Abstract
Thyroid nodules are very common with malignancies accounting for about 5 %. Fine-needle biopsy is the most accurate test for thyroid cancer diagnosis. Elastography, a new technology directly evaluating the elastic property of the tissue, has been recently added to the diagnostic armamentarium of the endocrinologists as noninvasive predictor of thyroid malignancy. In this paper, we critically reviewed characteristics and applications of elastographic methods in thyroid gland. Elastographic techniques can be classified on the basis of the following: source-of-tissue compression (free-hand, carotid vibration, ultrasound pulses), processing time (real-time, off-line), stiffness expression (qualitative, semi-quantitative, or quantitative). Acoustic radiation force impulse and aixplorer shear wave are the newest and most promising quantitative elastographic methods. Primary application of elastography is the detection of nodular lesions suspicious for malignancy. Published data show a high sensitivity and negative predictive value of the technique. Insufficient data are available on the possible application of elastography in the differential diagnosis of indeterminate lesions and in thyroiditis. Elastography represents a noninvasive tool able to increase the performance of ultrasound in the selection of thyroid nodules at higher risk of malignancy. Some technical improvements and definition of more robust quantitative diagnostic criteria are required for assigning a definite role in the management of thyroid nodules and thyroiditis to elastography.
Similar content being viewed by others
References
H. Gharib, E. Papini, R. Valcavi, H.J. Baskin, A. Crescenzi, M.E. Dottorini, D.S. Duick, R. Guglielmi, C.R. Hamilton Jr, M.A. Zeiger, M. Zini, AACE/AME Task Force on Thyroid Nodules, American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr. Pract. 12(1), 63–102 (2006)
M. Andrioli, C. Carzaniga, L. Persani, Standardized ultrasound report for thyroid nodules: the endocrinologist’s viewpoint. Eur. Thyroid. J. (2013). doi:10.1159/000347144
A. Lyshchik, T. Higashi, R. Asato, S. Tanaka, J. Ito, J.J. Mai, C. Pellot-Barakat, M.F. Insana, A.B. Brill, T. Saga, M. Hiraoka, K. Togashi, Thyroid gland tumor diagnosis at US elastography. Radiology 237(1), 202–211 (2005)
T. Rago, F. Santini, M. Scutari, A. Pinchera, P. Vitti, Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules. J. Clin. Endocrinol. Metab. 92(8), 2917–2922 (2007)
V. Cantisani, V. D’Andrea, F. Biancari, O. Medvedyeva, M. Di Segni, M. Olive, G. Patrizi, A. Redler, E. De Antoni, R. Masciangelo, F. Frezzotti, P. Ricci, Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: preliminary experience. Eur. J. Radiol. (2012). doi:10.1016/j.ejrad.2011.11.056
M. Friedrich-Rust, O. Romenski, G. Meyer, N. Dauth, K. Holzer, F. Grünwald, S. Kriener, E. Herrmann, S. Zeuzem, J. Bojunga, Acoustic Radiation Force Impulse-Imaging for the evaluation of the thyroid gland: a limited patient feasibility study. Ultrasonics (2012). doi:10.1016/j.ultras.2011.06.012
J. Bojunga, N. Dauth, C. Berner, G. Meyer, K. Holzer, L. Voelkl, E. Herrmann, H. Schroeter, S. Zeuzem, M. Friedrich-Rust, Acoustic radiation force impulse imaging for differentiation of thyroid nodules. PLoS ONE (2012). doi:10.1371/journal.pone.0042735
F. Sebag, J. Vaillant-Lombard, J. Berbis, V. Griset, J.F. Henry, P. Petit, C. Oliver, Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules. J. Clin. Endocrinol. Metab. (2010). doi:10.1210/jc.2010-0766
