Schilddrüsen-Elastografie

Zusammenfassung

Schilddrüsenknoten sind ein häufiger Befund insbesondere in Regionen mit unzureichender Iodversorgung. Ultraschall ist das sensitivste Verfahren zum Nachweis von Schilddrüsenknoten, hat aber eine nicht ausreichende Genauigkeit bei der Unterscheidung zwischen gutartigen und bösartigen Schilddrüsenknoten. Daher ist bei sonografisch auffälligen Knoten in der Sonografie derzeit die Feinnadel-Aspiration-Biopsie (FNAB) diagnostisches Verfahren der Wahl. Dennoch wird bei einer relevanten Anzahl von Patienten mit letztlich gutartigen Schilddrüsenknoten eine Operation mehr aus diagnostischer als aus therapeutischer Intention durchgeführt. Ein klassisches Kriterium der Bösartigkeit ist eine harte oder feste Konsistenz bei Palpation. Bisher war dieses Kriterium subjektiv und abhängig von der Erfahrung des Untersuchers. Mit der Einführung der ultraschallbasierten Elastografie steht eine reproduzierbare Beurteilung der Gewebekonsistenz zur Verfügung. Ziel des vorliegenden Artikels ist eine aktuelle Darstellung der verschiedenen verfügbaren Techniken sowie deren Ergebnisse, sowohl für die Differenzierung von Schilddrüsenknoten als auch für diffuse Schilddrüsenerkrankungen. Vorteile und Grenzen der Elastografie werden kritisch diskutiert.

Abstract

Thyroid nodules are a common finding especially in regions with inadequate iodine supply. Ultrasound is an accurate method for the detection of thyroid nodules, but it has a low accuracy for the differentiation between benign and malignant thyroid nodules. Therefore, in patients with normal thyroid stimulating hormone fine-needle-aspiration-biopsy (FNAB) is presently recommended as supplementary diagnostic methods in the evaluation of thyroid nodules. However, a relevant number of patients with the final diagnosis of benign thyroid nodules receive thyroid surgery more for diagnostic than for therapeutic purposes. A classical criterion of malignancy is a hard or firm consistency upon palpation or ultrasound-probe pressure. Previously this attribute was subjective and dependent on the experience of the examiner. With the introduction ultrasound-based elastography a reproducible qualitative assessment of tissue consistency became available. The aim of the present article is to provide an update of the literature on different available techniques and the results reported both for thyroid nodules differentiation and for diffuse thyroid disease evaluation. Advantages and limitations of elastography are also discussed.

Schlüsselwörter

Ultraschall - Schilddrüse - Elastografie - Schilddrüsenknoten - Diagnostik

Key words

Ultrasound - Thyroid - elastography - thyroid nodules - diagnostics

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