Shear wave elastography for the evaluation of diffuse thyroid gland pathology: preliminary results

Shear wave elastography for the evaluation of diffuse thyroid gland pathology: preliminary results Poster No.: C-0495 Congress: ECR 2014 Type: Scientific Exhibit Authors: S. Wee, S. J. Jeon, S.-S. Choi; Iksan-si/KR Keywords: Head and neck, Ultrasound, Decision analysis, Image verification DOI: 10.1594/ecr2014/C-0495 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 22

Aims and objectives Thyroid stiffness normal thyroid parenchyme vs benign nodule : no significant difference Benign nodule normal thyroid tissue : malignant nodule harder ( there are significant difference) Bahn et al study (used MR elastography) : statistically significant differences were found between normal subjects and those with Hashimoto thyroiditis (p=0.004) : no significnat difference benign and malignant thyroid nodules in this small cohort of patients In present, breast and liver have been studied actively by using elastography but studies about thyroid, especially diffuse parenchymal disease, relatively as wasteland. There was reported few studies about parenchymal stiffness of thyroid gland and nodules To assess whether shear wave elastography can differentiate normal from diffuse thyroid disease (parenchymal pathology) Images for this section: Page 2 of 22

Fig. 1: Introduction Page 3 of 22

Fig. 2: introduction Page 4 of 22

Fig. 3: Introduction Page 5 of 22

Fig. 4: introduction Page 6 of 22

Fig. 5: introduction Page 7 of 22

Fig. 6: introduction Page 8 of 22

Fig. 7: purpose Page 9 of 22

Methods and materials We evaluated 34 subjects (mean age 39.7 ± 15.3 years, 19 women and 15 men): 15/34 were control group (normal thyroid function), and 19/34 were disease group. In disease group, 15 (78.9%) patients had Graves' disease, 3(15.8%) had Hashimoto's thyroiditis (diagnosed by specific tests), 1 (5.3%) had diffuse thyroid goiter. In all patients, thyroid hormon test performed and 2 to 4 elastographic measurements were made in the both thyroid lobes, using a 4-9 MHz linear probe. Median values were calculated for thyroid stiffness and expressed in kpa. Images for this section: Fig. 8: material and method Page 10 of 22

Fig. 9: material and method Page 11 of 22

Fig. 10: material and method Page 12 of 22

Results Thyroid stiffness (TS) assessed by means of shear wave in healthy subjects (20.83 ± 4.98 kpa) was significantly lower than in diffuse thyroid disease (37.13 ± 30.21 kpa) (P = 0.006). Results of recent study (World J Radiol 2012 ; 4: 174-8) and our study : autoimmune diffuse thyroid patholgy has more stiffness than normal thyroid tissue : Hashimoto thyroiditis was harder than Grave's disease these results shows opening a new field in thyroid elastography Images for this section: Page 13 of 22

Fig. 11: result clinical data Fig. 12: result Group II, disease composition Page 14 of 22

Fig. 13: result thyroid stiffness Page 15 of 22

Fig. 14: case 1 (control group) Page 16 of 22

Fig. 15: case 2 (control group) Page 17 of 22

Fig. 16: case 3 (Grave's disease) Page 18 of 22

Fig. 17: case 4 (Grave's disease) Page 19 of 22

Fig. 18: case 5 (Hashimoto thyroiditis) Page 20 of 22

Conclusion Shear waveseems to be a useful method for the assessment of diffuse thyroid gland pathology. Also, we expect that shear wave elastography can seem to evaluate for effect of treatment and can use by tool for follow up in patients who have diffuse thyroid disease. Images for this section: Fig. 19: conclusion Page 21 of 22

Personal information References Garra BS.Elastography: current status, future prospects, and making it work for you.ultrasound Q. 2011 Sep;27(3):177-86. Sporea I, Sirli R, Bota S, Vlad M, Popescu A, Zosin I. ARFI elastography for the evaluation of diffuse thyroid gland pathology: Preliminary results.world J Radiol. 2012 Apr 28;4(4):174-8. Sporea I, Vlad M, Bota S, Sirli RL, Popescu A, Danila M, Sendroiu M, Zosin I. Thyroid stiffness assessment by acoustic radiation force impulse elastography (ARFI).Ultraschall Med. 2011 Jun;32(3):281-5. Friedrich-Rust M, Romenski O, Meyer G, Dauth N, Holzer K, Grünwald F, Kriener S, Herrmann E, Zeuzem S, Bojunga J. Acoustic Radiation Force Impulse-Imaging for the evaluation of the thyroid gland: a limited patient feasibility study. Ultrasonics. 2012 Jan;52(1):69-74. Bahn MM, Brennan MD, Bahn RS, Dean DS, Kugel JL, Ehman RL. Development and application of magnetic resonance elastography of the normal and pathological thyroid gland in vivo. J Magn Reson Imaging. 2009 Nov;30(5):1151-4. Page 22 of 22