Palpation is an integral part in thyroid assessment. Nodule consistency is an accepted useful clinical parameter for judging its dignity.1-5 The aim of this prospective, randomized study was (1) to evaluate nodular hardness measured with ultrasound-elastography for differentiating benign versus malignant, and (2) to compare values acquired with two different elastography techniques: compression versus shear wave.

Patients 80 patients, scheduled for surgery because of nodular thyroid disease underwent ultrasound on two different scanners, one equipped with compression elastography (Hitachi Preirus®), one with shear wave elastography (Siemens S 2000®). Patient data and results of previous investigations (e.g. scintigraphy and histologic results afterbiopsy) were blinded. Randomisation came through daily routine work in our hospital -goiter is an endemic disease in our alpine population. The study was approved by the responsible Ethics Committee of the localgovernment. Examination technique All identified thyroid nodules were evaluated...

Parameters and cut off values Due to the heterogeneity of nodules in endemic goiter and due to an expectedlow incidence of advanced cancer, we did not make use of the described visual scoring systems 2-4,10-15 which are based onthe analysis of elastographic patterns. The latter taken into account of, however,for thepositioning of ROI´s for strain ratio measurements and velocity quantification. For compression elastography cut off values for strain ratios are described to bein a range of 2 to 4 - lesions depicting higher values more...

In our study, ranges of calculated values differ considerably from literature data. This may well be due to our study populationwith it´shigh incidence of endemic goiter. The shear wave technique fares inferiorly in our study which may be related to local factors such as tissue heterogeneity. The diagnostic value of direct quantification of shear wave velocities in thyroid nodules remainsquestionable in our study population. This may be related to tissue propertiesanda broad overlap of velocity ranges in benign and malignant nodules. Not suitable as a...

[1] Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology 2005; 237:202-211. [2] Shweel M, Mansour E. Diagnostic performance of combined elastosonography scoring and high-resolution ultrasonography for the differentiation of benign and malignant thyroid nodules. Eur J Radiol 2013; 82:995-1001. [3] Cantisani V, Lodise P, Grazhdani H, et al. Ultrasound elastography in the evaluation of thyroid pathology. Current status. Eur J Radiol 2013 in press. [4] Hong Y, Liu X, Li Z, et al. Real-time ultrasound elastography in...