Elastographic patterns of thyroid microcarcinomas: a new proposal
Introduction: Ultrasound (US) elastography for thyroid microcarcinomas has variable diagnostic performance. This study aimed to (1) define the elastographic features of thyroid nodules using two-dimensional shear-wave elastography (2D-SWE) and (2) evaluate the utility of combining conventional US, e...
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| Published in: | Journal of the Mexican Federation of Radiology and Imaging Vol. 3; no. 2 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
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18-07-2024
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| Online Access: | Get full text |
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| Summary: | Introduction: Ultrasound (US) elastography for thyroid microcarcinomas has variable diagnostic performance. This study aimed to (1) define the elastographic features of thyroid nodules using two-dimensional shear-wave elastography (2D-SWE) and (2) evaluate the utility of combining conventional US, elastography-strain (E-strain), and 2D-SWE for improving diagnostic performance in thyroid micronodules. Materials and Methods: Patients with thyroid nodules were evaluated in a cross-sectional study with conventional US, E-strain, and 2D-SWE. Nodule stiffness, the presence of a perinodular halo, and the halo/nodule A/B index were evaluated using 2D-SWE. Three elastographic patterns were defined based on conventional US, E-strain, and 2D-SWE features. The pathological diagnosis was made by fine needle aspiration biopsy and confirmed by surgery. Results: We included 158 patients with 158 thyroid nodules: 64 micronodules ≤10 mm and 94 macronodules > 10 mm. Malignancy was confirmed in 58 (36.7%) of 158 nodules, of which 29 were thyroid microcarcinomas. Stiffness at a cutoff value of 23.5 kPa predicted malignancy. Notably, 21 (72.4%) of 29 microcarcinomas with a perinodular halo had a stiffness value of < 23.5 kPa. All microcarcinomas with a perinodular halo (n = 21, 100%) had an elastographic stiffness A/B index ≥ 1.3. A congruent elastographic pattern was defined as thyroid imaging reporting and data system (TI-RADS) 4 or 5, E-strain pattern 4 or 5, with a stiffness ≥ 23.5 kPa without a perinodular halo, and an A/B index < 1.3 by 2D-SWE. An incongruent elastographic pattern was defined as TI-RADS 4 or 5, E-strain pattern 4 or 5, and discordant findings on 2D-SWE with intrinsic thyroid nodule laxity (< 23.5 kPa), a rigid perinodular halo, and an A/B index ≥ 1.3. An atypical congruent elastographic pattern was defined as TI-RADS 4 or 5 with atypical findings on E-strain (pattern 1, 2, or 3), and 2D-SWE with intrinsic thyroid nodule laxity (< 23.5 kPa), a rigid perinodular halo, and an A/B index ≥ 1.3. Conclusion: Three elastographic patterns of thyroid microcarcinomas are proposed based on 2D-SWE features such as nodule stiffness, a perinodular halo, and an A/B index in combination with conventional US and E-strain. These elastographic patterns have not been described in the literature. |
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| ISSN: | 2938-1215 2696-8444 |
| DOI: | 10.24875/JMEXFRI.M24000072 |