Medical Oncology

, 32:50 | Cite as

Acoustic radiation force impulse elastography for differentiation of benign and malignant thyroid nodules with concurrent Hashimoto’s thyroiditis

  • Bo-Ji Liu
  • Hui-Xiong XuEmail author
  • Yi-Feng Zhang
  • Jun-Mei Xu
  • Dan-Dan Li
  • Xiao-Wan Bo
  • Xiao-Long Li
  • Le-Hang Guo
  • Xiao-Hong Xu
  • Shen Qu
Original Paper


The purpose of the study was to explore the diagnostic performance of acoustic radiation force impulse (ARFI) elastography in differential diagnosis between benign and malignant thyroid nodules in patients with coexistent Hashimoto’s thyroiditis (HT). A total of 141 pathological proven nodules in 141 HT patients (7 males and 134 females, mean age 50.1 years, range 23–75 years) received conventional ultrasound (US), elasticity imaging (EI) and ARFI elastography, including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ), before surgery. Shear wave velocity (SWV) and SWV ratio were measured for each nodule on VTQ. The US, EI and ARFI elastography features were compared between benign and malignant nodules in HT patients. Receiver operating characteristic curve (ROC) analyses and area under curve (AUC) were performed to assess the diagnostic performance. Pathologically, 70 nodules were benign and 71 nodules were malignant. Significant differences were found between benign and malignant nodules in HT patients for EI (EI score) and ARFI (VTI grade and SWV) (all P value <0.05). The AUCs for EI, VTI, SWV and SWV ratio were 0.68 [95 % confidence interval (CI): 0.59–0.77], 0.90 (95 % CI: 0.84–0.95), 0.77 (95 %CI: 0.70–0.85) and 0.74 (95 %CI: 0.66–0.82), respectively. The cut-off points were EI score ≥3, VTI grade ≥4, SWV ≥2.58 m/s and SWV ratio ≥1.03, respectively. In conclusion, ARFI elastography is useful for differentiation between benign and malignant thyroid nodules in HT patients. The diagnostic performance of ARFI elastography is better than EI.


Acoustic radiation force impulse Hashimoto’s thyroiditis Elastography Thyroid nodules 



This work was supported in part by Grant SHDC12014229 from Shanghai Hospital Development Center, Grant 14441900900 from Science and Technology Commission of Shanghai Municipality, Grant 2012045 from Shanghai Municipal Human Resources and Social Security Bureau and Grant 81401417 from the National Natural Science Foundation of China.

Conflict of interest

The authors declare no conflict of interest.


