Acoustic radiation force impulse imaging (ARFI) for differentiation of benign and malignant thyroid nodules--A meta-analysis

Abstract

Objectives: Work-up of thyroid nodules remains challenging. Acoustic radiation force impulse imaging (ARFI)-generated shear wave elastography, which can measure quantitatively tissue stiffness (virtual touch tissue quantification) is used as a complement to conventional sonography for improving the diagnosis of thyroid nodules. This meta-analysis was performed to expand on a previous meta-analysis to assess the diagnostic power of ARFI in differentiating benign and malignant thyroid nodules.

Methods: The MEDLINE, PubMed, SpringerLink databases up to December 31, 2014, were searched. The pooled sensitivity, specificity, and summary receiver operating characteristic curve were obtained from individual studies with a random effects model.

Results: Sixteen studies that included a total of 2436 nodules in 2147 patients for ARFI studies were analyzed. The overall mean sensitivity and specificity of ARFI for differentiation of thyroid nodules were 0.80 (95% confidence interval [CI], 0.73-0.87) and 0.85 (95% CI, 0.80-0.90), respectively. A significant heterogeneity was found for both sensitivity and specificity of the different studies (P<0.001). The area under the curve for the ARFI was 0.91.

Conclusions: ARFI has high sensitivity and specificity for identification of thyroid. This technique might be useful to select patients with thyroid nodules for surgery.

Keywords: Acoustic radiation force impulse imaging (ARFI); Fine-needle aspiration biopsy (FNAB); Real-time elastography (RTE); Virtual touch tissue quantification (VTQ).