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TIRADS, SRE and SWE in INDETERMINATE thyroid nodule characterization: Which has better diagnostic performance?
Ilaria Celletti1, Daniele Fresilli1, Corrado De Vito2
1Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
La Radiologia Medica
|June 15, 2021
Summary
Strain Ratio (SRE) elastography improves thyroid nodule risk assessment when combined with K-TIRADS classification, significantly increasing sensitivity and negative predictive value for indeterminate nodules. This technique offers enhanced diagnostic accuracy for thyroid nodule characterization.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Indeterminate thyroid nodules require accurate risk stratification to guide management.
- Conventional ultrasound and K-TIRADS classification have limitations in differentiating benign from malignant nodules.
- Elastography techniques offer novel approaches to assess tissue stiffness, potentially improving diagnostic accuracy.
Purpose of the Study:
- To evaluate the accuracy of Strain Ratio (SRE) and Shear Wave Elastography (SWE) in risk stratification of indeterminate thyroid nodules.
- To compare the diagnostic performance of SRE and SWE, alone and in combination with K-TIRADS classification.
- To determine if elastography enhances the diagnostic capabilities of K-TIRADS for thyroid nodules.
Main Methods:
- A prospective study involving 128 patients with indeterminate thyroid nodules undergoing preoperative ultrasound and K-TIRADS classification.
- Semi-quantitative Strain Ratio (SRE) and quantitative Shear Wave Elastography (SWE) were performed.
- Diagnostic performance was assessed using ROC curves, with cut-off values determined by the Liu test. Statistical significance was evaluated using the Bonferroni test.
Main Results:
- Strain Ratio (SRE) demonstrated superior diagnostic accuracy compared to Shear Wave Elastography (SWE) (p < 0.05).
- K-TIRADS alone had sensitivity/specificity of 71.4%/82.4%, SRE achieved 85.7%/94.1%, and SWE showed 57.1%/79.4%.
- Combining SRE with K-TIRADS increased sensitivity to 92.9% but decreased specificity to 76.5% compared to K-TIRADS alone.
Conclusions:
- Strain Elastosonography (SRE) can be effectively combined with K-TIRADS ultrasound for characterizing indeterminate thyroid nodules.
- Adding SRE to K-TIRADS assessment significantly enhances sensitivity and negative predictive value.
- Further multicenter studies with larger populations are recommended to validate these findings.
