Abstract
Objective
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.
Methods
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 %.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
Gharib H, Papini E, Garber JR et al (2016) AACE/ACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the diagnosis and management of thyroid nodules - 2016 Update. Endocr Pract. 22(5):622–639
Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 26:1–133
Durante C, Costante G, Lucisano G et al (2015) The natural history of benign thyroid nodules. JAMA. 313(9):926–935
Korkusuz Y, Gröner D, Raczynski N, Relin O, Kingeter Y, Grünwald F, Happel C (2017) Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods? Eur Radiol. https://doi.org/10.1007/s00330-017-5039-x
Sung JY, Baek JH, Kim KS et al (2013) Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study. Radiology. 269(1):293–300
Wong KP, Lang BH (2013) Use of Radiofrequency Ablation in Benign Thyroid Nodules: A Literature Review and Updates. Int J Endocrinol. 2013:428363
Korkusuz H, Sennert M, Fehre N, Happel C, Grünwald F (2014) Local thyroid tissue ablation by high-intensity focused ultrasound: effects on thyroid function and first human feasibility study with hot and cold thyroid nodules. Int J Hyperthermia. 30(7):480–485
Kovatcheva RD, Vlahov JD, Stoinov JI, Zaletel K (2015) Benign Solid Thyroid Nodules: US-guided High-Intensity Focused Ultrasound Ablation-Initial Clinical Outcomes. Radiology. 276(2):597–605
Lang BH, Woo YC, Wong CKH (2017) High-Intensity Focused Ultrasound for Treatment of Symptomatic Benign Thyroid Nodules: A Prospective Study. Radiology. 284(3):897–906
Haar GT, Coussios C (2007) High intensity focused ultrasound: physical principles and devices. Int J Hyperthermia. 23(2):89–104
Al-Mahrouki AA, Wong E, Czarnota GJ (2015) Ultrasound-stimulated microbubble enhancement of radiation treatments: endothelial cell function and mechanism. Oncoscience. 2(12):944–957
Lai P, Tarapacki C, Tran WT et al (2016) Breast tumor response to ultrasound mediated excitation of microbubbles and radiation therapy in vivo. Oncoscience. 3(3-4):98–108
Kovatcheva R, Zaletel K (2017) High-intensity focused ultrasound for thyroid nodule ablation: the evidence to date. Reports in Medical Imaging 10:9–16
Lang BH, Woo YC, Chiu KW (2017) Single-Session High-Intensity Focused Ultrasound Treatment in Large-Sized Benign Thyroid Nodules. Thyroid. 27(5):714–721
Lang BH, Wong CKH, Ma EPM (2017) Single-session high intensity focused ablation (HIFU) versus open cervical hemithyroidectomy for benign thyroid nodule: analysis on early efficacy, safety and voice quality. Int J Hyperthermia. https://doi.org/10.1080/02656736.2017.1305127
Lang BHH, Woo YC, Chiu KW (2017) Vocal cord paresis following single-session high intensity focused ablation (HIFU) treatment of benign thyroid nodules: incidence and risk factors. Int J Hyperthermia.:1–7. https://doi.org/10.1080/02656736.2017.1328130
Pacella CM, Mauri G, Cesareo R et al (2017) A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis. Int J Hyperthermia.:1–9. https://doi.org/10.1080/02656736.2017.1332395
Mauri G, Cova L, Monaco CG et al (2017) Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA). Int J Hyperthermia. 33(3):295–299
Acknowledgement
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.
Funding
The authors state that this work has not received any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Guarantor
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.
Methodology
• Retrospective
• Observational
• Single institution
Rights and permissions
About this article
Cite this article
Lang, B.H., Woo, YC. & Chiu, K.WH. Significance of hyperechoic marks observed during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules. Eur Radiol 28, 2675–2681 (2018). https://doi.org/10.1007/s00330-017-5207-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-017-5207-z