Main Challenges and Pitfalls in Thyroid Ultrasound



Despite recent advances in thyroid imaging, approximately 30–50% of patients with thyroid cancer are misdiagnosed. Convenient ultrasound access, “sufficient” neck size, some constitutional features, and other individual patients’ factors influence the quality of thyroid ultrasound imaging. Various techniques have been developed to improve poor thyroid visualization. High intra- and interobserver variations in thyroid sonography are largely due to the quality of the equipment and the skill level of the operator. High-resolution ultrasound equipment allows several thyroid pathologies to be detected, which used to be considered the norm. Alternatively, there are hyperdiagnostic cases when normal thyroid structures are interpreted as nodules. Rare neck pathologies, such as adenoma and hyperplasia of the parathyroid glands or esophageal diverticulum, may be misdiagnosed due to insufficient experience of the ultrasound operator. Imaging of the thyroid diseases may be accompanied with ultrasound artifacts conferring acoustic shadowing, which is typical for calcifications; reverberation (appears in colloid lesions); marginal artifact of lateral acoustic shadows; posterior echo enhancement (characteristic of fluid collections); and Doppler artifacts. Compression ultrasound elastography can also be accompanied with several artifacts discussed in the chapter.


  1. 1.
    Sencha AN. Ultrasound diagnostics. Surface-located organs. Moscow: Vidar M Publishing House; 2015. (Book in Russian).Google Scholar
  2. 2.
    Bataeva RS, Mitkov VV, Mitkova MD. Evaluation of the reproducibility of the results of ultrasound volumetry of the thyroid gland. Ultrazvukovaya i Funkcionalnaya Diagnostica. 2006;1:37–43. (Article in Russian).Google Scholar
  3. 3.
    Bamber J, Cosgrove D, Dietrich CF, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology. Ultraschall Med. 2013;34(2):169–84.CrossRefGoogle Scholar
  4. 4.
    Osipov LV. Ultrasound diagnostic devices. Modes, methods and techniques. Moscow: Izomed; 2011 (Book in Russian).Google Scholar

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Authors and Affiliations

  1. 1.Department of Ultrasound DiagnosticsCenter for Radiological Diagnostics of Non-State Healthcare Institution Yaroslavl Railway Clinic of JSC “Russian Railways”YaroslavlRussia
  2. 2.Department of Visual and Functional DiagnosticsNational Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian FederationMoscowRussia
  3. 3.Department for Internal Diseases PropaedeuticCourse of Diagnostic Radiology of Medical Faculty of Federal State Budget Educational Institution of Higher Education “I. N. Ulianov Chuvash State University”CheboksaryRussia
  4. 4.Department of Ultrasound DiagnosticsKazan State Medical Academy – Branch Campus of the Federal State Budget Educational Institution of Further Professional Education, Russian Medical Academy of Continuing Professional Education of the Ministry of Healthcare of the Russian FederationKazanRussia

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