[Diagnostic value of ultrasonic elastic strain ratio and elasticity score for thyroid micronodules of TI-RADS 4]

Objective: To investigate diagnostic value of ultrasonic elastic strain ratio and elasticity score for thyroid micronodules of TI-RADS 4. Method: In total, 211 consecutive patients with 225 thyroid micronodules were enroled in the study, all the nodules were evaluated by TI-RADS criteria before and all of them were examined by elastic imaging. We set the histology as the reference standard. The elastic strain ratio and elasticity score values, as well as their diagnostic threshold and efficiency, were compared and analyzed by the receiver operating characteristic(ROC) curve. Result: Statistically significant differences(P<0.05) in both elastic strain ratio and elasticity score values were detected among the thyroid microcarcinoma and benign groups. The area under the ROC curve of elastic strain ratio was significantly greater than that of elasticity score(0.935 and 0.825, respectively; P<0.05). Using elastic strain ratio ≥3.45 and elasticity score ≥3.00 as diagnostic threshold values, the diagnostic sensitivity, specificity, and accuracy of elastic strain ratio for differentiating benign and malignant nodules were 86.51%, 90.32%, and 87.56%, respectively, whereas those of elasticity score were 80.98%, 79.03% and 80.44%, respectively. Conclusion: Ultrasonic elastic strain ratio and elasticity score have very high diagnostic value for the thyroid micronodules of TI-RADS 4, and strain ratio has more advantages.

Correlation between elastosonography and nailfold microvascular alterations in systemic sclerosis patients

AIM

Vascular damage and fibrotic process represent the pathophysiological hallmarks of systemic sclerosis (SSc). Peripheral microangiopathy can be early detected by nailfold videocapillaroscopy (NVC), whereas recent studies suggest that ultrasound real time elastosonography (US-RTE) can be a useful tool to evaluate the reduction of skin elasticity. The aim of our study was to investigate possible correlations between NVC microvascular alterations and finger tissue stiffness evaluated with US-RTE in SSc subjects.

METHODS

20 subjects (16 women and 4 men) who met the ACR criteria for SSc were recruited. All subjects underwent complete clinical examination, NVC and US-RTE evaluation. US-RTE was carried out on both the hands, at the level of the palmar surface of the distal phalanx of the fingers.

RESULTS

10 subjects showed limited disease subset (LSS) and 10 showed diffuse disease subset (DSS). Eight patients had 'Early/Active' NVC pattern and 12 had 'Late' NVC pattern. DSS subjects showed highest skin stiffness values when compared to both LSS (p = 0.03) and healthy subjects (p = 0.002). Multiple regression analysis shows an independent association between Late NVC pattern and skin stiffness (R2 = 0.24, p = 0.027).

CONCLUSION

This study demonstrates, for the first time, a strong relationship between microvascular alterations and skin stiffness, evaluated with US-RTE, in SSc patients.