Clinical Abstracts using Hitachi Real-time Tissue Elastography

OBJECTIVE: The purpose of this study was to evaluate whether ultrasound elastography performed by using carotid pulsation as a compression source and generating the systolic thyroid stiffness index (STSI) can be used as a pre-fine-needle aspiration (FNA) screening tool. METHODS: Ultrasound data previously acquired from 62 thyroid nodules in 59 patients who underwent a thyroid FNA were used. Pulsation from the carotid artery was used as the compression source, and the strain was calculated offline. A metric called the STSI was computed for each nodule during systole. On the basis of the derived STSI value, thyroid nodules were retrospectively classified into 2 types: I, no FNA (observation only); and II, FNA. RESULTS: The STSI value of malignant nodules (n = 12) was significantly higher than that of benign nodules (n = 39; P < .00002). Using an STSI cutoff value of 10, 31 nodules were classified as type I, all of which were benign, whereas 20 nodules were classified as type II, 12 malignant and 8 benign, with sensitivity of 100% and specificity of 79.4%. This suggests that ultrasound elastography could have screened out 31 type I nodules, reducing the number of FNAs by 60.8%. CONCLUSIONS: Thyroid ultrasound elastography has the potential to substantially reduce the number of FNA biopsies by detecting type I benign nodules. Patients with suspicious type II nodules would be referred for an FNA. Future prospective studies are needed to confirm the efficacy of thyroid ultrasound elastography as a triage tool to FNA. J Ultrasound Med. 2010 Apr;29(4):565-74. ________________________ THYROID ELASTOGRAPHY MAY REDUCE UNNECESSARY FNA BIOPSIES By Erik L. Ridley AuntMinnie staff writer April 21, 2010 A significant percentage of thyroid nodule fine-needle aspiration (FNA) biopsies lead to benign findings. But use of thyroid elastography may avoid the need for biopsy in many of these patients, according to research published in the April issue of the Journal of Ultrasound in Medicine. A research team led by Dr. Manjiri Dighe of the University of Washington Medical Center in Seattle found that quantitative measurements generated from ultrasound elastography could be used to reliably characterize a substantial amount of benign nodules. As a result, only nodules with suspicious findings would go on to receive FNA biopsy. "With that approach, we may be able to decrease the number of FNA biopsies by 60%," Dighe told AuntMinnie.com. "The ability to confidently diagnose a benign nodule is the most important benefit of elastography." The researchers sought to determine if a systolic thyroid stiffness index (STSI) -generated from ultrasound elastography performed by using carotid pulsation as a compression source -could serve as a pre-FNA biopsy screening tool. They gathered ultrasound data previously acquired from 62 thyroid nodules in 59 patients who had received a thyroid FNA (J Ultrasound Med, April 2010, Vol. 29:4, pp. 565-574). The ultrasound elastography studies were performed prior to the FNA procedure using a Hi Vision