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Thyroid Gland Tumor Diagnosis at US Elastography¹

¹ From the Departments of Nuclear Medicine and Diagnostic Imaging (A.L., T.H., T.S., K.T.), Otolaryngology-Head and Neck Surgery (R.A., S.T., J.I.), and Therapeutic Radiology and Oncology (M.H.), Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan; Department of Biomedical Engineering, University of California, Davis, Davis, Calif (J.J.M., C.P., M.F.I.); and Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tenn (A.B.B.). Received July 16, 2004; revision requested September 27; revision received October 8; accepted November 15. Supported in part by NSF award 9817722. Address correspondence to A.L. (e-mail: lyshchik{at}kuhp.kyoto-u.ac.jp).

View larger version (163K): [in a new window]   Figure 1a. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 31-year-old man show a normal left thyroid gland lobe without lesions. Anterior and posterior borders (arrows) of thyroid gland, subcutaneous fat (arrowheads in a and b), anterior neck muscles (*), carotid artery (C), and trachea (Tr) are seen.

View larger version (78K): [in a new window]   Figure 1b. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 31-year-old man show a normal left thyroid gland lobe without lesions. Anterior and posterior borders (arrows) of thyroid gland, subcutaneous fat (arrowheads in a and b), anterior neck muscles (*), carotid artery (C), and trachea (Tr) are seen.

View larger version (157K): [in a new window]   Figure 1c. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 31-year-old man show a normal left thyroid gland lobe without lesions. Anterior and posterior borders (arrows) of thyroid gland, subcutaneous fat (arrowheads in a and b), anterior neck muscles (*), carotid artery (C), and trachea (Tr) are seen.

View larger version (161K): [in a new window]   Figure 2a. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 31-year-old man show a cyst (arrowheads) in the central part of the right lobe of the thyroid gland. In b, the cyst is clearly visible as a very dark lesion with a distinct, moderately irregular margin. The off-line processed elastogram (c) is characterized by extensive amounts of decorrelation noise in the central area of the lesion due to excessive movements of cyst content under compression. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (74K): [in a new window]   Figure 2b. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 31-year-old man show a cyst (arrowheads) in the central part of the right lobe of the thyroid gland. In b, the cyst is clearly visible as a very dark lesion with a distinct, moderately irregular margin. The off-line processed elastogram (c) is characterized by extensive amounts of decorrelation noise in the central area of the lesion due to excessive movements of cyst content under compression. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (127K): [in a new window]   Figure 2c. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 31-year-old man show a cyst (arrowheads) in the central part of the right lobe of the thyroid gland. In b, the cyst is clearly visible as a very dark lesion with a distinct, moderately irregular margin. The off-line processed elastogram (c) is characterized by extensive amounts of decorrelation noise in the central area of the lesion due to excessive movements of cyst content under compression. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (174K): [in a new window]   Figure 3a. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 54-year-old woman with a solid benign isoechoic thyroid gland tumor (arrowheads) in the lateral segment of the right thyroid gland lobe. In b, the tumor is partially visible; it is markedly darker than the surrounding normal thyroid gland tissue and has an irregular, barely distinct margin. In c, the tumor is somewhat visible; it is slightly darker than the surrounding normal thyroid gland tissue and has a very irregular, almost indistinct margin. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (73K): [in a new window]   Figure 3b. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 54-year-old woman with a solid benign isoechoic thyroid gland tumor (arrowheads) in the lateral segment of the right thyroid gland lobe. In b, the tumor is partially visible; it is markedly darker than the surrounding normal thyroid gland tissue and has an irregular, barely distinct margin. In c, the tumor is somewhat visible; it is slightly darker than the surrounding normal thyroid gland tissue and has a very irregular, almost indistinct margin. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (131K): [in a new window]   Figure 3c. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 54-year-old woman with a solid benign isoechoic thyroid gland tumor (arrowheads) in the lateral segment of the right thyroid gland lobe. In b, the tumor is partially visible; it is markedly darker than the surrounding normal thyroid gland tissue and has an irregular, barely distinct margin. In c, the tumor is somewhat visible; it is slightly darker than the surrounding normal thyroid gland tissue and has a very irregular, almost indistinct margin. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (21K): [in a new window]   Figure 4. Benign thyroid gland lesion measurements. Graph illustrates correlation between the tumor-to–normal thyroid gland tissue elasticity ratio measured during biomechanical testing of resected thyroid gland specimens and the strain index measured on off-line processed elastograms. There is a significant positive correlation between the relative measurements of benign thyroid gland tumor elasticity evaluated at US elastography and the direct biomechanical measurements used as the reference standard of elasticity in our study. Dashed line represents the threshold strain index value used for the differential diagnosis of thyroid gland cancer.

View larger version (182K): [in a new window]   Figure 5a. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 48-year-old woman with papillary thyroid carcinoma (arrowheads) in the central part of the left thyroid gland lobe. In b and c, the tumor is highly visible; it is very dark compared with the surrounding normal tissue and has a regular and distinct margin. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (89K): [in a new window]   Figure 5b. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 48-year-old woman with papillary thyroid carcinoma (arrowheads) in the central part of the left thyroid gland lobe. In b and c, the tumor is highly visible; it is very dark compared with the surrounding normal tissue and has a regular and distinct margin. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (136K): [in a new window]   Figure 5c. (a) Transverse B-mode sonogram, (b) real-time elastogram, and (c) off-line processed elastogram obtained in 48-year-old woman with papillary thyroid carcinoma (arrowheads) in the central part of the left thyroid gland lobe. In b and c, the tumor is highly visible; it is very dark compared with the surrounding normal tissue and has a regular and distinct margin. In a–c, arrows mark anterior and posterior borders of thyroid gland. C = carotid artery, Tr = trachea.

View larger version (21K): [in a new window]   Figure 6. Malignant thyroid gland tumor measurements. Graph shows correlation between the tumor-to–normal thyroid gland tissue elasticity ratio measured during biomechanical testing of resected thyroid gland specimens and the strain index measured on off-line processed elastograms. There is a significant positive correlation between the relative measurements of malignant tumor elasticity evaluated at US elastography and the direct biomechanical measurements used as the reference standard of elasticity in our study. Dashed line represents the threshold strain index value used for the differential diagnosis of thyroid gland cancer.