Journal of Ultrasound

, Volume 17, Issue 1, pp 13–20 | Cite as

Prospective evaluation of acoustic radiation force impulse technology in the differentiation of thyroid nodules: accuracy and interobserver variability assessment

  • Hektor GrazhdaniEmail author
  • Vito CantisaniEmail author
  • Pietro Lodise
  • Giorgio Di Rocco
  • Maria Cristina Proietto
  • Eloisa Fioravanti
  • Antonello Rubini
  • Adriano Redler
Original Article



The aim of this study is to assess the diagnostic efficacy and interobserver agreement of acoustic radiation force impulse (ARFI) elasticity imaging in differentiating thyroid nodules.


In our study, 74 consecutive patients (52 females, 22 males; age range 27–77 years, mean: 41 years) with 82 thyroid nodules (60 benign nodules, and 22 malignant) were examined by two radiologists with different experience. Patients underwent either cytology using fine needle aspiration cytology or thyroid surgery. The diagnostic performance of the two operators at ARFI with sensitivity, specificity, positive predictive and negative predictive value, and ROC curves was estimated. Inter-reader variability between the two operators was defined using Cohen’s k.


According to receiver operating characteristics ROC curves (AUROC = 0.86 for observer 1; 0.81 for observer 2) sensitivity, specificity, PPV and NPV of reader 1 and 2 were respectively: 90, 75, 90.91 and 96.55 %; (cut-off value of shear wave: 2.455 m/s); 90, 72, 90 and 96.90 % (cut-off value shear wave: 2.365 m/s). Concordance between the two operators was good (k = 0.755).


This work is a feasibility study evaluating ARFI imaging. Its results suggest that ARFI imaging is a reproducible method which can be utilized with good diagnostic performance in the thyroid for discriminating benign and malignant nodules using the cut-off value of 2.455 m/s. However, larger studies are needed to validate this method.


Acoustic radiation force impulse (ARFI) Elastography Benign thyroid nodules Malignant thyroid nodules Ultrasound 



Lo scopo di questo studio è la valutazione della efficacia diagnostica e della concordanza inter-osservatore dell’imaging elastografico ARFI, per la differenziazione di noduli tiroidei.


Nel nostro studio, 74 pazienti consecutivi (52 femmine, 22 maschi; range di età 22–77 anni, età media 41 anni) con 82 noduli tiroidei (60 noduli benigni e 22 maligni), sono stati esaminati da due radiologi con diverso livello di esperienza. I pazienti sono stati sottoposti o a citologia aspirativa con ago sottile (FNAC), o a chirurgia tiroidea. La performance diagnostica dei due operatori all’ ARFI è stata stimata con la sensibilità, la specificità, il valore predittivo positivo (VPP) e negativo (VPN), attraverso le curve ROC (receiver operating characteristics). La variabilità inter-osservatore tra i due operatori, è stata definita usando la kappa di Cohen.


Secondo le curve ROC (AUROC = 0.86 per il primo osservatore; 0.81 per il secondo osservatore) la sensibilità, la specificità, il VPP e il VPN per gli osservatori 1 e 2, erano rispettivamente: 90, 75, 90,91, e 96.55 %; (valore medio di shear wave: 2.455 m/s); 90, 72, 90 e 96.90 % (valore medio di shear wave: 2.365 m/s). La concordanza tra I due operatori era buona (k = 0.755).


Questo lavoro è uno studio preliminare che valuta l’imaging elastografico con Acustic Radiation Force Impulse. I risultati suggeriscono che l’ARFI è un metodo riproducibile che può essere utilizzato con buona performance diagnostica per la differenziazione di noduli benigni e maligni della tiroide, usando come valore di cut-off 2.455 m/s. Comunque, sono necessari studi con più ampia casistica di pazienti per la validazione di questa metodica.


Conflict of interest

The authors of this paper, Hektor Grazhdani, Vito Cantisani, Pietro Lodise, Giorgio Di Rocco, Maria Cristina Proietto, Eloisa Fioravanti, Antonello Rubini, Adriano Redler, declare that no fund or grant was received for this research and that there are no relationships/conditions/circumstances that present a potential conflict of interest.

Ethical standard statement

Informed consent was obtained from all patients and the study was performed in accordance with the ethical guidelines of the Helsinki Declaration and approved by the local ethics committee.


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Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2014

Authors and Affiliations

  • Hektor Grazhdani
    • 1
    • 3
    Email author
  • Vito Cantisani
    • 1
    • 3
    Email author
  • Pietro Lodise
    • 1
  • Giorgio Di Rocco
    • 2
  • Maria Cristina Proietto
    • 1
  • Eloisa Fioravanti
    • 1
  • Antonello Rubini
    • 1
  • Adriano Redler
    • 2
  1. 1.Department of Radiology“Sapienza” University of RomeRomeItaly
  2. 2.Department of Surgical Sciences“Sapienza” University of RomeRomeItaly
  3. 3.Department of Radiological, Oncological and Anatomopathological Sciences“Sapienza” University of RomeRomeItaly

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