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Ultraschall Med 2012; 33(05): 463-468
DOI: 10.1055/s-0032-1325428
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Reliability of Shear Wave Ultrasound Elastography for Neck Lesions Identified in Routine Clinical Practice

Reliabilität der Scherwellen-Ultraschall-Elastografie von Halsläsionen, die bei der klinischen Routine entdeckt wurden
K. Bhatia
1   Diagnostic Imaging and Interventional Radiology, Chinese University of Hong Kong
,
C. S. L. Tong
2   Diagnostic Imaging and Interventional Radiology, Prince of Wales Hospital
,
C. C. M. Cho
2   Diagnostic Imaging and Interventional Radiology, Prince of Wales Hospital
,
E. H. Y. Yuen
2   Diagnostic Imaging and Interventional Radiology, Prince of Wales Hospital
,
J. Lee
3   Divison of Biostatistics, School of Public Health, The Chinese University of Hong Kong
,
A. T. Ahuja
1   Diagnostic Imaging and Interventional Radiology, Chinese University of Hong Kong
› Author Affiliations
Further Information

Publication History

02 February 2012

09 August 2012

Publication Date:
21 September 2012 (online)

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Abstract

Purpose: To evaluate the reliability of shear wave ultrasound elastography (SWE) in the neck.

Materials and Methods: 176 neck lesions (40 thy roid, 56 lymph nodes, 46 salivary, 34 miscella neous) identified in a routine US clinic underwent SWE by one or two blinded radiologists. For this study, SWE required the operator to acquire three 10 second dynamic colour-coded SWE cineloops per lesion, select one static image per cineloop, and place circular regions-of-interest within the entire lesion and stiffest part to generate 3 SWE measurements per static image. For logistical rea sons, one radiologist evaluated all 176 lesions and the other evaluated 58 lesions. Both radiologists also reviewed 27 archived cineloops independ ently to assess SWE excluding practical technique. Reliability was assessed using intraclass correla tion coefficients (ICCs) concordance correlation coefficients (CCCs) and coefficients of repeatabil ity (CORs).

Results: Test-retest ICCs for the radiologist evalu ating 176 lesions were 0.78–0.85 (fair-excellent agreement), CCCs were 0.85–0.88 (substantial agreement), and CORs were 14.9–36.1 kPa. For both radiologists evaluating 58 lesions, intra-rater and inter-rater ICCs were 0.65–0.78 and 0.72–0.77 respectively. For SWE excluding practical technique, inter-rater ICCs were 0.97–0.98 (ex cellent agreement). ICCs differed according to tis sue, being higher in thyroid lesions than lymph nodes (p < 0.001), and higher in benign than ma lignant lesions (p values < 0.001).

Conclusion: Intra- and inter-rater reliability of SWE is fair to excellent according to ICCs. SWE re liability is influenced appreciably by acquisition technique. Nevertheless, CORs for SWE are not negligible. To determine whether these results are acceptable clinically, further research is re quired to establish SWE stiffness values of normal and pathological tissues in the neck.

Zusammenfassung

Ziel: Die Bewertung der Reabilität der Scherwellen-Ultraschall-Elastografie (SWE) des Halses.

Material und Methoden: Bei 176 Halsläsionen (davon 40 der Schilddrüse, 56 der Lymphknoten, 46 der Speicheldrüsen und 34 verschiedenartige), die durch Routineultraschall festgestellt wurden, wurde eine SWE durch einen oder zwei Radiologen unter Verblindung durchgeführt. In dieser Studie war bei der SWE erforderlich, dass der Untersucher drei 10 s lange dynamische farbkodierte SWE-Cineloops pro Läsion aufnahm, ein statisches Bild für den Cineloop auswählte und kreisförmige Bereiche der Region-of-Interest innerhalb der gesamten Läsion platzierte und den steifsten Teil um 3 SWE-Messungen pro statischem Bild zu generieren. Aus logistischen Gründen beurteilte ein Radiologe alle 176 Läsionen und ein anderer 58 Läsionen. Beide Radiologen überprüften unabhängig voneinander 27 archivierte Cineloops, um die SWE unter Aus schluss der praktischen Technik einzuschätzen. Die Reliabilität wurde mittels „Intra-Class“- Korrelationskoeffizienten (ICCs), Konkordanz- Korrelationskoeffizienten (CCCs) und den Wie derholbarkeitskoeffizienten (coefficients of re peatability, CORs) bewertet.

Ergebnisse: Die Test-Testwiederholungs-ICCs des Radiologen, der die 176 Läsionen bewertete, betrugen 0,78–0,85 (gute bis ausgezeichnete Über einstimmung), die CCCs betrugen 0,85–0,88 (erhe bliche Übereinstimmung) und die CORs betrugen 14,9–36,1 kPa. Für beide Radiologen, die 58 Läsio nen bewerteten, betrugen die Intrarater-ICCs 0,65–0,78 und die Interrater-ICCs 0,72–0,77. Für die SWE unter Ausschluss der praktischen Technik betrugen die Interrater-ICCs 0,97–0,98 (ausge zeichnete Übereinstimmung). Die ICCs unterschie den sich je nach Gewebe und waren in Schilddrü sen-Läsionen höher als in Lymphknoten (p < 0,001) und in gutartigen Läsionen höher als in malignen (p-Werte < 0,001).

Schlussfolgerung: Die Intra- und Interrater-Reliabilität der SWE ist den ICCs zufolge gut bis ausgezeichnet. Die Reabilität der SWE wird deutlich von der Aufnahmetechnik beeinflusst. Dennoch sind die CORs der SWE nicht unerheblich. Um zu ermitteln, ob diese Ergeb nisse klinisch akzeptierbar sind, ist noch weitere Forschungsarbeit in Bezug auf die Feststellung der SWE-Steifigkeitswerte im normal en und pathologischen Halsgewebe erforderlich.

Key words

ultrasound - thyroid - head/neck - salivary glands - elastography
 

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