Nuklearmedizin 2014; 53(05): 173-177
DOI: 10.3413/Nukmed-0660-14-04
Original article
Schattauer GmbH

Diagnosis of hyperfunctional thyroidn odules

Impact of US-elastographyDiagnostik hyperfunktioneller Schilddrüsenknoten Bedeutung der US-Elastographie
M. Ruhlmann
1   Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany
,
V. Stebner
1   Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany
,
R. Görges
1   Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany
,
J. Farahati
1   Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany
,
D. Simon
2   Department of General and Visceral Surgery, Bethesda Hospital, Duisburg, Germany
,
A. Bockisch
1   Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany
,
S. Rosenbaum-Krumme
1   Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany
,
J. Nagarajah
1   Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany
› Author Affiliations
Further Information

Publication History

received: 06 April 2014

accepted in revised form: 26 May 2014

Publication Date:
02 January 2018 (online)

Summary

Aim: Several studies described the ultrasound based real-time elastography (USE) having a high sensitivity, specificity and negative predictive value in the diagnosis of suspicious thyroid nodules. Recently published studies called these results into question. Until now the usefulness of USE in the diagnosis of scintigraphically hyperfunctional thyroid nodules is not examined. Patients, methods: This study included 135 hyperfunctional thyroid nodules of 102 consecutive patients. The following attributes of the nodules were analyzed: stiffness with the USE using scores of Rago or Asteria and ultrasound criteria using TIRADS. Results: 94 of the examined thyroid nodules (70%) were rated as hard (suspicious for malignancy) and 41 nodules (30%) as soft (not suspicious) with a specificity of 30%. The scoring systems of Rago and Asteria showed no sigificant difference. Applying the TIRADS criteria 44 nodules (33%) have a higher risk for malignancy (33 nodules TIRADS 4a, 11 nodules TIRADS 4b). Combining USE and TIRADS 32 nodules (24%) are categorized as suspicious (intersection of hard nodules that are categorized as TIRADS 4a or 4b). Conclusion: Ultrasound based real-time elastography cannot identify scintigraphically hyperfunctional thyroid nodules as benign nodules reliably. Its accuracy in the assessment of at least “hot” thyroid nodules is to be questioned.

Zusammenfassung

Ziel: Die ersten Studien zeigten, dass die ultraschallbasierte Real-time-Elastographie (USE) hohe Sensitivität, Spezifität und negativen prädiktiven Wert in der Diagnostik von suspekten Schilddrüsenknoten hat. Allerdings stellen aktuell publizierte Arbeiten die initialen Ergebnisse in Frage. Im Gegensatz zu den bisher publizierten Arbeiten soll in dieser Arbeit der Nutzen der USE in der Diagnose von szintigraphisch hyperfunktionellen Schilddrüsenknoten untersucht werden. Patienten, Methoden: Es wurden 135 hyperfunktionelle Schilddrüsenknoten von 102 konsekutiven Patienten untersucht. Dabei wurden der Härtegrad in der USE nach den Einteilungen von Rago und Asteria sowie die Ultraschallkriterien nach TIRADS angewendet. Ergebnisse: Es wurden 94 der Schilddrüsenknoten (70%) als elastographisch hart (= malignom- suspekt) bewertet und 41 Knoten (30%) als weich (= nicht malignomsuspekt) bei einer Spezifität von 30%. Die Einteilungen nach Rago und Asteria zeigten keinen statistisch signifikanten Unterschied. Unter Anwendung der TIRADS Kriterien wiesen 44 Schilddrüsenknoten (33%) ein höheres Risiko für Maligni tät auf (33 Knoten TIRADS 4a, 11 Knoten TIRADS 4b). Die Kombination der Kriterien aus USE und TIRADS identifizierte 32 Knoten (24%) mit einem größeren Risiko für Maligni- tät (Schnittmenge aus harten Knoten und TIRADS 4a und 4b). Schlussfolgerung: Die ultra schallbasierte Real-time-Elastographie kann hyperfunktionelle Schilddrüsenknoten nicht sicher als benigne Schilddrüsenknoten identifizieren. Ihre Zuverlässigkeit in der Beurteilung zumindest von „heißen” Schilddrüsenknoten muss in Frage gestellt werden.

 
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