method and that of a combination of three methods were compared. RESULTS The sensitivity and specificity in diagnosing thyroid nodules were 70.83% and 65.22% for TI-RADS, 68.75% and 91.30% for SWE, 77.08% and 78.26% for CEUS, and 91.67% and 95.65% for TI-RADS + SWE + CEUS, respectively. The area under the curve for TI-RADS, SWE, CEUS, and TI-RADS + SWE + CEUS in diagnosing thyroid nodules were 0.680, 0.839, 0.799, and 0.937, respectively. A significant difference was observed between a combination of the three methods and any of them alone (p < 0.05). CONCLUSION Combining SWE and CEUS improves the differential diagnosis of TI-RADS category 4a and 4b nodules.
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Guan Y, Liu S, Li AC, Pan XB, Liang ZG, Cheng WQ, Zhu XD. A Pilot Study: N-Staging Assessment of Shear Wave Elastrography in Small Cervical Lymph Nodes for Nasopharyngeal Carcinoma. Front Oncol 2020; 10:520. [PMID: 32351896 PMCID: PMC7174777 DOI: 10.3389/fonc.2020.00520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate N-staging Assessment of pretreatment Shear wave elastrography (SWE) in small cervical lymph nodes (0. 5 cm ≤ maximum diameter < 1 cm, intact capsule, no central necrosis, sCLNs) in nasopharyngeal carcinoma (NPC) patients. Methods: Pathological biopsy proven 28 NPC patients with sCLNs shown in pretreatment magnetic resonance (MR) images and 40 target lymph nodes were enrolled. All target lymph nodes were divided into metastasis and benign lymph node groups according to pathology. SWE was used to exam the real time SWE imaging of each target lymph nodes before conducting ultrasonography guided fine needle biopsy. The minimum (Emin), maximum (Emax), and mean (Emean) elasticity indices (kPa) of target lymph nodes were recorded. The SWE examination was repeated three times for the same target lymph node and each elasticity indices for statistic was determined by average of three measurements. SPSS 21.0 statistics software is used for statistical analysis. The receiver operating characteristic (ROC) curve was performed to obtain the cutoff value of elasticity indices of metastatic sCLNs. Statistical significance was assumed when the P < 0.05. Results: Nine lymph nodes were metastatic and 31 were benign. The Emin, Emax, and Emean of benign group were 8.15 ± 6.12, 25.05 ± 12.37, and 16.05 ± 8.29 kPa, respectively; Emin, Emax, and Emean of metastasis group were 11.5 ± 6.17, 41.38 ± 17.87, and 23.48 ± 6.50 kPa, respectively. The difference of the Emax and Emean between metastasis and benign group were statistically significant (P = 0.003 and 0.018). The area under the ROC curve of Emin, Emax, and Emean of metastasis lymph node were 0.685 (P = 0.095), 0.785 (P = 0.010), and 0.765 (P = 0.017), respectively. Emax of 27 kPa and Emean of 17 kPa were taken as the cutoff value of diagnosis for metastasis sCLNs: the sensitivity, specificity, and accuracy were 77.8 and 100%, 71.0 and 61.3%, 75.0 and 70.0%, respectively. Conclusions: Pretreatment SWE has high accuracy in evaluating the sCLNs in NPC patients and is helpful for accurate N-staging and survival prognosis. It can be used as a clinical supplementary examination.
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Affiliation(s)
- Ying Guan
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shuai Liu
- Department of Radiotherapy Oncology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - An-Chuan Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin-Bin Pan
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhong-Guo Liang
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wan-Qin Cheng
- Department of Radiation Oncology, Shunde Hospital, Southern Medical University, Shunde, China
| | - Xiao-Dong Zhu
- Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China
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Shang H, Wu B, Liu Z, Liu Y, Cheng W. The effectiveness of shear wave elastography in the diagnosis of PTMC. Technol Health Care 2020; 28:221-226. [DOI: 10.3233/thc-191895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ying ZMD, Yifeng ZMD, Hanxiang WMD, Anqi ZMD, Hui SMD. A Novel Two-dimensional Quantitative Shear Wave Elastography Mode for Differential Diagnosis of Benign and Malignant Thyroid Nodules. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.190039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Tuan PA, Duc NM, An M, Vien MV, Giang BV. The Role of Shear Wave Elastography in the Discrimination Between Malignant and Benign Thyroid Nodules. Acta Inform Med 2020; 28:248-253. [PMID: 33627925 PMCID: PMC7879443 DOI: 10.5455/aim.2020.28.248-253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Grayscale ultrasound (US) is the most common imaging modality for the assessment of thyroid nodules. Objective: This research aimed to assess the value of using the elasticity index (EI), obtained using shear wave elastography (SWE), to discriminate between malignant and benign thyroid nodules. Materials and methods: A total of 86 patients (94 distinct thyroid nodules) were operated on at Vietnam National Cancer Hospital from June 2018 to June 2019. Comparisons of the grayscale ultrasound (US) findings and the EI values between the benign and malignant groups were performed using the Chi-square test and Student’s t-test, respectively. The discrimination abilities of EI were determined through receiver operating characteristic (ROC) curve analysis, with the computation of optimal cut-off points. Results: The EI values of the benign and malignant groups were 37.6 ± 26.1 kPa and 105.4 ± 48.8 kPa, respectively. The area under the ROC curve (AUROC) value for discrimination between groups based on EI values was 0.889 when using an optimal cut-off point of 74.5 kPa, which resulted in a sensitivity of 74.3% and a specificity of 90%. Logistic multivariate regression analysis found that EI and microcalcification were significant factors for the discrimination between groups, with an odds ratio (OR): 1.487 [95% confidence interval (95% CI): 1.124–1.968, p = 0.005] and OR: 12.119 (95% CI: 2.031–72.323, p = 0.006), respectively. Combining grayscale US imaging with SWE can increase the specificity of the diagnosis but does not increase the accuracy. Conclusion: SWE can be helpful for predicting the malignancy of thyroid nodules, although the accuracy of this method is only moderate.
