Skip to main content
SpringerLink
Log in

Can ARFI elastography be used to differentiate parathyroid from thyroid lesions?

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Objectives

To assess if elasticity score (ES) and shear wave velocity (SWV) measurement obtained using ARFI elastography can differentiate between parathyroid lesions and thyroid nodules.

Materials and methods

ARFI elastography was performed on patients with primary hyperparathyroidism or solid thyroid nodules who were being considered for surgery using virtual touch quantification and virtual touch imaging (VTI) software. Only patients with surgical histopathology (47 parathyroid lesions, 38 benign thyroid nodules and 55 malignant thyroid nodules) were included for final analysis. SWV and ES of the parathyroid and thyroid nodules were compared and their ability to differentiate between parathyroid and thyroid was analyzed using receiver operating characteristic curve analysis.

Results

There were 39 solitary adenomas, 2 double adenomas and 4 parathyroid hyperplasias with mean size of 19.6 ± 9.7 mm in 44 patients (21 male, 23 females) with primary hyperparathyroidism. The mean SWV of the parathyroid lesion (1.6 ± 0.78 m/s) was significantly different from benign (2.11 ± 0.8 m/s) and malignant (4.3 ± 2.71 m/s) thyroid nodules, p < 0.05; so was the ES, Chi square = 51.6, p < 0.001. The majority of parathyroid lesions (n = 37, 78.7%) had ES of 2 with speckled (n = 42, 89.3%) appearance, and none showed ES of 4. The diagnostic performance of speckled appearance on VTI, elasticity score and SWV measurements was 0.901, 0.724 and 0.797, respectively, to differentiate between parathyroid and thyroid lesions.

Conclusions

Parathyroid lesions are softer than thyroid nodules. A shear wave velocity of 1.72 m/s can differentiate between parathyroid lesions and thyroid nodules.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

Abbreviations

ARFI:

Acoustic radiation force impulse

SWV:

Shear wave velocity

ES:

Elasticity score

BTN:

Benign thyroid nodules

MTN:

Malignant thyroid nodules

ROI:

Region of interest

VTQ:

Virtual touch quantification

VTI:

Virtual touch imaging

References

  1. Doppman JL, Miller DL (1991) Localization of parathyroid tumors in patients with asymptomatic hyperparathyroidism and no previous surgery. J Bone Miner Res 6(Suppl 2):S153–S158 discussion S9. PubMed PMID: 1763668

    PubMed  Google Scholar 

  2. Johnson NA, Tublin ME, Ogilvie JB (2007) Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol 188(6):1706–1715 PubMed PMID: 17515397

    Article  PubMed  Google Scholar 

  3. Kebapci M, Entok E, Kebapci N, Adapinar B (2004) Preoperative evaluation of parathyroid lesions in patients with concomitant thyroid disease: role of high resolution ultrasonography and dual phase technetium 99 m sestamibi scintigraphy. J Endocrinol Invest 27(1):24–30 PubMed PMID: 15053239

    Article  CAS  PubMed  Google Scholar 

  4. Abboud B, Sleilaty G, Rabaa L, Daher R, Abou Zeid H, Jabbour H et al (2008) Ultrasonography: highly accuracy technique for preoperative localization of parathyroid adenoma. The Laryngoscope. 118(9):1574–1578 PubMed PMID: 18475203

    Article  PubMed  Google Scholar 

  5. Chandramohan A, Sathyakumar K, Irodi A, Abraham D, Paul MJ (2012) Causes of discordant or negative ultrasound of parathyroid glands in treatment naive patients with primary hyperparathyroidism. Eur J Radiol 81(12):3956–3964 PubMed PMID: 23017194

    Article  PubMed  Google Scholar 

  6. Zheng YX, Xu SM, Wang P, Chen L (2007) Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease. J Zhejiang Univ Sci B 8(9):626–631

