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Elastography Imaging - Thyroid
Transcript of Elastography Imaging - Thyroid
Nodules seen in up to
of general population (Sebag et al., 2010)
of the nodules are MALIGNANT
Nodules felt on palpation/incidental finding
Ultrasound to decide if further assessment is needed
Suspicious nodules are indicated for a Fine Needle Aspiration
1500$ per exam (Luo et al, 2011)
300,000 thyroid exams per year (Luo et al. 2011)
Contraindicated for: needle phobias, bleeding disorders, anti-coagulant therapies, etc
3) Time Consuming
4) Most are NOT needed!
60-70% are benign - 5% malignant - 5-15% inconclusive - 15-25% suspicious (Hong et al., 2009)
We are over-prescribing FNA's due to ambiguous findings with Grey Scale/Doppler Ultrasound
How effective is
Shear Wave Elastography
as an adjunct to conventional ultrasound to rule out benign thyroid nodules?
Decrease the number of FNAs indicated which would have been benign anyways
What type of nodule is it?
Grey Scale/Doppler US
What is Elastography?
How Does It Work?
Based on: Young's Modulus (E)
Young's Modulus = Stiffness
E = Stress/Strain
1) Mechanical Force
Axial Strain Elastography
2) Acoustic Radiation Force
Shear wave elastography
waves that are perpendicular to the push beam
Ultra-fast imaging system that acquires the speed of these waves, requiring up to 20,000 FPS (Sebag et al.,2010)
E = 3P
Faster speeds occur in stiffer materials and therefore increase shear wave speed = increase E
Conventional 2D Ultrasound
What do we look for?
Is Conventional US adequate?
Any single echo pattern cannot be considered
for malignancy (Ateria et al., 2008)
Interpreting the Results
Table 1. Conventional US and elastography pattern with their associated specificity and sensitivity values.
Adapted from “TABLE 1” by Sebag et al., 2010, Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules, p. 5285.
assigns color based on stiffness
The tissue of interest is color-coded according to its degree of strain
Egg shell calcifications
The colors that represent soft and hard may be altered by the sonographer
Figure 2. Ultrasound demonstrating a uniform thin halo surround a thyroid nodule. Adapted from "Figure 1" by Rago et al., 2008, Role of thyroid ultrasound in the diagnostic
evaluation of thyroid nodules, p. 915.
Figure 1. Qualitative & Quantitative Analysis
Adapted from “FIG. 2. B” by Sebag et al., 2010, Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules, p. 5285.
E values (kPA) are calculated based on the measured speed of the shear waves
Figure 1. Qualitative & Quantitative Analysis
Adapted from “Fig. 1. D” by Veyrieres et al., 2012, A threshold value in Shear Wave elastography to rule out malignant thyroid nodules: a reality?. 81, p. 3967
A qualitative and quantifiable method of measuring
because it gives
as a color map of stiffness
it gives as definite
-58% malignant nodules= microcalcifcations
-16% benign nodules=microcalcifcations
RESULTS ARE NOT ALWAYS CONSISTENT
risk of malignancy
Asteria et al. (2008) studied 86 thyroid nodules and found the presence of microcalcifications is one of the
BEST SOLE PREDICTORS
Elastography Vs. Conventional Ultrasound
Conventional ultrasound indicated too many FNA procedures to query malignancy in thyroid nodules
: FNAs are expensive, time-consuming, have contraindications, and most are not needed!
Use SWE as a method to differentiate benign from malignant nodules in order to indicate less FNAs
1) Sebag et al. (2010)
Ultrasound + SWE:
2) Veyrieres et al. (2012)
Threshold at < 65 kPA benign
Threshold at < 66 kPA benign
Ultrasound + SWE
Figure 4. Qualitative assessment. Adapted from "Fig. 1. B", by Veyrieres et al., 2012, A threshold value in Shear Wave elastography to rule out malignant thyroid nodules: a reality?. 81, p. 3967
absent halo sign
intranodal blood flow
Figure 3. Microcalcifications. Adapted from "Figure 3 A", by Soto et al., 2010, Update in thyroid imaging. The expanding world of thyroid imaging and its translation to clinical practice, p. 287-298.
Figure 4. Intranodular blood flow. Adapted from "Figure 4 C", by Soto et al., 2010, Update in thyroid imaging. The expanding world of thyroid imaging and its translation to clinical practice, p. 287-298.
Thyroid Elastography: Relieving the
on the Health Care System
Amy Harrigan & Michael Uy
Dimensions, echotexture, calcfications, location
Vascular presence, velocity, RI, PI
Shear Wave Elastography:
More diagnostic criteria and confidence to rule out benign nodules!
= LESS FNAs!
to rule out benign nodules
More time, more convenience, more money!
= Quantifiable number
Why is that
Asteria, C., Giovanardi, A., Pizzocaro, A., Cozzaglio, L., Morabito, A., Somalvico, F., & Zoppo, A. (2008). US-elastography in the differential diagnosis of benign and malignant thyroid nodules.
, 523-531. doi: 10.1089=thy.2007.0323
Bhatia, K. S., Tong, C. S., Cho, C. C., Yuen, E. H., Lee, Y. Y., & Ahuja, A. T. (2012). Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy. European radiology, 22(11), 2397-2406. doi: 10.1007/s00330-012-2495-1
Darrin, C. (2015). Mod 1 Unit 8.Elastography.postable [PDF]. Retrieved from https://avenue.cllmcmaster.ca/d2l/le/content/144949/viewContent/1175601/View
Hegedüs, L. (2001). Thyroid ultrasound.
Endocrinology and metabolism clinics of North America, 30(2)
Hong, Y., Liu, X., Li, Z., Zhang, X., Chen, M., & Luo, Z. (2009). Real-time ultrasound elastography in the differential diagnosis of benign and malignant thyroid nodules.
Journal of Ultrasound in Medicine, 28(7),
Luo, S., Kim, E. H., Dighe, M., & Kim, Y. (2011). Thyroid nodule classification using ultrasound elastography via linear discriminant analysis.
, 425-431. doi:10.1016/j.ultras.2010.11.008
Pickerell, M., D. (2010). Elastography: The imaging of tomorrow.
Journal of Diagnostic Medical Sonography. 26(3)
, 109-113. DOI: 10.1177/8756479310370482
Rago, T., Santini, F., Scutari, M., Pinchera, A., & Vitti, P. (2007). Elastography: new developments in ultrasound for predicting malignancy in thyroid nodules.
The Journal of Clinical Endocrinology & Metabolism, 92(8)
, 2917-2922. doi: 10.1210/jc.2007-0641
Rago, T., & Vitti, P. (2008). Role of thyroid ultrasound in the diagnostic evaluation of thyroid nodules.
Best Practice & Research Clinical Endocrinology & Metabolism, 22(6)
, 913-928. doi:10.1016/j.beem.2008.09.016
Sebag, F., Vaillant-Lombard, J., Berbis, J., Griset, V., Henry, J. F., Petit, P., & Oliver, C. (2010). Shear wave elastography: a new ultrasound imaging mode for the differential diagnosis of benign and malignant thyroid nodules.
The Journal of Clinical Endocrinology & Metabolism, 95(12)
, 5281-5288. DOI: http://dx.doi.org/10.1210/jc.2010-0766
Veyrieres, J. B., Albarel, F., Lombard, J. V., Berbis, J., Sebag, F., Oliver, C., & Petit, P. (2012). A threshold value in Shear Wave elastography to rule out malignant thyroid nodules: a reality?. European journal of radiology, 81(12), 3965-3972. doi: 10.1016/j.ejrad.2012.09.002