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. 2018 Aug 9;3(4):319-325.
doi: 10.1002/lio2.165. eCollection 2018 Aug.

Clinical efficacy of novel elastography using acoustic radiation force impulse (ARFI) for diagnosis of malignant thyroid nodules

Takahiro Fukuhara  1 , Eriko Matsuda  1 , Ryohei Donishi  1 , Satoshi Koyama  1 , Naritomo Miyake  1 , Kazunori Fujiwara  1 , Hiromi Takeuchi  1
Affiliations

Clinical efficacy of novel elastography using acoustic radiation force impulse (ARFI) for diagnosis of malignant thyroid nodules

Takahiro Fukuhara et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objective: Acoustic radiation force impulse (ARFI) imaging is a recent ultrasound elastography technique; consequently, its efficacy is not fully known. In this study, we compared ARFI imaging with conventional strain elastography (SE) and shear wave velocities (SWVs) to evaluate the utility of ARFI imaging for diagnosing thyroid nodules.

Subjects and methods: In this study we examined 233 thyroid nodules (183 benign nodules and 50 malignant nodules) isolated from human patients. The nodules were evaluated with SE and ARFI imaging, and SWVs of the nodules were simultaneously measured. ARFI images were classified using a four-point score based on grayscale intensity of the images. The sensitivity, specificity, and diagnostic accuracy were compared between SE and ARFI imaging. Finally, SWVs for each score of SE and ARFI imaging were compared.

Results: The new scoring system for ARFI imaging can be divided into four virtual touch imaging (VTI) scores. Nodules with a VTI score of 3 or 4 as determined by ARFI imaging were determined to be malignant. The sensitivity, specificity, and diagnostic accuracy, respectively, were 63.2%, 66.3%, and 65.6% for SE, compared with 80.0%, 86.3%, and 85.0% for ARFI imaging. The median SWVs of the nodules were 1.57 m/s, 1.73 m/s, 1.88 m/s, and 2.09 m/s for VTI scores of 1, 2, 3, and 4, respectively. The SWVs of VTI scores 3 and 4 were significantly higher than those of VTI scores 1 and 2.

Conclusions: The diagnostic accuracy of ARFI imaging for differentiating malignant thyroid nodules was higher than that of SE. The VTI scores of the nodules accurately reflected their SWVs.

Level of evidence: 4.

Keywords: ARFI; elastography; shear wave; thyroid nodule; ultrasonography.

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Figures

Figure 1
Figure 1
Flowchart of patient selection during this study. FNA = fine needle aspiration; FNAC = fine needle aspiration cytology; PEIT = percutaneous ethanol injection therapy
Figure 2
Figure 2
Four‐pattern scoring system of VTI (B‐mode [left side] and ARFI imaging [right side] images) a. Score 1: the nodule is white or white honeycomb (lighter than the surrounding tissue); b. Score 2: the nodule is light gray (similar in color to a thyroid parenchyma); c. Score 3: the nodule is dark gray (significantly darker than surrounding tissue); d. Score 4: the nodule is black.
Figure 3
Figure 3
A. Shear wave velocities (SWVs) of each SE score. There were no significant differences among the four scores (P = .12). Kruskal–Wallis Test. B. SWVs of each VTI score. There were significant differences among the four scores (P < .001). Kruskal–Wallis Test.
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