    Article  PubMed  PubMed Central  Google Scholar 

  7. Krausz Y, Lebensart PD, Klein M, Weininger J, Blachar A, Chisin R et al (2000) Preoperative localization of parathyroid adenoma in patients with concomitant thyroid nodular disease. World J Surg 24(12):1573–1578 PubMed PMID: 11193726

    Article  CAS  PubMed  Google Scholar 

  8. Barbaros U, Erbil Y, Salmashoglu A, Issever H, Aral F, Tunaci M et al (2009) The characteristics of concomitant thyroid nodules cause false-positive ultrasonography results in primary hyperparathyroidism. Am J Otolaryngol 30(4):239–243 PubMed PMID: 19563934

    Article  PubMed  Google Scholar 

  9. Asteria C, Giovanardi A, Pizzocaro A, Cozzaglio L, Morabito A, Somalvico F et al (2008) US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 18(5):523–531 PubMed PMID: 18466077

    Article  PubMed  Google Scholar 

  10. Ghandur-Mnaymneh L, Kimura N (1984) The parathyroid adenoma. A histopathologic definition with a study of 172 cases of primary hyperparathyroidism. Am J Pathol 115(1):70–83 PubMed PMID: 6711681. PubMed Central PMCID: 1900356

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Magri F, Chytiris S, Capelli V, Alessi S, Nalon E, Rotondi M 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 76(1):137–141 PubMed PMID: 21740455

    Article  Google Scholar 

  12. Xu JM, Xu HX, Xu XH, Liu C, Zhang YF, Guo LH et al (2014) Solid hypo-echoic thyroid nodules on ultrasound: the diagnostic value of acoustic radiation force impulse elastography. Ultrasound Med Biol 40(9):2020–2030 PubMed PMID: 25109691

    Article  PubMed  Google Scholar 

  13. Calvete AC, Mestre JD, Gonzalez JM, Martinez ES, Sala BT, Zambudio AR (2014) Acoustic radiation force impulse imaging for evaluation of the thyroid gland. J Ultrasound Med 33(6):1031–1040 PubMed PMID: 24866610

    Article  PubMed  Google Scholar 

  14. Zhan J, Jin JM, Diao XH, Chen Y (2015) Acoustic radiation force impulse imaging (ARFI) for differentiation of benign and malignant thyroid nodules–A meta-analysis. Eur J Radiol 84(11):2181–2186 PubMed PMID: 26259701

    Article  PubMed  Google Scholar 

  15. Zhuo J, Ma Z, Fu WJ, Liu SP (2014) Differentiation of benign from malignant thyroid nodules with acoustic radiation force impulse technique. Br J Radiol 87(1035):20130263 PubMed PMID: 24588664. Pubmed Central PMCID: 4064611

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Unluturk U, Erdogan MF, Demir O, Culha C, Gullu S, Baskal N (2012) The role of ultrasound elastography in preoperative localization of parathyroid lesions: a new assisting method to preoperative parathyroid ultrasonography. Clin Endocrinol 76(4):492–498 PubMed PMID: 21955171

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India

    A. Chandramohan, M. Therese, D. Abhraham, T. V. Paul & P. Jacob Mazhuvanchary

Authors
  1. A. Chandramohan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Therese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Abhraham
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. V. Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Jacob Mazhuvanchary
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Chandramohan.

Ethics declarations

Conflict of interest

There were no disclosures or conflicts of interest.

Ethical approval

This is an institution review board (IRB)-approved prospective study performed with informed consent.

Informed consent

Consecutive patients with primary hyperparathyroidism considered for parathyroid surgery and patients with solid thyroid nodules considered for thyroidectomy were recruited into the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chandramohan, A., Therese, M., Abhraham, D. et al. Can ARFI elastography be used to differentiate parathyroid from thyroid lesions?. J Endocrinol Invest 41, 111–119 (2018). https://doi.org/10.1007/s40618-017-0694-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-017-0694-y

Keywords

Search

Navigation