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Affiliation(s)
- Phung Anh Tuan
- Department of Radiology, Vietnam Military Medical University, Hanoi, Vietnam.,Diagnostic Imaging Center, 103 Military Hospital, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Mac An
- Radiology Center, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Mai Van Vien
- Department of Thoracic Surgery, 108 Military Central Hospital, Hanoi, Vietnam
| | - Bui Van Giang
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
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Li X, Hou XJ, Du LY, Wu JQ, Wang L, Wang H, Zhou XL. Virtual Touch Tissue Imaging and Quantification (VTIQ) combined with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for malignancy risk stratification of thyroid nodules. Clin Hemorheol Microcirc 2019; 72:279-291. [PMID: 30856102 DOI: 10.3233/ch-180477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Xiang Li
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, Heilongjiang, China
| | - Xiu-Juan Hou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, Heilongjiang, China
| | - Lin-Yao Du
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, Heilongjiang, China
| | - Jia-Qi Wu
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, Heilongjiang, China
| | - Luo Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, Heilongjiang, China
| | - Hong Wang
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, Heilongjiang, China
| | - Xian-Li Zhou
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Nangang, Harbin, Heilongjiang, China
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Swan KZ, Bonnema SJ, Jespersen ML, Nielsen VE. Reappraisal of shear wave elastography as a diagnostic tool for identifying thyroid carcinoma. Endocr Connect 2019; 8:1195-1205. [PMID: 31340198 PMCID: PMC6709542 DOI: 10.1530/ec-19-0324] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/24/2019] [Indexed: 12/14/2022]
Abstract
Thyroid nodular disease is common, but predicting the risk of malignancy can be difficult. In this prospective study, we aimed to assess the diagnostic accuracy of shear wave elastography (SWE) in predicting thyroid malignancy. Patients with thyroid nodules were enrolled from a surgical tertiary unit. Elasticity index (EI) measured by SWE was registered for seven EI outcomes assessing nodular stiffness and heterogeneity. The diagnosis was determined histologically. In total, 329 patients (mean age: 55 ± 13 years) with 413 thyroid nodules (mean size: 32 ± 13 mm, 88 malignant) were enrolled. Values of SWE region of interest (ROI) for malignant and benign nodules were highly overlapping (ranges for SWE-ROImean: malignant 3-100 kPa; benign 4-182 kPa), and no difference between malignant and benign nodules was found for any other EI outcome investigated (P = 0.13-0.96). There was no association between EI and the histological diagnosis by receiver operating characteristics analysis (area under the curve: 0.51-0.56). Consequently, defining a cut-off point of EI for the prediction of malignancy was not clinically meaningful. Testing our data on previously proposed cut-off points revealed a low accuracy of SWE (56-80%). By regression analysis, factors affecting EI included nodule size >30 mm, heterogeneous echogenicity, micro- or macrocalcifications and solitary nodule. In conclusion, EI, measured by SWE, showed huge overlap between malignant and benign nodules, and low diagnostic accuracy in the prediction of thyroid malignancy. Our study supports that firmness of thyroid nodules, as assessed by SWE, should not be a key feature in the evaluation of such lesions.
