Exp Clin Endocrinol Diabetes 2010; 118(9): 602-609
DOI: 10.1055/s-0029-1237701
Article

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Real-time Elastography and Contrast-Enhanced Ultrasound for the Assessment of Thyroid Nodules

M. Friedrich-Rust1 , A. Sperber1 , K. Holzer2 , J. Diener3 , F. Grünwald3 , K. Badenhoop1 , S. Weber1 , S. Kriener4 , E. Herrmann5 , W. O. Bechstein2 , S. Zeuzem1 , J. Bojunga1
  • 1Department of Internal Medicine 1, J. W. Goethe-University Hospital, Frankfurt, Germany
  • 2Department of General and Visceral Surgery, J. W. Goethe-University Hospital, Frankfurt, Germany
  • 3Department of Nuclear Medicine, J. W. Goethe-University Hospital, Frankfurt, Germany
  • 4Institute of Pathology, J. W. Goethe-University Hospital, Frankfurt, Germany
  • 5Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J. W. Goethe-University, Frankfurt, Germany
Further Information

Publication History

received 04.04.2009 first decision 16.07.2009

accepted 31.07.2009

Publication Date:
23 October 2009 (online)

Abstract

Objective: Work-up of thyroid nodules remains challenging. Recent technologies enable determination of tissue elasticity and perfusion using ultrasound devices. The aim of the present study was to evaluate real-time elastography (RTE) and contrast-enhanced ultrasound with Sonovue (CEUS) for the differentiation of benign and malignant thyroid nodules.

Materials and Methods: Inclusion criteria were: nodules ≥1 cm, non-functioning or hypo-functioning on radionuclide scanning, and cytological/histological assessment. All patients received conventional ultrasound, RTE and CEUS. RTE was classified as: Elasticity-Score (ES)1=soft, ES2=predominantly soft, ES3=predominantly hard, ES4=hard nodule. CEUS-video clips were digitally recorded and analyzed using time-intensity-curves within selected regions-of-interest.

Results: Fifty-three nodules in 50 patients were available for analysis. Forty-six nodules were benign on cytology/histology, 6 nodules were papillary carcinoma and one nodule was a follicular carcinoma. Nodule margin irregularity was the ultrasound pattern most predictive of malignancy with sensitivity 57% (95% confidence interval: 18–90%) and specificity 85% (71–94% p<0.05). When using ES3&4 for the diagnosis of malignant nodules sensitivity and specificity were 86% (42–99.7%) and 87% (75–95%), respectively (p=0.0003). The only malignant nodule missed with RTE was a follicular carcinoma. Sensitivity for the diagnosis of papillary carcinoma therefore was 100%. No specific CEUS pattern could be identified to differentiate between benign and malignant nodules.

Conclusions: RTE seems to be a useful tool in the work-up of thyroid nodules to exclude papillary thyroid cancer. However, follicular carcinoma remains a challenging problem. CEUS did not improve the characterization of thyroid nodules in this preliminary study.

