ARFI Imaging of Thyroid Nodules

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ARFI measurements of 85 thyroid nodules in comparison to FNAC results

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ARFI Imaging of Thyroid Nodules

  1. 1. HUNG THIEN NGUYEN, CUONG TUAN NGUYEN, XUAN THANH THI PHAM, HAI THANH PHAN MEDIC MEDICAL CENTER, HCMC, VIETNAM
  2. 2.  Acoustic radiation force impulse (ARFI)-imaging is a new technology of elastography of ultrasound enabling quantitative measurement of tissue stiffness. Theaim of the present study was to evaluate the feasibility of ARFI-measurements in the thyroid nodule.
  3. 3.  All patients underwent conventional ultrasound, ARFI-imaging and cytological assessment. ARFI-imaging (VTI and VTQ technologies) and eSie Touch technology were performed with 9L4 probe, using Siemens (ACUSON S2000) B- mode-ARFI combination transducer.
  4. 4. 85 nodules were available for analysis. 67 nodules were benign on cytology, 13nodules were malignant (papillary carcinoma), and 5 follicular lesions.
  5. 5.  Themedian velocity of ARFI-imaging in benign was of 2.06 m/s, andmalignant thyroid nodules, of 3.00 m/s, respectively.
  6. 6. Plot of 177 ARFI velocity measurements of 85 thyroid nodules
  7. 7.  eSieTouch= malignant: red code (hard) homogenous or not VTI= malignant: dark color (hard) and bigger size than B-mode image VTI with dark color helps characterizing malignant nodule, from follicular lesions and dense colloidal cysts which have bright color on VTI.
  8. 8. eSie Touch of a papillary carcinoma, black (hard)
  9. 9. VTI of a papillary carcinoma, black (hard) and bigger size (R. panel) than B-mode image (L. panel)
  10. 10. eSie Touch of papillary carcinoma, inhomogenous black
  11. 11. VTQ of a papilary carcinoma with ARFI velocity in out of range
  12. 12. eSie Touch of a papillary carcinoma, color code (red= hard, purple= soft, yellow= between hard and soft). FNAC should perform at red region.
  13. 13. FNAC of a papillary carcinoma
  14. 14. FNAC of a papillary carcinoma
  15. 15. VTQ of a follicular lesion with ARFI velocity of 2.99 m/s (>2.3 m/s)
  16. 16. 3 follicular lesions on Doppler and B-mode ultrasound
  17. 17. VTI of a follicular lesion (R. panel) with dark color (hard) and bigger size in comparison to B-mode image (L. panel)
  18. 18. FNAC of a follicular lesion
  19. 19. FNAC of a follicular lesion
  20. 20. FNAC of a colloidal cyst
  21. 21. A specificity of ARFI-imaging of 95% could be achieved using a cut-off of 3.1 m/s (area under ROC curve is 0.778). A sensibility of ARFI-imaging of 86.49% and specificity of 59.29% could be achieved using a cut-off of 2.3 m/s (area under ROC curve is 0.778).
  22. 22. Area under the ROC curve: 0.778.
  23. 23. DISCUSSIONS1/ Specificity important than sensibility2/ The higher of ARFI velocity the harder ofthyroid nodule3/ Overlapping the ARFI velocities of benign andmalignant nodules: combining with VTI, eSieTouch to charaterize lesion4/ Inhomogenous structure of malignant thyroidnodules: more site measurements of VTQ basedon VTI and eSie Touch and biopsy
  24. 24.  ARFI can be performed in thyroid nodule with reliable results. Notonly base on VTQ but should refer VTI and eSie Touch technologies. ARFI might be the reference criteria for differentiation of benign and malignant thyroid nodules.

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