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Affiliation(s)
- Kristine Zøylner Swan
- Department of Otorhinolaryngology Head & Neck Surgery, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
- Correspondence should be addressed to K Z Swan:
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Odense C, Denmark
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Xu HX, Yan K, Liu BJ, Liu WY, Tang LN, Zhou Q, Wu JY, Xue ES, Shen B, Tang Q, Chen Q, Xue HY, Li YJ, Guo J, Wang B, Li F, Yan CY, Li QS, Wang YQ, Zhang W, Wu CJ, Yu WH, Zhou SJ. Guidelines and recommendations on the clinical use of shear wave elastography for evaluating thyroid nodule1. Clin Hemorheol Microcirc 2019; 72:39-60. [PMID: 30320562 DOI: 10.3233/ch-180452] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- 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
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Bo-Ji Liu
- 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
| | - Wen-Ying Liu
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Li-Na Tang
- Department of Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Qi Zhou
- Department of Ultrasound, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jin-Yu Wu
- Department of Ultrasound, Harbin First Hospital, Harbin, China
| | - En-Sheng Xue
- Department of Ultrasound, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Bin Shen
- Department of Ultrasound, People’s Hospital of Fenghua, Fenghua, China
| | - Qing Tang
- Department of Ultrasound, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qin Chen
- Department of Ultrasound, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Hong-Yuan Xue
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China
| | - Ying-Jia Li
- Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Guo
- Department of Ultrasound, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Bin Wang
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Fang Li
- Department of Ultrasound, Chongqing Cancer Hospital, Chongqing, China
| | - Chun-Yang Yan
- Department of Ultrasound, Seventh People’s Hospital of Ningbo, Ningbo, China
| | - Quan-Shui Li
- Department of Ultrasound, Luohu Hospital Group Affiliated to Shenzhen University, Shenzhen, China
| | - Yan-Qing Wang
- Department of Ultrasound, Zhengzhou People’s Hospital, Zhengzhou, China
| | - Wei Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chang-Jun Wu
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wen-Hui Yu
- Department of Ultrasound, Wuchang Hospital of Hubei Province, Wuhan, China
| | - Su-Jin Zhou
- Department of Ultrasound, Guangdong Second Provincial General Hospital, Guangzhou, China
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Measurement of Spleen Stiffness by Shear-Wave Elastography for Prediction of Splenomegaly Etiology. Ultrasound Q 2019; 35:153-156. [DOI: 10.1097/ruq.0000000000000403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Multifactor Analysis of Thyroid Stiffness in Graves Disease: A Preliminary Study. AJR Am J Roentgenol 2019; 212:950-957. [PMID: 30807222 DOI: 10.2214/ajr.18.20414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE. The aim of this study was to evaluate the value of shear wave elastography (SWE) in Graves disease (GD) and to identify the potential factors influencing thyroid stiffness. MATERIALS AND METHODS. A total of 207 subjects were enrolled and underwent SWE examination in the study, including 162 patients with GD and 45 healthy volunteers with normal thyroids, matched for age and sex. For all subjects, five measurements of elastic modulus values (SWE mean, SWE minimum, and SWE maximum of a 9-mm ROI) were performed on each thyroid lobe, and a mean value was calculated. The indicators including free three-triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), thyroid size, isthmus thickness, anti-thyroid peroxidase (TPO) antibodies (Abs), and antithyroglobulin (TG) Abs were detected in the 162 patients with GD, among whom 88 patients underwent initial TSH receptor (TR) Ab examination. RESULTS. The elastic modulus values for patient with GD were significantly higher than those for healthy control subjects. The ROC AUC values for GD by SWE mean was 0.656, and the cutoff value was 15.45 kPa. The sensitivity and specificity were 56.8% and 71.1%, respectively. The duration of disease, thyroid size, isthmus thickness, and levels of TPO Ab, TG Ab, and TR Ab were positively correlated with SWE mean in GD. However, there was no correlation between age, FT3, FT4, TSH, and SWE mean. CONCLUSION. Quantitative SWE helps in the diagnosis of GD. The duration of disease, thyroid size, isthmus thickness, and levels of thyroid autoantibodies (TPO Ab, TG Ab, and TR Ab) could influence thyroid stiffness of GD.
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Farghadani M, Tabatabaei SA, Barikbin R, Shahsanai A, Riahinezhad M, Jafarpishe S. Comparing the Sensitivity and Specificity of Two-Dimensional Shear Wave Elastography and Fine Needle Aspiration in Determining Malignant Thyroid Nodules. Adv Biomed Res 2019; 8:30. [PMID: 31114770 PMCID: PMC6507363 DOI: 10.4103/abr.abr_215_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Malignancy in thyroid nodules is a common clinical problem, and epidemiological studies have shown that it is increasing. Since malignancy is a very important problem in treating patients and misdiagnosis leads to many physical and financial damages, the importance of diagnostic methods becomes more important. Hence, the aim of this study was to investigate the sensitivity and specificity of the two dimensional-shear wave elastography (2D-SWE) diagnostic method in comparison with fine-needle aspiration (FNA) in determining the malignant thyroid nodules. Materials and Methods This study is cross-sectional which was performed on 57 thyroid nodules are proven by conventional ultrasound. Afterward, 2D-SWE images were taken with the help of a superSonic ultrasound machine. Then, FNA was performed from the thyroid nodules and the specimens were evaluated in a single specialized thyroid pathology center. The results of conventional sonography and 2D-SWE were compared with histopathologic results as a gold standard method. The elasticity quantity was recorded by measuring the amount of the appropriate quantities by a recording machine and analyzed using the SPSS and MedCalc software. Results From 57 nodules studied, 50 nodules were evaluated with benign diagnosis and 7 nodules with the malignant diagnosis. Among all the parameters recorded by the machine, SWE. ratio provided the highest surface area under the curve and the highest sensitivity and specificity with 0.94, 100% and 84%, respectively, and a cut-off point of 1.7. Conclusion The 2D-SWE method and the conventional ultrasound can be good references for decision making about with the thyroid nodules.
