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Ultraschall Med 2016; 37(03): 262-270
DOI: 10.1055/s-0042-104647
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Evaluation of Strain Elastography for Differentiation of Thyroid Nodules: Results of a Prospective DEGUM Multicenter Study

Evaluation der Strain Elastografie für die Differenzierung von Schilddrüsenknoten: Ergebnisse einer prospektiven DEGUM Multizenter-Studie
M. Friedrich-Rust   *
1   Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
,
C. Vorlaender   *
2   Department of General Surgery, Buergerhospital Frankfurt, Germany
,
C. F. Dietrich
3   Innere Medizin 2, Caritas Hospital, Bad Mergentheim, Germany
,
W. Kratzer
4   Department of Internal Medicine I, University Hospital Ulm, Germany
,
W. Blank
5   Medizinische Klinik 1, Hospital am Steinenberg, Reutlingen, Germany
,
A. Schuler
6   Department of Internal Medicine, Helfenstein Hospital, Geislingen, Germany
,
N. Broja
1   Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
,
X. W. Cui
3   Innere Medizin 2, Caritas Hospital, Bad Mergentheim, Germany
7   Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
,
E. Herrmann
8   Institute of Biostatistics and Mathematical Modelling, Faculty of Medicine, J.W. Goethe-University, Frankfurt, Germany
,
J. Bojunga
1   Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany
› Author Affiliations
Further Information

Publication History

30 October 2015

22 February 2016

Publication Date:
12 April 2016 (online)

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Abstract

Purpose: Many patients with thyroid nodules are presently referred to surgery for not only therapeutic but also diagnostic purposes. The aim of noninvasive diagnostic methods is to optimize the selection of patients for surgery. Strain elastography (SE) enables the ultrasound-based determination of tissue elasticity. The aim of the present study was to evaluate the value of SE for the differentiation of thyroid nodules in a prospective multicenter study.

Materials and Methods: The study was registered at clinicaltrials.gov and was approved by the local ethics committees of all participating centers. All patients received an ultrasound (US) of the thyroid gland including color Doppler US. In addition, all nodules were evaluated by SE (Hitachi Medical Systems) using qualitative image interpretation of color distribution (SE-ES), strain value and strain ratio.

Results: Overall, 602 patients with 657 thyroid nodules (567 benign, 90 malignant) from 7 centers were included in the final analysis. The sensitivity, specificity, NPV, PPV, +LR were 21 %, 73 %, 86 %, 11 %, 0.8, respectively, for color Doppler US; 69 %, 75 %, 94 %, 30 %, 2.9, respectively, for SE-ES; 56 %, 81 %, 92 %, 32 %, 2.9, respectively, for SE-strain value; and 58 %, 78 %, 92 %, 30 %, 2.6, respectively, for SE-strain ratio. The diagnostic accuracy was 71 % for both strain value and strain ratio of nodules.

Conclusion: SE as an additional ultrasound tool improves the value of ultrasound for the work-up of thyroid nodules. It might reduce diagnostic surgery of thyroid nodules in the future.

Zusammenfassung

Ziel: Viele Patienten mit Schilddrüsenknoten werden nicht nur therapeutisch, sondern auch zu diagnostischem Zweck operiert. Ziel von nicht-invasiven diagnostischen Verfahren ist es daher die Selektion von Patienten zur Operation zu optimieren. Strain Elastografie (SE) ermöglicht die Ultraschall-basierte Messung der Gewebeelastizität. Das Ziel der vorliegenden Studie war es den Stellenwert der SE in einer prospektiven Multizenter-Studie für die Differenzierung von Schilddrüsenknoten zu evaluieren.

Material und Methoden: Die Studie wurde bei clinicaltrials.gov registriert und von den lokalen Ethikkommissionen der teilnehmenden Zentren genehmigt. Alle Patienten erhielten einen Ultraschall (US) der Schilddrüse inklusive Farbduplex-US. Zusätzlich wurden alle Knoten mittels SE (Hitachi Medical System) untersucht und eine Beurteilung der qualitativen Farbverteilung (SE-ES) und eine semiquantitative Messung der Elastizität mittels strain value und strain ratio durchgeführt.

Ergebnisse: Insgesamt wurden 602 Patienten mit 657 Schilddrüsenknoten (567 benigne, 90 maligne) an 7 deutschen Zentren ausgewertet. Sensitivität, Spezifität, NPV, PPV, und +LR betrugen entsprechend 21 %, 73 %, 86 %, 11 %, 0,8 für den Duplex-US; 69 %, 75 %, 94 %, 30 %, 2,9 für SE-ES; 56 %, 81 %, 92 %, 32 %, 2,9 für SE-strain value; 58 %, 78 %, 92 %, 30 %, 2,6 für SE- strain ratio. Die diagnostische Genauigkeit betrug 71 % sowohl für SE-strain value, als auch SE-strain ratio.

Schlussfolgerung: Strain Elastografie als zusätzliche Ultraschallfunktion verbessert die Ultraschall-Diagnostik von Schilddrüsenknoten und könnte in Zukunft die Zahl der diagnostischen Operationen von Schilddrüsenknoten reduzieren.

Key words

elastography - thyroid - strain elastography

* both authors contributed equally


Tabelle 1a + b/Table 1a + b

 

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