European Radiology

, Volume 25, Issue 3, pp 624–634 | Cite as

Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: a prospective single-centre experience

  • Baoxian Liu
  • Jinyu Liang
  • Yanling Zheng
  • Xiaoyan XieEmail author
  • Guangliang Huang
  • Luyao Zhou
  • Wei Wang
  • Mingde Lu
Head and Neck



To evaluate the diagnostic performance of two-dimensional shear wave elastography (2D-SWE) in distinguishing malignant from benign thyroid nodules.


A total of 331 focal thyroid nodules from 271 patients scheduled for fine-needle aspiration or thyroid surgery were included. After a routine conventional ultrasound evaluation, 2D-SWE examinations were performed to obtain 2D-SWE measurements on a colour-coded mapping, which were then correlated with pathology results.


A total of 230 nodules were benign and 101 were malignant on pathology. The areas under the receiver operating characteristic curve (AUC) of mean and minimum values in the largest region of interest (ROI) over the whole nodule, and mean, maximum and minimum values in 2-mm ROI over the stiffest area of the nodule were 0.794, 0.673, 0.808, 0.805 and 0.799, respectively. The most accurate cut-off value, 39.3 kPa, for mean value in a 2-mm ROI achieved 66.3 % sensitivity and 84.4 % specificity to discriminate malignancy. Nodule size correlated with 2D-SWE value for malignant nodules (P < 0.01). In the group of nodules ≤10 mm, the AUC was 0.730, while it was 0.883 in nodules sized 11–30 mm and 0.821 in nodules >30 mm.


2D-SWE is a promising diagnostic tool for discriminating malignant thyroid nodules, although the performance for nodules ≤10 mm is not satisfactory.

Key Points

2D-shear wave elastography (2D-SWE) helps differentiate benign nodules from malignancy.

Calcification will increase the 2D-SWE value.

2D-SWE appears limited in terms of identifying papillary thyroid microcarcinomas accurately.

Combination of 2D-SWE and conventional ultrasound is highly sensitivity for thyroid malignancy.


2D-shear wave elastography Thyroid nodules Malignancy Ultrasound Fine-needle aspiration 



Two-dimensional shear wave elastography


Areas under the ROC curve


Fine-needle aspiration


Negative predictive value


Positive predictive value


Receiver operating characteristic


Region of interest


Maximum SWE value in the 2-mm ROI


Mean SWE value in the 2-mm ROI


Minimum SWE value in the 2-mm ROI


Mean SWE value in the largest ROI


Minimum SWE value in the largest ROI


Ratio between SWE_mean and the elastic value of the surrounding thyroid tissue





The scientific guarantor of this publication is Xiaoyan Xie. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.