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Affiliation(s)
- Maryam Farghadani
- Department of Radiology, Isfahan university of Medical Sciences, Isfahan, Iran
| | | | - Roozbeh Barikbin
- Department of Radiology, Isfahan university of Medical Sciences, Isfahan, Iran
| | - Armindokht Shahsanai
- Department of Community and Family Medicine, Isfahan university of Medical Sciences, Isfahan, Iran
| | - Maryam Riahinezhad
- Department of Radiology, Isfahan university of Medical Sciences, Isfahan, Iran
| | - Saleh Jafarpishe
- Department of Radiology, Isfahan university of Medical Sciences, Isfahan, Iran
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Li T, Lu M, Li Y, Li J, Hu Z, Li X, Cheng X, Jiang J, Tan B. Quantitative Elastography of Rectal Lesions: The Value ofShear Wave Elastography in Identifying Benign and Malignant Rectal Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:85-92. [PMID: 30342780 DOI: 10.1016/j.ultrasmedbio.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/01/2018] [Accepted: 09/11/2018] [Indexed: 06/08/2023]
Abstract
We evaluate the value of shear wave elastography (SWE) in diagnosing benign and malignant rectal lesions. A total of 96 lesions were reviewed in this study; endorectal ultrasound (ERUS) and SWE examinations were performed before surgery in all cases. Elasticity parameters including mean elastographic index (Emean), maximum elastographic index (Emax) and minimum elastographic index (Emin) were analyzed. Correlations between elastographic parameters and histopathological results were studied. Inter-observer and intra-observer agreement was analyzed. Of the 96 rectal lesions, 72 were malignant and 24 were benign. Compared with ERUS, ERUS + SWE had higher sensitivity (93.0% vs. 88.9%), specificity (83.3% vs. 79.2%), positive predictive value (94.4% vs. 92.7%), negative predictive value (80.0% vs. 70.4%) and overall accuracy (90.6% vs. 86.4%). In receiver operating characteristic curve analysis, Emean and Emax had larger areas under the curve: 0.92 and 0.91, respectively. The optimal cutoff value was 61.3 kPa for Emean (sensitivity = 88.9%, specificity = 87.5%) and 63.4 kPa for Emax (sensitivity = 94.4%, specificity = 83.3%). We obtained κ values of 0.83 (95% confidence interval [CI]: 0.72-0.95) for ERUS and 0.90 (95% CI: 0.81-0.99) for ERUS + SWE of differential diagnosis in two observers. The intra-class correlation coefficients for intra-observer variability of stiffness (Emean) in malignant lesions, benign lesions, surrounding normal rectal wall in malignant lesions and surrounding normal rectal wall in benign lesions were 0.91 (95% CI: 0.86-0.94), 0.94 (95% CI: 0.88-0.97), 0.92 (95% CI: 0.88-0.95) and 0.89 (95% CI: 0.77-0.95), respectively. SWE is a promising tool that yields valuable quantitative data additional to that provided by ERUS examination in rectal lesions. The cutoff value 61.3 kPa for Emean may serve as a complementary tool in diagnosis of rectal lesions.
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Affiliation(s)
- Tingting Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yuan Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Juan Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ziyue Hu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; North Sichuan Medical College, Nanchong, China
| | - Xu Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xueqing Cheng
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingzhen Jiang
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; North Sichuan Medical College, Nanchong, China
| | - Bo Tan
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Quantitative Assessment of Thyroid, Submandibular, and Parotid Glands Elasticity With Shear-Wave Elastography in Children. Ultrasound Q 2018; 34:58-61. [PMID: 29596300 DOI: 10.1097/ruq.0000000000000352] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tissue elasticity is becoming a more commonly used parameter in evaluation of parenchyma in inflammatory diseases. Considering the changes in the thyroid and salivary glands with adolescence, determination of mean elasticity ranges with a function of age is necessary to apply ultrasound elastography more widely in the pediatric population.The thyroid, submandibular, and parotid glands of 127 healthy volunteers (66 males, 61 females; mean age = 10.3 ± 3.9 years; range = 3-17 years) were evaluated with shear-wave elastography.The mean elasticity values for the thyroid, submandibular, and parotid glands were 14.6 ± 3.3, 11.8 ± 2.2, and 11.8 ± 2.6 kPa, respectively. There was a significant positive correlation between age and elasticity of the thyroid, submandibular, and parotid glands. There was a significant correlation between age and elasticity value of the thyroid gland adjusted for weight and height.This study provided the baseline quantitative elasticity measures of thyroid, submandibular, and parotid glands, which would be a reference for upcoming studies. In addition, an increase in elasticity value in thyroid gland as a function of age independent of change in weight and height was demonstrated.