C. Cappelli, I. Pirola, E. Gandossi, B. Agosti, E. Cimino, C. Casella, A. Formenti, M. Castellano, Real-time elastography: a useful tool for predicting malignancy in thyroid nodules with nondiagnostic cytologic findings. J. Ultrasound Med. 31(11), 1777–1782 (2012)
M. Scacchi, M. Andrioli, C. Carzaniga, G. Vitale, M. Moro, L. Poggi, F. Pecori Giraldi, L.M. Fatti, F. Cavagnini, Elastosonographic evaluation of thyroid nodules in acromegaly. Eur. J. Endocrinol. (2009). doi:10.1530/EJE-09-0558
Y. Hong, X. Liu, Z. Li, X. Zhang, M. Chen, Z. Luo, Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules. J. Ultrasound Med. 28(7), 861–867 (2009)
C. Vorländer, J. Wolff, S. Saalabian, R.H. Lienenlüke, R.A. Wahl, Real-time ultrasound elastography—a non-invasive diagnostic procedure for evaluating dominant thyroid nodules. Langenbecks. Arch. Surg. (2010). doi:10.1007/s00423-010-0685-3
U. Unlütürk, M.F. Erdoğan, O. Demir, S. Güllü, N. Baskal, Ultrasound elastography is not superior to grayscale ultrasound in predicting malignancy in thyroid nodules. Thyroid (2012). doi:10.1089/thy.2011.0502
H. Wang, D. Brylka, L.N. Sun, Y.Q. Lin, G.Q. Sui, J. Gao, Comparison of strain ratio with elastography score system in differentiating malignant from benign thyroid nodules. Clin. Imaging (2013). doi:10.1016/j.clinimag.2012.04.003
P. Xing, L. Wu, C. Zhang, S. Li, C. Liu, C. Wu, Differentiation of benign from malignant thyroid lesions: calculation of the strain ratio on thyroid sonoelastography. J. Ultrasound Med. 30(5), 663–669 (2011)
P. Ning, S.Q. Jiang, T. Zhang, L.T. Sun, Y.J. Liu, J.W. Tian, The value of strain ratio in differential diagnosis of thyroid solid nodules. Eur. J. Radiol. (2012). doi:10.1016/j.ejrad.2010.12.010
U. Bae, M. Dighe, T. Dubinsky, S. Minoshima, V. Shamdasani, Y. Kim, Ultrasound thyroid elastography using carotid artery pulsation. J. Ultras. Med. 26(6), 797–805 (2007)
M. Dighe, S. Luo, C. Cuevas, Y. Kim, Efficacy of thyroid ultrasound elastography in differential diagnosis of small thyroid nodules. Eur. J. Radiol. (2013). doi:10.1016/j.ejrad.2013.01.009
K.S. Bhatia, C.S. Tong, C.C. Cho, E.H. Yuen, Y.Y. Lee, A.T. Ahuja, Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy. Eur. Radiol. (2012). doi:10.1007/s00330-012-2495-1
P. Trimboli, R. Guglielmi, S. Monti, I. Misischi, F. Graziano, N. Nasrollah, S. Amendola, S.N. Morgante, M.G. Deiana, S. Valabrega, V. Toscano, E. Papini, Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J. Clin. Endocrinol. Metab. (2012). doi:10.1210/jc.2012-2951
G. Azizi, J. Keller, M. Lewis Pa, D.W. Puett, K. Rivenbark, C.D. Malchoff, Performance of elastography for the evaluation of thyroid nodules: a prospective study. Thyroid (2013). doi:10.1089/thy.2012.0227
B. Cakir, C. Aydin, B. Korukluoglu, D. Ozdemir, I.C. Sisman, D. Tüzün, A. Oguz, G. Güler, G. Güney, A. Kusdemir, S.Y. Sanisoglu, R. Ersoy, Diagnostic value of elastosonographically determined strain index in the differential diagnosis of benign and malignant thyroid nodules. Endocrine (2011). doi:10.1007/s12020-010-9416-3
H.J. Moon, J.M. Sung, E.K. Kim, J.H. Yoon, J.H. Youk, J.Y. Kwak, Diagnostic performance of gray-scale US and elastography in solid thyroid nodules. Radiology (2012). doi:10.1148/radiol.11110839
