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DOI: 10.1055/s-0029-1237701
© 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
Publication History
received 04.04.2009
first decision 16.07.2009
accepted 31.07.2009
Publication Date:
23 October 2009 (online)
![](https://www.thieme-connect.de/media/eced/201009/lookinside/thumbnails/10.1055-s-0029-1237701-1.jpg)
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.
Key words
sonography - thyroid cancer - radionuclide scanning - CEUS - dignity
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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