References

  • 1 Guidelines of the Papanicolaou Society of Cytopathology for the Examination of Fine-Needle Aspiration Specimens from Thyroid Nodules . The Papanicolaou Society of Cytopathology Task Force on Standards of Practice.  Mod Pathol. 1996;  9 710-715
  • 2 Argalia G, De Bernardis S, Mariani D. et al . Ultrasonographic contrast agent: evaluation of time-intensity curves in the characterisation of solitary thyroid nodules.  Radiol Med. 2002;  103 407-413
  • 3 Asteria C, Giovanardi A, Pizzocaro A. et al . US-elastography in the differential diagnosis of benign and malignant thyroid nodules.  Thyroid. 2008;  18 523-531
  • 4 Bartolotta TV, Midiri M, Galia M. et al . Qualitative and quantitative evaluation of solitary thyroid nodules with contrast-enhanced ultrasound: initial results.  Eur Radiol. 2006;  16 2234-2241
  • 5 Berker D, Aydin Y, Ustun I. et al . The value of fine-needle aspiration biopsy in subcentimeter thyroid nodules.  Thyroid. 2008;  18 603-608
  • 6 Cooper DS, Doherty GM, Haugen BR. et al . Management guidelines for patients with thyroid nodules and differentiated thyroid cancer.  Thyroid. 2006;  16 109-142
  • 7 Dietlein M, Dressler J, Grünwald F. et al. .Leitlinie zur Schilddrüsendiagnostik. Deutsche Gesellschaft für Nuklearmedizin e.V.; 2003
  • 8 Dighe M, Bae U, Richardson ML. et al . Differential diagnosis of thyroid nodules with US elastography using carotid artery pulsation.  Radiology. 2008;  248 662-669
  • 9 Frey H. Realtime-elastography.  A new ultrasound procedure for the reconstruction of tissue elasticity. Radiologe. 2003;  43 850-855
  • 10 Gharib H, Goellner JR, Johnson DA. Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11 000 biopsies.  Clin Lab Med. 1993;  13 699-709
  • 11 Gritzmann N, Koischwitz D, Rettenbacher T. Sonography of the thyroid and parathyroid glands.  Radiol Clin North Am. 2000;  38 1131-1145 , xii
  • 12 Hegedus L. Clinical practice The thyroid nodule.  N Engl J Med. 2004;  351 1764-1771
  • 13 Hegedus L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: Current status and future perspectives.  Endocr Rev. 2003;  24 102-132
  • 14 Iannuccilli JD, Cronan JJ, Monchik JM. Risk for malignancy of thyroid nodules as assessed by sonographic criteria: The need for biopsy.  J Ultrasound Med. 2004;  23 1455-1464
  • 15 Ivanac G, Brkljacic B, Ivanac K. et al . Vascularisation of benign and malignant thyroid nodules: CD US evaluation.  Ultraschall Med. 2007;  28 502-506
  • 16 Lyshchik A, Higashi T, Asato R. et al . Thyroid gland tumor diagnosis at US Elastography.  Radiology. 2005;  237 202-211
  • 17 Meller J, Becker W. The continuing importance of thyroid scintigraphy in the era of high-resolution ultrasound.  Eur J Nucl Med Mol Imaging. 2002;  29 ((Suppl 2)) S425-S438
  • 18 Ophir J, Cespedes I, Ponnekanti H. et al . Elastography: a quantitative method for imaging the elasticity of biological tissues.  Ultrason Imag. 1991;  13 111-114
  • 19 Pacini F, Schlumberger M, Dralle H. et al . European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium.  Eur J Endocrinol. 2006;  154 787-803
  • 20 Rago T, Santini F, Scutari M. et al . Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules.  J Clin Endocrinol Metab. 2007;  92 2917-2922
  • 21 Ramsden JD. Angiogenesis in the thyroid gland.  J Endocrinol. 2000;  166 475-480
  • 22 Reiners C, Wegscheider K, Schicha H. et al . Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96 278 unselected employees.  Thyroid. 2004;  14 926-932
  • 23 Rubaltelli L, Corradin S, Dorigo A. et al . Differential diagnosis of benign and malignant thyroid nodules at elastosonography.  Ultraschall Med. 2008;  1 1-2
  • 24 Spiezia S, Farina R, Cerbone G. et al . Analysis of color Doppler signal intensity variation after levovist injection: a new approach to the diagnosis of thyroid nodules.  J Ultrasound Med. 2001;  20 223-231
  • 25 Strobel D, Seitz K, Blank W. et al . Contrast-enhanced ultrasound for the characterization of focal liver lesions – diagnostic accuracy in clinical practice (DEGUM multicenter trial).  Ultraschall in der Medizin. 2008;  5 499-505

Correspondence

Priv.- Doz. Dr. med. J. Bojunga

Medizinische Klinik 1

Klinikum der Johann Wolfgang

Goethe Universität

Theodor-Stern-Kai 7

60590 Frankfurt am Main

Phone: +49(0)69-6301-5297

Email: Joerg.Bojunga@kgu.de