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Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules. A bi-centre university experience

  • Ultrasound
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Abstract

Objectives

To assess whether ultrasound elastography (USE) with strain ratio increases diagnostic accuracy of Doppler ultrasound in further characterisation of cytologically Thy3 thyroid nodules.

Methods

In two different university diagnostic centres, 315 patients with indeterminate cytology (Thy3) in thyroid nodules aspirates were prospectively evaluated with Doppler ultrasound and strain ratio USE before surgery. Ultrasonographic features were analysed separately and together as ultrasound score, to assess sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Receiver operating characteristic (ROC) curves to identify optimal cut-off value of the strain ratio were also provided. Diagnosis on a surgical specimen was considered the standard of reference.

Results

Higher strain ratio values were found in malignant nodules, with an optimum strain ratio cut-off of 2.09 at ROC analysis. USE with strain ratio showed 90.6 % sensitivity, 93 % specificity, 82.8 % PPV, 96.4 % NPV, while US score yielded a sensitivity of 52.9 %, specificity of 84.3 %, PPV 55.6 % and NPV 82.9 %. The diagnostic gain with strain ratio was statistically significant as proved by ROC areas, which was 0.9182 for strain ratio and 0.6864 for US score.

Conclusions

USE with strain ratio should be considered a useful additional tool to colour-Doppler US, since it improves characterisation of thyroid nodules with indeterminate cytology.

Key points

• Strain ratio measurements improve differentiation of thyroid nodules with indeterminate cytology

• Elastography with strain ratio is more reliable than ultrasound features and ultrasound score

• Strain ratio may help to better select patients with Thy 3 nodules candidate for surgery

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Acknowledgments

The scientific guarantor of this publication is Vito Cantisani. The authors of this manuscript declare relationships with the following companies: Cantisani Vito, Speaker for Toshiba Medical System, Samsung Medical Healthcare and Bracco Imaging. The authors state that this work has not received any funding. Prof. Corrado De Vito kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects in this study. Methodology: prospective, diagnostic study/observational/experimental, multicentre study.

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Authors and Affiliations

  1. Department of Radiology, Anatomical Pathology and Oncology, “Sapienza” University of Rome, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy

    Vito Cantisani, Mattia Di Segni, Hektor Grazhdani, Carlo Catalano & Ferdinando D’Ambrosio

  2. Department of Diagnostic Imaging for Surgery, Orthopaedics and Traumatology, “Sapienza” University of Rome, Rome, Italy

    Piero Maceroni

  3. Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy

    Vito D’Andrea, Gregorio Patrizi, Adriano Redler, Fabrizio Frattaroli, Laura Giacomelli & Giorgio Di Rocco

  4. Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy

    Corrado De Vito

  5. Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy

    Andrea M. Isidori & Elisa Giannetta

Authors
  1. Vito Cantisani
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  2. Piero Maceroni
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Correspondence to Vito Cantisani.

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Cantisani, V., Maceroni, P., D’Andrea, V. et al. Strain ratio ultrasound elastography increases the accuracy of colour-Doppler ultrasound in the evaluation of Thy-3 nodules. A bi-centre university experience. Eur Radiol 26, 1441–1449 (2016). https://doi.org/10.1007/s00330-015-3956-0

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  • DOI: https://doi.org/10.1007/s00330-015-3956-0

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