Abstract
Objectives
To assess if elasticity score (ES) and shear wave velocity (SWV) measurement obtained using ARFI elastography can differentiate between parathyroid lesions and thyroid nodules.
Materials and methods
ARFI elastography was performed on patients with primary hyperparathyroidism or solid thyroid nodules who were being considered for surgery using virtual touch quantification and virtual touch imaging (VTI) software. Only patients with surgical histopathology (47 parathyroid lesions, 38 benign thyroid nodules and 55 malignant thyroid nodules) were included for final analysis. SWV and ES of the parathyroid and thyroid nodules were compared and their ability to differentiate between parathyroid and thyroid was analyzed using receiver operating characteristic curve analysis.
Results
There were 39 solitary adenomas, 2 double adenomas and 4 parathyroid hyperplasias with mean size of 19.6 ± 9.7 mm in 44 patients (21 male, 23 females) with primary hyperparathyroidism. The mean SWV of the parathyroid lesion (1.6 ± 0.78 m/s) was significantly different from benign (2.11 ± 0.8 m/s) and malignant (4.3 ± 2.71 m/s) thyroid nodules, p < 0.05; so was the ES, Chi square = 51.6, p < 0.001. The majority of parathyroid lesions (n = 37, 78.7%) had ES of 2 with speckled (n = 42, 89.3%) appearance, and none showed ES of 4. The diagnostic performance of speckled appearance on VTI, elasticity score and SWV measurements was 0.901, 0.724 and 0.797, respectively, to differentiate between parathyroid and thyroid lesions.
Conclusions
Parathyroid lesions are softer than thyroid nodules. A shear wave velocity of 1.72 m/s can differentiate between parathyroid lesions and thyroid nodules.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40618-017-0694-y/MediaObjects/40618_2017_694_Fig1_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40618-017-0694-y/MediaObjects/40618_2017_694_Fig2_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40618-017-0694-y/MediaObjects/40618_2017_694_Fig3_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40618-017-0694-y/MediaObjects/40618_2017_694_Fig4_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40618-017-0694-y/MediaObjects/40618_2017_694_Fig5a_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40618-017-0694-y/MediaObjects/40618_2017_694_Fig5b_HTML.jpg)
Similar content being viewed by others
Abbreviations
- ARFI:
-
Acoustic radiation force impulse
- SWV:
-
Shear wave velocity
- ES:
-
Elasticity score
- BTN:
-
Benign thyroid nodules
- MTN:
-
Malignant thyroid nodules
- ROI:
-
Region of interest
- VTQ:
-
Virtual touch quantification
- VTI:
-
Virtual touch imaging
References
Doppman JL, Miller DL (1991) Localization of parathyroid tumors in patients with asymptomatic hyperparathyroidism and no previous surgery. J Bone Miner Res 6(Suppl 2):S153–S158 discussion S9. PubMed PMID: 1763668
Johnson NA, Tublin ME, Ogilvie JB (2007) Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol 188(6):1706–1715 PubMed PMID: 17515397
Kebapci M, Entok E, Kebapci N, Adapinar B (2004) Preoperative evaluation of parathyroid lesions in patients with concomitant thyroid disease: role of high resolution ultrasonography and dual phase technetium 99 m sestamibi scintigraphy. J Endocrinol Invest 27(1):24–30 PubMed PMID: 15053239
Abboud B, Sleilaty G, Rabaa L, Daher R, Abou Zeid H, Jabbour H et al (2008) Ultrasonography: highly accuracy technique for preoperative localization of parathyroid adenoma. The Laryngoscope. 118(9):1574–1578 PubMed PMID: 18475203
Chandramohan A, Sathyakumar K, Irodi A, Abraham D, Paul MJ (2012) Causes of discordant or negative ultrasound of parathyroid glands in treatment naive patients with primary hyperparathyroidism. Eur J Radiol 81(12):3956–3964 PubMed PMID: 23017194
Zheng YX, Xu SM, Wang P, Chen L (2007) Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease. J Zhejiang Univ Sci B 8(9):626–631
Krausz Y, Lebensart PD, Klein M, Weininger J, Blachar A, Chisin R et al (2000) Preoperative localization of parathyroid adenoma in patients with concomitant thyroid nodular disease. World J Surg 24(12):1573–1578 PubMed PMID: 11193726
Barbaros U, Erbil Y, Salmashoglu A, Issever H, Aral F, Tunaci M et al (2009) The characteristics of concomitant thyroid nodules cause false-positive ultrasonography results in primary hyperparathyroidism. Am J Otolaryngol 30(4):239–243 PubMed PMID: 19563934
Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F et al (2008) US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 18(5):523–531 PubMed PMID: 18466077
Ghandur-Mnaymneh L, Kimura N (1984) The parathyroid adenoma. A histopathologic definition with a study of 172 cases of primary hyperparathyroidism. Am J Pathol 115(1):70–83 PubMed PMID: 6711681. PubMed Central PMCID: 1900356
Magri F, Chytiris S, Capelli V, Alessi S, Nalon E, Rotondi M et al (2012) Shear wave elastography in the diagnosis of thyroid nodules: feasibility in the case of coexistent chronic autoimmune Hashimoto’s thyroiditis. Clin Endocrinol 76(1):137–141 PubMed PMID: 21740455
Xu JM, Xu HX, Xu XH, Liu C, Zhang YF, Guo LH et al (2014) Solid hypo-echoic thyroid nodules on ultrasound: the diagnostic value of acoustic radiation force impulse elastography. Ultrasound Med Biol 40(9):2020–2030 PubMed PMID: 25109691
Calvete AC, Mestre JD, Gonzalez JM, Martinez ES, Sala BT, Zambudio AR (2014) Acoustic radiation force impulse imaging for evaluation of the thyroid gland. J Ultrasound Med 33(6):1031–1040 PubMed PMID: 24866610
Zhan J, Jin JM, Diao XH, Chen Y (2015) Acoustic radiation force impulse imaging (ARFI) for differentiation of benign and malignant thyroid nodules–A meta-analysis. Eur J Radiol 84(11):2181–2186 PubMed PMID: 26259701
Zhuo J, Ma Z, Fu WJ, Liu SP (2014) Differentiation of benign from malignant thyroid nodules with acoustic radiation force impulse technique. Br J Radiol 87(1035):20130263 PubMed PMID: 24588664. Pubmed Central PMCID: 4064611
Unluturk U, Erdogan MF, Demir O, Culha C, Gullu S, Baskal N (2012) The role of ultrasound elastography in preoperative localization of parathyroid lesions: a new assisting method to preoperative parathyroid ultrasonography. Clin Endocrinol 76(4):492–498 PubMed PMID: 21955171
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There were no disclosures or conflicts of interest.
Ethical approval
This is an institution review board (IRB)-approved prospective study performed with informed consent.
Informed consent
Consecutive patients with primary hyperparathyroidism considered for parathyroid surgery and patients with solid thyroid nodules considered for thyroidectomy were recruited into the study.
Rights and permissions
About this article
Cite this article
Chandramohan, A., Therese, M., Abhraham, D. et al. Can ARFI elastography be used to differentiate parathyroid from thyroid lesions?. J Endocrinol Invest 41, 111–119 (2018). https://doi.org/10.1007/s40618-017-0694-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40618-017-0694-y