Int J Thyroidol.  2017 May;10(1):14-23. 10.11106/ijt.2017.10.1.14.

Ultrasonographic Evaluation of Diffuse Thyroid Disease: a Study Comparing Grayscale US and Texture Analysis of Real-Time Elastography (RTE) and Grayscale US

• Yoon JH
• Lee E
• Lee HS
• Kim EK
• Moon HJ
• Kwak JY

• KMID: 2379357
• DOI: http://doi.org/10.11106/ijt.2017.10.1.14

Abstract

BACKGROUND AND OBJECTIVES
To evaluate and compare the diagnostic performances of grayscale ultrasound (US) and quantitative parameters obtained from texture analysis of grayscale US and elastography images in evaluating patients with diffuse thyroid disease (DTD).
MATERIALS AND METHODS
From September to December 2012, 113 patients (mean age, 43.4±10.7 years) who had undergone preoperative staging US and elastography were included in this study. Assessment of the thyroid parenchyma for the diagnosis of DTD was made if US features suggestive of DTD were present. Nine histogram parameters were obtained from the grayscale US and elastography images, from which "˜grayscale index' and "˜elastography index' were calculated. Diagnostic performances of grayscale US, texture analysis using grayscale US and elastography were calculated and compared.
RESULTS
Of the 113 patients, 85 (75.2%) patients were negative for DTD and 28 (24.8%) were positive for DTD on pathology. The presence of US features suggestive of DTD showed significantly higher rates of DTD on pathology, 60.7% to 8.2% (p<0.001). Specificity, accuracy, and positive predictive value was highest in US features, 91.8%, 84.1%, and 87.6%, respectively (all ps<0.05). Grayscale index showed higher sensitivity and negative predictive value (NPV) than US features. All diagnostic performances were higher for grayscale index than the elastography index. Area under the curve of US features was the highest, 0.762, but without significant differences to grayscale index or mean of elastography (all ps>0.05).
CONCLUSION
Diagnostic performances were the highest for grayscale US features in diagnosis of DTD. Grayscale index may be used as a complementary tool to US features for improving sensitivity and NPV.

Keyword

Thyroid; Ultrasound; Diffuse thyroid disease; Elastography; Texture analysis

MeSH Terms

Diagnosis
Elasticity Imaging Techniques*
Humans
Pathology
Sensitivity and Specificity
Thyroid Diseases*
Thyroid Gland*
Ultrasonography

Figure

• 

  Fig. 1. Example of texture analysis of elastography and grayscale US. One longitudinal elastographic image was selected for texture analysis. Images are automatically displayed in split-screen mode to show both grayscale US and corresponding color-scale elastographic images. A region of interest (ROI) was previously set on the elastography by the radiologist who performed US (left, upper row, box). The same ROI was set on the grayscale US (right, upper row, box) transferring from elastographic ROI. From these ROIs, histogram and cooccurrence matrix parameters are automatically calculated with an in-house built software. Histogram analysis (bottom row) show the distribution of the number pixels (y-axis) according to the pixel intensity value (x-axis) within the ROIs.

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