European Radiology

, Volume 28, Issue 6, pp 2675–2681 | Cite as

Significance of hyperechoic marks observed during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules

  • Brian H.H. LangEmail author
  • Yu-Cho Woo
  • Keith Wan-Hang Chiu



To examine the association between the appearance of hyperechoic marks (HEMs) during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules and nodule shrinkage at 6 months.


One hundred and thirty-six patients who underwent HIFU for benign thyroid nodule were analysed. An independent person carefully examined the B-mode ultrasonography screen for the appearance of HEMs after each pulse. The proportion of HEMs (%) was calculated by: [(Number of pulses that resulted in HEMs) / (Total number of pulses given per treatment) × 100] while the nodule shrinkage was measured by volume reduction ratio (VRR) = [Baseline volume–volume at 6 months]/[Baseline volume] * 100. Treatment success was defined as VRR ≥ 50 %.


Patients with HEMs (n=91) had significantly greater 6-month VRR than those without HEMs (n=45) (65.76 % vs. 36.76 %, p<0.001). By regression analysis, after adjusting for age and energy per pulse, smaller nodule volume at baseline (OR 1.143, 95 % CI 1.038–1.256, p=0.006) and appearance of HEMs (OR 275.44, 95 % CI 26.63–2848.98, p<0.001) were independent predictors for treatment success.


The appearance of HEMs during treatment was an independent determinant of treatment success following single-session HIFU ablation of benign thyroid nodule.

Key Points

• HIFU is a safe and effective treatment for benign thyroid nodules.

• Lower BMI and greater applied power increase likelihood of hyperechoic marks.

• The appearance of hyperechoic marks during HIFU affects subsequent treatment outcome.


Interventional ultrasonography High-intensity focused ultrasound ablation Induced hyperthermia Nodular goitre Ablation techniques 



We would like to thank Ms. Cindy Choi for determining the presence or absence of hyperechoic marks during HIFU treatment and Professor Stephen Cheng (Head of Department of Surgery, University of Hong Kong) for agreeing to be the guarantor of this paper.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantors of this publication is Professor Stephen Cheng (Head of Department).

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Outcomes of some study subjects or cohorts have been previously reported but data on the appearance of hyperechoic marks have never been reported.


• Retrospective

• Observational

• Single institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Brian H.H. Lang
    • 1
    Email author
  • Yu-Cho Woo
    • 2
  • Keith Wan-Hang Chiu
    • 3
  1. 1.Department of SurgeryQueen Mary Hospital, The University of Hong KongHong KongChina
  2. 2.Department of MedicineThe University of Hong KongHong KongChina
  3. 3.Department of RadiologyThe University of Hong KongHong KongChina

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