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Chen J, Li XL, Zhao CK, Wang D, Wang Q, Li MX, Wei Q, Ji G, Xu HX. Conventional Ultrasound, Immunohistochemical Factors and BRAF V600E Mutation in Predicting Central Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2296-2306. [PMID: 30100099 DOI: 10.1016/j.ultrasmedbio.2018.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/28/2018] [Accepted: 06/29/2018] [Indexed: 12/18/2022]
Abstract
The study was aimed at evaluating the correlation between central cervical lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) patients and ultrasound (US) features, immunohistochemical factors and BRAFV600E mutation. A total of 225 consecutive patients (225 PTCs) who had undergone surgery were included. All PTCs were pre-operatively analysed by US with respect to size, components, echogenicity, shape, margins, microcalcification, multiple cancers or not, internal vascularity and capsule contact or involvement. The presence of four immunohistochemical factors, including cytokeratin 19, human bone marrow endothelial cell 1, galectin-3 and thyroid peroxidase, and BRAFV600E mutation was also evaluated. Univariate and multivariate analyses were performed to identify the risk factors for central CLNM, and a risk model was established. Pathologically, 44% (99/225) of the PTCs had central CLNMs. Multivariate analysis revealed that size ≤10mm, microcalcification, internal vascularity, capsule contact or involvement and BRAFV600E mutation were independent risk factors for central CLNM. The risk score for central CLNM was calculated as follows: risk score = 1.5 × (if lesion size ≤10 mm) + 1.9 × (if microcalcification) + 0.8 × (if internal flow) + 3.0 × (if capsule contact or involvement) + 1.5 × (if BRAFV600E mutation). The rating result was divided into six stages, and the relevant risk rates of central CLNM were 0% (0/1), 0% (0/22), 7.4% (4/54), 48.6% (34/70), 71.2% (42/59) and 100% (19/19), respectively. In conclusion, PTC ≤10mm, microcalcification, internal vascularity, capsule contact or involvement and BRAFV600E mutation are risk factors for central CLNM. The risk model may be useful in treatment planning and management of patients with PTCs.
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Affiliation(s)
- Jie Chen
- Department of Medical Ultrasound, The Affiliated Shanghai Tenth People's Hospital of Nanjing Medical University, Shanghai, China; 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 Disease, Shanghai, China; Department of Medical Ultrasound, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, The Affiliated Shanghai Tenth People's Hospital of Nanjing Medical University, Shanghai, China; 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 Disease, Shanghai, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, The Affiliated Shanghai Tenth People's Hospital of Nanjing Medical University, Shanghai, China; 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 Disease, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, The Affiliated Shanghai Tenth People's Hospital of Nanjing Medical University, Shanghai, China; 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 Disease, Shanghai, China
| | - Qiao Wang
- Department of Medical Ultrasound, The Affiliated Shanghai Tenth People's Hospital of Nanjing Medical University, Shanghai, China; 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 Disease, Shanghai, China
| | - Ming-Xu Li
- Department of Medical Ultrasound, The Affiliated Shanghai Tenth People's Hospital of Nanjing Medical University, Shanghai, China; 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 Disease, Shanghai, China
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guo Ji
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, The Affiliated Shanghai Tenth People's Hospital of Nanjing Medical University, Shanghai, China; 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 Disease, Shanghai, China.
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Yin L, Lu R, Cao W, Zhang L, Li W, Sun H, Guo R. Three-Dimensional Shear Wave Elastography of Skeletal Muscle: Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2053-2062. [PMID: 29399850 DOI: 10.1002/jum.14559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/15/2017] [Accepted: 11/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Two-dimensional (2D) shear wave elastography (SWE) can measure the elasticity of skeletal muscle, tendons, and ligaments. Three-dimensional (3D) SWE has been used to detect breast cancer but has not been applied to the musculoskeletal system. This study aimed to investigate whether 3D SWE could be used in skeletal muscles in vivo. METHODS The study enrolled 20 healthy volunteers at Beijing Chaoyang Hospital from August to October 2016. Two-dimensional and 3D SWE scans were used to measure the Young modulus of the flexor carpi radialis in the relaxed state. Longitudinal and transverse scanning was performed. Data were analyzed by a 1-way analysis of variance/least significant difference post hoc test, a paired t test, and Bland-Altman plots. RESULTS The participants included 10 male and 10 female volunteers with a mean age ± SD of 25 ± 5 years. The Young modulus did not differ between 3D and 2D SWE for the sagittal plane (longitudinal scanning, 34.9 ± 5.7 versus 32.7 ± 5.2 kPa; P = .096) or transverse plane (transverse scanning, 9.1 ± 2.1 versus 9.2 ± 1.6 kPa; P = .877). The Young modulus did not differ between sagittal, transverse, and coronal planes for 3D SWE longitudinal scanning (34.9 ± 5.7, 34.3 ± 5.8, and 34.8 ± 5.9 kPa, respectively; P = .936) or 3D SWE transverse scanning (9.1 ± 2.0, 9.1 ± 2.1, and 8.8 ± 2.1 kPa; P = .838). However, the Young modulus for each individual plane (sagittal, transverse, or coronal) differed significantly between longitudinal and transverse scanning (P < .001). CONCLUSIONS Both 2D SWE and 3D SWE are suitable techniques for clinical use, depending on the examiner's experience/preference. However, 3D SWE provides a multiplanar/multislice view that better illustrates the spatial characteristics of muscle tissue. Three-dimensional SWE may be a new method for fully visualizing the musculoskeletal system.