  1. 1.
    Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol Oxf. 1995;43:55–68.CrossRefPubMedGoogle Scholar
  2. 2.
    Delemer B, Aubert JP, Nys P, Landron F, Bouee S. An observational study of the initial management of hypothyroidism in France: the ORCHIDÉE study. Eur J Endocrinol. 2012;167:817–23.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99:39–51.CrossRefPubMedGoogle Scholar
  4. 4.
    Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014;13:391–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Machenzie EJ, Mortimer RH. 6: Thyroid nodules and thyroid cancer. Med J Aust. 2004;180:242–7.Google Scholar
  6. 6.
    Lannaci G, Luise R, Sapere P, Coluccino V, Ronchi A, Faggiano A, Marotta V, Colao A, Spiezia S. Fibrous variant of Hashimoto’s thyroiditis as a diagnostic pitfall in thyroid pathology. Case Rep Endocrinol. 2013;2013:308908.Google Scholar
  7. 7.
    Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas: prevalence by palpation and ultrasonography. Arch Intern Med. 1994;154:1838–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Konturek A, Barczynski M, Wierzchowski W, Stopa M, Nowak W. Coexistence of papillary thyroid cancer with Hashimoto thyroiditis. Langenbecks Arch Surg. 2013;398:389–94.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Zhang L, Li H, Ji QH, Zhu YX, Wang ZY, Wang Y, Huang CP, Shen Q, Li DS, Wu Y. The clinical features of papillary thyroid cancer in Hashimoto’s thyroiditis patients from an area with a high prevalence of Hashimoto’s disease. BMC Cancer. 2012;12:610.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Kim KW, Park YJ, Kim EH, Park SY, Park do J, Ahn SH, Park do J, Jang HC, Cho BY. Elevated risk of papillary thyroid cancer in Korean patients with Hashimoto’s thyroiditis. Head Neck. 2011;33:691–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Zhang Y, Dai J, Wu T, Yang N, Yin Z. The study of the coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma. J Cancer Res Clin Oncol. 2014;140:1021–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, Yoo HS. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002;178:687–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee JH, Anzai Y. Imaging of thyroid and parathyroid glands. Semin Roentgenol. 2013;48:87–104.CrossRefPubMedGoogle Scholar
  14. 14.
    Solbiati L, Osti V, Cova L, Tonolini M. Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol. 2001;11:2411–24.CrossRefPubMedGoogle Scholar
  15. 15.
    Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, Cronan JJ, Doubilet PM, Evans DB, Goellner JR, Hay ID, Hertzberg BS, Intenzo CM, Jeffrey RB, Langer JE, Larsen PR, Mandel SJ, Middleton WD, Reading CC, Sherman SI, Tessler FN. Society of radiologists in ultrasound. Management of thyroid nodules detected at US: society of radiologists in ultrasound consensus conference statement. Radiology. 2005;237:794–800.CrossRefPubMedGoogle Scholar
  16. 16.
    Zhang YF, Xu HX, He Y, Liu C, Guo LH, Liu LN, Xu JM. Virtual touch tissue quantification of acoustic radiation force impulse: a new ultrasound elastic imaging in the diagnosis of thyroid nodules. PLoS ONE. 2012;7:e49094.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Xu JM, Xu XH, Xu HX, Zhang YF, Zhang J, Guo LH, Liu LN, Liu C, Zheng SG. Conventional US, US elasticity imaging, and acoustic radiation force impulse imaging for prediction of malignancy in thyroid nodules. Radiology. 2014;272:57–86.CrossRefGoogle Scholar
  18. 18.
    Ceylan I, Yener S, Bayraktar F, Secil M. Roles of ultrasound and power Doppler ultrasound for diagnosis of Hashimoto thyroiditis in anti-thyroid marker-positive euthyroid subjects. Quant Imaging Med Surg. 2014;4:232–8.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Kim DW, Eun CK, In HS, Kim MH, Jung SJ, Bae SK. Sonographic differentiation of asymptomatic diffuse thyroid disease from normal thyroid: a prospective study. AJNR Am J Neuroradiol. 2010;31:1956–60.CrossRefPubMedGoogle Scholar
  20. 20.
    Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Mai JJ, Pellot-Barakat C, Insana MF, Brill AB, Saga T, Hiraoka M, Togashi K. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–11.CrossRefPubMedGoogle Scholar
  21. 21.
    Rago T, Santini F, Scutari M, Pinchera A, Vitti P. Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J Clin Endocrinol Metab. 2007;92:2917–22.CrossRefPubMedGoogle Scholar
  22. 22.
    Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F, Zoppo A. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008;18:523–31.CrossRefPubMedGoogle Scholar
  23. 23.
    Tranquart F, Bleuzen A, Pierre-Renoult P, Chabrolle C, Sam Giao M, Lecomte P. Elastosonography of thyroid lesions. J Radiol. 2008;89:35–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Bojunga J, Herrmann E, Meyer G, Weber S, Zeuzem S, Friedrich-Rust M. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid. 2010;20:1145–50.CrossRefPubMedGoogle Scholar
  25. 25.
    Bojunga J, Dauth N, Berner C, Meyer G, Holzer K, Voelkl L, Herrmann E, Schroeter H, Zeuzem S, Friedrich-Rust M. Acoustic radiation force impulse imaging for differentiation of thyroid nodules. PLoS ONE. 2012;7:e42735.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Zhang YF, He Y, Xu HX, Xu XH, Liu C, Guo LH, Liu LN, Xu JM. Virtual touch tissue imaging on acoustic radiation force impulse elastography: a new technique for differential diagnosis between benign and malignant thyroid nodules. J Ultrasound Med. 2014;33:585–95.CrossRefPubMedGoogle Scholar
  27. 27.
    Han R, Li F, Wang Y, Ying Z, Zhang Y. Virtual touch tissue quantification (VTQ) in the diagnosis of thyroid nodules with coexistent chronic autoimmune Hashimoto’s thyroiditis: a preliminary study. Eur J Radiol. 2015;84:327–31.CrossRefPubMedGoogle Scholar
  28. 28.
    Şahin M, Çakal E, Özbek M, Güngünes A, Arslan MS, Akkaymak ET, Uçan B, Ünsal IÖ, Bozkurt NÇ, Delibaşi T. Elastography in the differential diagnosis of thyroid nodules in Hashimoto thyroiditis. Med Oncol. 2014;31:97.CrossRefPubMedGoogle Scholar
  29. 29.
    Magri F, Chytiris S, Capelli V, Alessi S, Nalon E, Rotondi M, Cassibba S, Calliada F, Chiovato L. Shear wave elastography in the diagnosis of thyroid nodules: feasibility in the case of coexistent chronic autoimmune Hashimoto’s thyroiditis. Clin Endocrinol Oxf. 2012;76:137–41.CrossRefPubMedGoogle Scholar
  30. 30.
    Menzilcioglu MS, Duymus M, Gungor G, Citil S, Sahin T, Boysan SN, Sarica A. The value of real-time ultrasound elastography in chronic autoimmune thyroiditis. Br J Radiol. 2014;87:20140604.CrossRefPubMedGoogle Scholar
  31. 31.
    Swets JA. Measuring the accuracy of diagnostic systems. Science. 1988;240:1285–93.CrossRefPubMedGoogle Scholar
  32. 32.
    Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Stathatos N, Daniels GH. Autoimmune thyroid disease. Curr Opin Rheumatol. 2012;24:70–5.CrossRefPubMedGoogle Scholar
  34. 34.
    Boi F, Lai ML, Marziani B, Minerba L, Faa G, Mariotti S. High prevalence of suspicious cytology in thyroid nodules associated with positive thyroid autoantibodies. Eur J Endocrinol. 2005;153:637–42.CrossRefPubMedGoogle Scholar
  35. 35.
    Zhang FJ, Han RL. The value of acoustic radiation force impulse (ARFI) in the differential diagnosis of thyroid nodules. Eur J Radiol. 2013;82:e686–90.CrossRefPubMedGoogle Scholar
  36. 36.
    Zhan J, Diao XH, Chai QL, Chen Y. Comparative study of acoustic radiation force impulse imaging with real-time elastography in differential diagnosis of thyroid nodules. Ultrasound Med Biol. 2013;39:2217–25.CrossRefPubMedGoogle Scholar
  37. 37.
    Hou XJ, Sun AX, Zhou XL, Ji Q, Wang HB, Wei H, Sun JW, Liu H. The application of Virtual Touch tissue quantification (VTQ) in diagnosis of thyroid lesions: a preliminary study. Eur J Radiol. 2013;82:797–801.CrossRefPubMedGoogle Scholar
  38. 38.
    Fink H, Hintze G. Autoimmune thyroiditis (Hashimoto’s thyroiditis): current diagnostics and therapy. Med Klin Munich. 2010;105:485–93.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Bo-Ji Liu
    • 1
    • 2
  • Hui-Xiong Xu
    • 1
    • 2
    • 3
    Email author
  • Yi-Feng Zhang
    • 1
    • 2
  • Jun-Mei Xu
    • 1
    • 2
  • Dan-Dan Li
    • 1
    • 2
  • Xiao-Wan Bo
    • 1
    • 2
  • Xiao-Long Li
    • 1
    • 2
  • Le-Hang Guo
    • 1
    • 2
  • Xiao-Hong Xu
    • 3
  • Shen Qu
    • 2
    • 4
  1. 1.Department of Medical Ultrasound, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiChina
  2. 2.Thyroid InstituteTongji University School of MedicineShanghaiChina
  3. 3.Department of UltrasoundGuangdong Medical College Affiliated HospitalZhanjiangChina
  4. 4.Department of Endocrinology and Metabolism, Shanghai Tenth People’s HospitalTongji University School of MedicineShanghaiChina

Personalised recommendations