M. Andrioli, M. Scacchi, C. Carzaniga, G. Vitale, M. Moro, L. Poggi, L.M. Fatti, F. Cavagnini, Thyroid nodules in acromegaly: the role of elastography. J. Ultrasound (2010). doi:10.1016/j.jus.2010.09.008
M. Andrioli, P. Trimboli, S. Amendola, S. Valabrega, N. Fukunari, M. Moro, L. Persani, Elastographic presentation of medullary thyroid carcinoma. Endocrine (2013). doi:10.1007/s12020-013-0064-4
C. Shuzhen, Comparison analysis between conventional ultrasonography and ultrasound elastography of thyroid nodules. Eur. J. Radiol. (2012). doi:10.1016/j.ejrad.2011.02.070
H. Wu, B. Zhang, Y. Zang, J. Wang, B. Zhu, Y. Cao, Q. Liu, Ultrasound-guided fine-needle aspiration for solid thyroid nodules larger than 10 mm: correlation between sonographic characteristics at the needle tip and nondiagnostic results. Endocrine (2013). doi:10.1007/s12020-013-0042-8
T. Rago, M. Scutari, F. Santini, V. Loiacono, P. Piaggi, G. Di Coscio, F. Basolo, P. Berti, A. Pinchera, P. Vitti, Real-time elastosonography: useful tool for refining the presurgical diagnosis in thyroid nodules with indeterminate or nondiagnostic cytology. J. Clin. Endocrinol. Metab. (2010). doi:10.1210/jc.2010-0901
V. Cantisani, S. Ulisse, E. Guaitoli, C. De Vito, R. Caruso, R. Mocini, V. D’Andrea, V. Ascoli, A. Antonaci, C. Catalano, F. Nardi, A. Redler, P. Ricci, E. De Antoni, S. Sorrenti, Q-elastography in the presurgical diagnosis of thyroid nodules with indeterminate cytology. PLoS ONE (2012). doi:10.1371/journal.pone.0050725
P.V. Lippolis, S. Tognini, G. Materazzi, A. Polini, R. Mancini, C.E. Ambrosiani, A. Dardano, F. Basolo, M. Seccia, P. Miccoli, F. Monzani, Is elastography actually useful in the presurgical selection of thyroid nodules with indeterminate cytology? J. Clin. Endocrinol. Metab. (2011). doi:10.1210/jc.2011-1021
M. Friedrich-Rust, A. Sperber, L. Holzer, J. Diener, F. Grunwald, K. Badenhoop, S. Weber, S. Kriener, E. Herrmann, W.O. Bechstein, S. Zeuzem, J. Bojunga, Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp. Clin. Endocrinol. Diabetes (2010). doi:10.1055/s-0029-1237701
M. Ruchala, E. Szczepanek-Parulska, A. Zybek, J. Moczko, A. Czarnywojtek, G. Kaminski, J. Sowinski, The role of sonoelastography in acute, subacute and chronic thyroiditis: a novel application of the method. Eur. J. Endocrinol. (2012). doi:10.1530/EJE-11-0736
I. Sporea, M. Vlad, S. Bota, R.L. Sirli, A. Popescu, M. Danila, M. Sendroiu, I. Zosin, Thyroid stiffness assessment by acoustic radiation force impulse elastography (ARFI). Ultraschall Med. (2011). doi:10.1055/s-0029-1246048
F. Magri, S. Chytiris, V. Capelli, M. Gaiti, F. Zerbini, R. Carrara, A. Malovini, M. Rotondi, R. Bellazzi, L. Chiovato, Comparison of elastographic strain index and thyroid fine-needle aspiration cytology in 631 thyroid nodules. J. Clin. Endocrinol. Metab. (2013). doi:10.1210/jc.2013-2672
R. Slman, H. Monpeyssen, S. Desarnaud, J. Haroche, P. Fediaevsky Ldu, M. Fabrice, D. Seret-Begue, Z. Amoura, A. Aurengo, L. Leenhardt, Ultrasound, elastography, and fluorodeoxyglucose positron emission tomography/computed tomography imaging in Riedel’s thyroiditis: report of two cases. Thyroid. (2011). doi:10.1089/thy.2010.0242
Conflict of interest
The authors do not have any conflict of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Andrioli, M., Persani, L. Elastographic techniques of thyroid gland: current status. Endocrine 46, 455–461 (2014). https://doi.org/10.1007/s12020-014-0178-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-014-0178-1