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Affiliation(s)
- Li Yin
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruigang Lu
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wen Cao
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lingling Zhang
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenjing Li
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hong Sun
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ruijun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Zhao CK, Chen SG, Alizad A, He YP, Wang Q, Wang D, Yue WW, Zhang K, Qu S, Wei Q, Xu HX. Three-Dimensional Shear Wave Elastography for Differentiating Benign From Malignant Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1777-1788. [PMID: 29315789 DOI: 10.1002/jum.14531] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To prospectively evaluate the diagnostic performance of 3-dimensional (3D) shear wave elastography (SWE) for assessing thyroid nodules. METHODS A total of 176 surgically or cytologically confirmed thyroid nodules (63 malignant and 113 benign) in 176 patients who had undergone conventional ultrasound (US), 2-dimensional (2D) SWE, and 3D SWE examinations were included in this study. Quantitative elasticity values (mean elasticity, maximum elasticity, and standard deviation of elasticity of a large region of interest and mean elasticity of a 2-mm region of interest) were measured on 2D and 3D SWE. Diagnostic performances of conventional US, 2D SWE, and 3D SWE were assessed. The role of 2D and 3D SWE in reducing unnecessary fine-needle aspiration (FNA) for nodules with low suspicion was also evaluated. RESULTS The diagnostic performances in terms of the area under the receiver operating characteristic curve were 0.612 for conventional US, 0.836 for 2D SWE (P < .001 in comparison with conventional US), and 0.839 for 3D SWE (P < .001 in comparison with conventional US). The mean elasticity achieved the highest diagnostic performance in 2D SWE, whereas the standard deviation of elasticity achieved the highest performance in 3D SWE, although no significant difference was found between them (P > .05). Three-dimensional SWE increased the specificity in comparison with 2D SWE (88.5% versus 82.3%; P = .039). For the 37 nodules with low suspicion on conventional US imaging, 2D SWE was able to avoid unnecessary FNA in 77.1% (27 of 35) of benign nodules, and 3D SWE further increased the number to 88.6% (31 of 35). CONCLUSIONS Three-dimensional SWE is a useful tool for predicting thyroid nodule malignancy and reducing unnecessary FNA procedures in thyroid nodules with low suspicion of malignancy.
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Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Shi-Gao Chen
- Departments of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Azra Alizad
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Kun Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Shen Qu
- Department of Pathology, Shanghai Tenth People's Hospital, and Thyroid Institute Tongji University School of Medicine, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Qing Wei
- Departments of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Shanghai Tenth People's Hospital, and Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
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Abstract
Tissue stiffness has long been known to be a biomarker of tissue pathology. Ultrasound elastography measures tissue mechanical properties by monitoring the response of tissue to acoustic energy. Different elastographic techniques have been applied to many different tissues and diseases. Depending on the pathology, patient-based factors, and ultrasound operator-based factors, these techniques vary in accuracy and reliability. In this review, we discuss the physical principles of ultrasound elastography, discuss differences between different ultrasound elastographic techniques, and review the advantages and disadvantages of these techniques in clinical practice.
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Affiliation(s)
- Arinc Ozturk
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Joseph R Grajo
- Department of Radiology, Division of Abdominal Imaging, University of Florida College of Medicine, Gainesville, FL, USA
| | - Manish Dhyani
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Brian W Anthony
- Device Realization and Computational Instrumentation Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Anthony E Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA.
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Mao F, Xu HX, Zhou H, Bo XW, Li XL, Li DD, Liu BJ, Zhang YF, Xu JM, Qu S. Assessment of Virtual Touch Tissue Imaging Quantification and the Ultrasound Thyroid Imaging Reporting and Data System in Patients With Thyroid Nodules Referred for Biopsy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:725-736. [PMID: 28960465 DOI: 10.1002/jum.14413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of Virtual Touch tissue imaging quantification (VTIQ; Siemens Medical Solutions, Mountain View, CA) in combination with the Thyroid Imaging Reporting and Data System (TI-RADS) for assessing thyroid nodules referred for biopsy. METHODS A total of 197 surgically or cytologically proven thyroid nodules in 187 patients were included. Nodules evaluated by conventional ultrasound (US) and VTIQ examinations were classified into US TI-RADS categories. The shear wave velocity (SWV) on VTIQ was assessed, and the cutoff value was obtained from a receiver operating characteristic curve analysis. Diagnostic performances of conventional US, VTIQ, and their combination were compared. RESULTS There were 134 benign and 63 malignant nodules. The sensitivity and specificity for the US TI-RADS were 98.4% and 20.1%, respectively. The areas under the receiver operating characteristic curves for the mean, maximum, minimum, and ratio of the SWV were 0.818, 0.805, 0.799, and 0.728. With a cutoff value of 2.90 m/s, the sensitivity and specificity of the mean SWV were 71.4% and 82.8%. By applying this value or less as a standard for downgrading TI-RADS category 4a to category 3 lesions, the specificity significantly rose from 20.1% to 47.0% (P < .001) without a loss of sensitivity. CONCLUSIONS The additional application of VTIQ can improve the specificity of the TI-RADS for evaluating thyroid nodules without a loss of sensitivity.