  1. 1.
    Sebag F, Vaillant-Lombard J, Berbis J et al (2010) Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J Clin Endocrinol Metab 95:5281–5288CrossRefPubMedGoogle Scholar
  2. 2.
    Magri F, Chytiris S, Capelli V 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 (Oxf) 76:137–141CrossRefGoogle Scholar
  3. 3.
    Hegedus L (2004) Clinical practice. The thyroid nodule. N Engl J Med 351:1764–1771CrossRefPubMedGoogle Scholar
  4. 4.
    Remontet L, Esteve J, Bouvier AM et al (2003) Cancer incidence and mortality in France over the period 1978-2000. Rev Epidemiol Sante Publique 51:3–30PubMedGoogle Scholar
  5. 5.
    Zhang B, Jiang YX, Liu JB et al (2010) Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules. Thyroid 20:51–57CrossRefPubMedGoogle Scholar
  6. 6.
    Bhatia KS, Tong CS, Cho CC, Yuen EH, Lee YY, Ahuja AT (2012) Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy. Eur Radiol 22:2397–2406CrossRefPubMedGoogle Scholar
  7. 7.
    Kim H, Kim JA, Son EJ, Youk JH (2013) Quantitative assessment of shear-wave ultrasound elastography in thyroid nodules: diagnostic performance for predicting malignancy. Eur Radiol 23:2532–2537CrossRefPubMedGoogle Scholar
  8. 8.
    Veyrieres JB, Albarel F, Lombard JV et al (2012) A threshold value in shear wave elastography to rule out malignant thyroid nodules: a reality? Eur J Radiol 81:3965–3972CrossRefPubMedGoogle Scholar
  9. 9.
    Shuzhen C (2012) Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur J Radiol 81:1806–1811CrossRefPubMedGoogle Scholar
  10. 10.
    Zhang YF, Xu HX, He Y et al (2012) Virtual touch tissue quantification of acoustic radiation force impulse: a new ultrasound elastic imaging in the diagnosis of thyroid nodules. PLoS One 7:e49094CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Liu BX, Xie XY, Liang JY et al (2014) Shear wave elastography versus real-time elastography on evaluation thyroid nodules: a preliminary study. Eur J Radiol 83:1135–1143CrossRefPubMedGoogle Scholar
  12. 12.
    Evans A, Whelehan P, Thomson K et al (2012) Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology 263:673–677CrossRefPubMedGoogle Scholar
  13. 13.
    Ferraioli G, Tinelli C, Dal Bello B, Zicchetti M, Filice G, Filice C (2012) Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology 56:2125–2133CrossRefPubMedGoogle Scholar
  14. 14.
    Foucher J, Chanteloup E, Vergniol J et al (2006) Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 55:403–408CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Kwon HJ, Kang MJ, Cho JH et al (2011) Acoustic radiation force impulse elastography for hepatocellular carcinoma-associated radiofrequency ablation. World J Gastroenterol 17:1874–1878CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Garra BS (2011) Elastography: current status, future prospects, and making it work for you. Ultrasound Q 27:177–186CrossRefPubMedGoogle Scholar
  17. 17.
    Lee SH, Chang JM, Kim WH et al (2013) Differentiation of benign from malignant solid breast masses: comparison of two-dimensional and three-dimensional shear-wave elastography. Eur Radiol 23:1015–1026CrossRefPubMedGoogle Scholar
  18. 18.
    Tae HJ, Lim DJ, Baek KH et al (2007) Diagnostic value of ultrasonography to distinguish between benign and malignant lesions in the management of thyroid nodules. Thyroid 17:461–466CrossRefPubMedGoogle Scholar
  19. 19.
    Wang Y, Dan HJ, Dan HY, Li T, Hu B (2010) Differential diagnosis of small single solid thyroid nodules using real-time ultrasound elastography. J Int Med Res 38:466–472CrossRefPubMedGoogle Scholar
  20. 20.
    Tozaki M, Fukuma E (2011) Pattern classification of ShearWave elastography images for differential diagnosis between benign and malignant solid breast masses. Acta Radiol 52:1069–1075CrossRefPubMedGoogle Scholar
  21. 21.
    Lee EJ, Jung HK, Ko KH, Lee JT, Yoon JH (2013) Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses? Eur Radiol 23:1803–1811CrossRefPubMedGoogle Scholar
  22. 22.
    Lagalla R, Caruso G, Romano M, Midiri M, Novara V, Zappasodi F (1993) Echo-color Doppler in thyroid disease. Radiol Med 85:109–113PubMedGoogle Scholar
  23. 23.
    Messina G, Viceconti N, Trinti B (1996) Echotomography and color-Doppler in the diagnosis of thyroid carcinoma. Ann Ital Med Int 11:263–267PubMedGoogle Scholar
  24. 24.
    Soares P, Celestino R, Gaspar DRA, Sobrinho-Simoes M (2014) Papillary thyroid microcarcinoma: how to diagnose it and how to manage this epidemics? Int J Surg Pathol 22:113–119CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Baoxian Liu
    • 1
    • 3
  • Jinyu Liang
    • 1
    • 3
  • Yanling Zheng
    • 1
    • 3
  • Xiaoyan Xie
    • 1
    • 3
    Email author
  • Guangliang Huang
    • 1
    • 3
  • Luyao Zhou
    • 1
    • 3
  • Wei Wang
    • 1
    • 3
  • Mingde Lu
    • 2
    • 3
  1. 1.Department of Medical UltrasonicsThe First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina
  2. 2.Department of Hepatobiliary SurgerySun Yat-Sen UniversityGuangzhouChina
  3. 3.Division of Interventional Ultrasound, Institute of Diagnostic and Interventional UltrasoundThe First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen UniversityGuangzhouChina

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