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Affiliation(s)
- Feng Mao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hang Zhou
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- In-Patient Ultrasound Department, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Shen Qu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Shanghai Center for Thyroid Diseases, Shanghai, China
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Chang N, Zhang X, Wan W, Zhang C, Zhang X. The Preciseness in Diagnosing Thyroid Malignant Nodules Using Shear-Wave Elastography. Med Sci Monit 2018; 24:671-677. [PMID: 29391387 PMCID: PMC5806774 DOI: 10.12659/msm.904703] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Our study aimed to identify more accurate results about the diagnostic role of shear-wave elastography (SWE) for thyroid malignant nodules through a meta-analysis. Potential articles were searched in PubMed, Embase, and the Cochrane Library databases. Overall sensitivity and specificity with 95% confidence intervals (CIs) was used to represent the diagnostic accuracy of SWE. Summary receiver operating characteristic (ROC) curve was constructed to illustrate the results. In addition, χ2 and I2 tests were performed to assess heterogeneity. A value of p≤0.05 indicated significant heterogeneity. All the analysis was conducted in Meta-DiSc version 1.4 software. Twenty studies were included in the analysis. There were a total of 2,907 patients and 3,397 thyroid nodules included in the meta-analysis. Overall sensitivity and specificity were 0.68 (95% CI: 0.66–0.70) and 0.85 (95% CI: 0.84–0.87), respectively. The results showed the area under curve (AUC) was 0.9041, suggesting high accuracy of SWE for differentiating benign and malignant thyroid nodules. SWE showed high accuracy in identifying thyroid malignant nodules, suggesting it could serve as a diagnostic biomarker in thyroid nodules.
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Affiliation(s)
- Na Chang
- Department of Medical Imaging, Shandong University, Jinan, Shandong, China (mainland).,Department of Medical Imaging, Jinan Vocational College of Nursing, Jinan, Shandong, China (mainland)
| | - Xianchao Zhang
- Department of Oncology, Xintai People's Hospital, Xintai, Shandong, China (mainland)
| | - Wenjing Wan
- Department of Nephrology, Xintai People's Hospital, Xintai, Shandong, China (mainland)
| | - Chengqi Zhang
- Department of Medical Imaging, Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
| | - Xianqi Zhang
- Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong, China (mainland)
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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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45
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Shear Wave Elastography Combining with Conventional Grey Scale Ultrasound Improves the Diagnostic Accuracy in Differentiating Benign and Malignant Thyroid Nodules. APPLIED SCIENCES-BASEL 2017. [DOI: 10.3390/app7111103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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46
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Wang D, He YP, Zhang YF, Liu BJ, Zhao CK, Fu HJ, Wei Q, Xu HX. The diagnostic performance of shear wave speed (SWS) imaging for thyroid nodules with elasticity modulus and SWS measurement. Oncotarget 2017; 8:13387-13399. [PMID: 28077785 PMCID: PMC5355106 DOI: 10.18632/oncotarget.14534] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/29/2016] [Indexed: 01/11/2023] Open
Abstract
To evaluate the diagnostic performance of a new technique of shear wave speed (SWS) imaging for the diagnosis of thyroid nodule with elasticity modulus and SWS measurement. 322 thyroid nodules in 322 patients (216 benign nodules, 106 malignant nodules) were included in this study. All the nodules received conventional ultrasound (US) and SWS imaging (Aplio500, Toshiba Medical Systems, Japan) before fine-needle aspiration (FNA) and/or surgery. The values of E-max and E-mean with elastic modulus (61.27 ± 36.31 kPa and 31.89 ± 19.11 kPa) or SWS (4.45 ± 1.49 m/s and 3.26 ± 2.71 m/s) in malignant nodules were significantly higher than those in benign lesions (29.18 ± 18.62 kPa and 15.85 ± 6.96 kPa, or 2.98 ± 0.85 m/s and 2.19 ± 0.42 m/s, all P < 0.001). No significant differences in area under the curve (AUC) between the SWS imaging parameters were found (all P > 0.05). In multivariate logistic regression analysis, E-max (m/s) with SWS was identified to be the strongest independent predictor for malignant nodules (odds ratio [OR] = 16.760), followed by poorly-defined margin (OR = 7.792), taller-than-wide shape (OR = 3.160), micro-calcification (OR = 2.422), and E-max (kPa) with elastic modulus (OR = 0.914). The AUC was 0.813 for E-max with SWS (m/s) and 0.796 for E-max with elastic modulus (kPa). With cut-off SWS value of 3.52 m/s in E-max, sensitivity of 69.8%, specificity of 81.5%, and accuracy of 77.6% were achieved. SWS imaging is a valuable tool in predicting thyroid malignancy. E-max with SWS measurement is the strongest independent predictor for thyroid malignancy.
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Affiliation(s)
- Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Ya-Ping He
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
| | - Hui-Jun Fu
- Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Qing Wei
- Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Center for Thyroid Diseases, Shanghai 200072, China
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He YP, Xu HX, Li XL, Li DD, Bo XW, Zhao CK, Liu BJ, Wang D, Xu HX. Comparison of Virtual Touch Tissue Imaging & Quantification (VTIQ) and Toshiba shear wave elastography (T-SWE) in diagnosis of thyroid nodules: Initial experience. Clin Hemorheol Microcirc 2017; 66:15-26. [PMID: 28211803 DOI: 10.3233/ch-16217] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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48
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He YP, Xu HX, Wang D, Li XL, Ren WW, Zhao CK, Bo XW, Liu BJ, Yue WW. First experience of comparisons between two different shear wave speed imaging systems in differentiating malignant from benign thyroid nodules. Clin Hemorheol Microcirc 2017; 65:349-361. [PMID: 27983544 DOI: 10.3233/ch-16197] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ya-Ping He
- 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 Research 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 Research Center for Thyroid Diseases, Shanghai, China
| | - Dan Wang
- 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 Research Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Long Li
- 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 Research Center for Thyroid Diseases, Shanghai, China
| | - Wei-Wei Ren
- 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 Research Center for Thyroid Diseases, Shanghai, China
| | - 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 Research Center for Thyroid Diseases, Shanghai, China
| | - Xiao-Wan Bo
- 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 Research Center for Thyroid Diseases, Shanghai, China
| | - Bo-Ji Liu
- 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 Research Center for Thyroid Diseases, Shanghai, China
| | - Wen-Wen Yue
- 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 Research Center for Thyroid Diseases, Shanghai, China
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Swan KZ, Nielsen VE, Bibby BM, Bonnema SJ. Is the reproducibility of shear wave elastography of thyroid nodules high enough for clinical use? A methodological study. Clin Endocrinol (Oxf) 2017; 86:606-613. [PMID: 28002625 DOI: 10.1111/cen.13295] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/04/2016] [Accepted: 12/14/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To systematically assess the reproducibility of thyroid ultrasonographic shear wave elastography (SWE). CONTEXT SWE has been suggested as a potential tool for thyroid nodule evaluation, but assessment of its reproducibility has been insufficiently addressed. DESIGN SWE examinations were performed prospectively by two investigators. PATIENTS Seventy-two patients (male/female: 19/53; mean age: 53 ± 14 years; malignant/benign 17/55) undergoing thyroid surgery were enrolled in the study. MEASUREMENTS Repeated and blinded measurements of elasticity index (EI) in predefined regions of interest (ROI) were collected. The inter- and intrarater agreement, along with the day-to-day agreement, was evaluated in terms of the 95% limits of agreement (LOA). Results are presented as a ratio, by which 1·0 indicates perfect agreement. RESULTS The interrater, intrarater and day-to-day LOA showed ratios between repeated measurements of 1·7-3·6, 1·8-3·7 and 2·2-2·9, respectively. These values reflect a low to moderate degree of agreement for all EI outcomes. The interrater LOA was higher for malignant nodules compared with benign nodules for six of seven EI outcomes (P < 0·001-0·03). The proportion of agreement calculated from the optimum cutoff point for differentiating malignant from benign nodules was 63-88% for the investigated EI outcomes. CONCLUSIONS In this methodological study, EI measured by thyroid SWE seems suboptimal for clinical use, due to a low inter- and intrarater agreement. That EI varies from day to day furthermore jeopardizes the validity of the method. Although the proportion of agreement was acceptable for some EI parameters, it is questionable whether EI assessments can reliably differentiate malignant from benign nodules in the individual patient.
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Affiliation(s)
- Kristine Zøylner Swan
- Department of Otorhinolaryngology and Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Viveque Egsgaard Nielsen
- Department of Otorhinolaryngology and Head- and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Martin Bibby
- Department of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Aarhus, Denmark
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Lin CY, Chen PY, Shau YW, Wang CL. An Artifact in Supersonic Shear Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:517-530. [PMID: 27793363 DOI: 10.1016/j.ultrasmedbio.2016.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 08/10/2016] [Accepted: 09/14/2016] [Indexed: 06/06/2023]
Abstract
Supersonic shear wave elastography is a novel ultrasound technology that allows objective evaluation of soft tissue stiffness. The purpose of this study is to report an artifact in supersonic shear wave elastography that may strongly affect the accuracy and quality of the measurement of soft tissue stiffness, and to step-by-step describe how the artifact was found and how it was verified by a series of experiments under different conditions. There were a total of three longitudinal band-like artifacts, 1.3 cm apart from each other on the entire image along the length of the SuperLinear SL15-4 transducer surface, with the middle one at the center of the image. When using supersonic shear wave elastography, users should be keenly aware of the possible occurrence of the artifact and avoid it by choosing the quantification measurement regions of interest (ROIs) away from the artifact regions.
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Affiliation(s)
- Che-Yu Lin
- Department of Orthopaedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Yu Chen
- Department of Orthopaedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yio-Wha Shau
- Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei, Taiwan; Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chung-Li Wang
- Department of Orthopaedic Surgery, School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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