Elastografie von Schilddrüsenknoten

Zusammenfassung

Hintergrund Die Elastografie ist eine bildgebende Methode, um die Elastizität von Gewebe zu untersuchen. Inzwischen wurden verschiedene Elastografie-Verfahren entwickelt, die nach der Art des angewandten Stimulus unterteilt werden. Prinzipiell ist zwischen der Strain-Elastografie (SE) und Scherwellen-Elastografie (SWE) zu unterscheiden. Beide Methoden bieten neben der konventionellen B-Mode-Sonografie eine weitere Möglichkeit zur Beurteilung von Schilddrüsenerkrankungen.

Ziel der Arbeit Es soll ein Überblick über die Elastografie-Verfahren einschließlich der physikalischen Grundlagen vermittelt werden sowie ihre Bedeutung im Abklärungsalgorithmus von Schilddrüsenknoten.

Material und Methoden Internationale Leitlinien sowie aktuelle Arbeiten zur Elastografie wurden selektiv recherchiert.

Ergebnisse Die Elastografie liefert zusätzliche Informationen gegenüber der konventionellen B-Mode-Sonografie. Der wesentliche physikalische Mechanismus, dem der Gewebekontrast in allen Elastogrammen zugrunde liegt, ist die Änderung der Schersteifigkeit. Neben der qualitativen Erfassung der Elastizität in der SE ist mit der SWE eine Quantifizierung möglich. In der internationalen Literatur wurde die Elastografie als einzelne Methode oder im Vergleich bzw. in Kombination zur konventionellen B-Mode-Sonografie und insbesondere mit der Standardisierung mittels eines Risikostratifizierungssystems (RSS, TIRADS) analysiert. Die Ergebnisse zeigten sich durchaus kontrovers. Bei Knoten mit unklaren Befunden der Feinnadelbiopsie (Bethesda III/IV) führte die Kombination aus morphologischen Kriterien und Elastografie zu einer Verbesserung der diagnostischen Genauigkeit. Insbesondere der hohe negative prädiktive Wert weicher Knoten stellt einen relevanten Mehrwert dar. Diese Stärke der Methode kann bei der Abklärung von Knoten mit mittlerem Malignomrisiko oder von unklaren FNB-Ergebnissen eine wichtige Rolle spielen. Die Elastografie wurde bisher nur in das (überwiegend durch das EU-TIRADS abgelöste) French-TIRADS integriert. Obwohl das Verfahren im EU-TIRADS als Komplementärmethode Erwähnung findet, wurde eine Integration nicht beschrieben. Limitationen des Verfahrens sind idealisierte Grundannahmen, Hersteller- und Untersucherabhängigkeit sowie Artefakte.

Schlussfolgerung Die Elastografie kann bei der Beurteilung von Schilddrüsenknoten die standardisierten Diagnostikverfahren sinnvoll ergänzen, insbesondere bei Knoten mit mittlerem Malignomrisiko und unklaren Ergebnissen in der Feinnadelpunktion.

Abstract

Background Elastography is an imaging method to examine the elasticity of tissue. In the meantime, various elastography methods have been developed, which are subdivided according to the type of stimulus applied. In principle, a distinction should be made between strain elastography (SE) and shear wave elastography (SWE). Both methods provide another means of assessing thyroid disease in addition to conventional B-mode sonography.

Objective The aim is to provide an overview of elastography techniques including physical basics and their importance in the clarification algorithm of thyroid nodules.

Materials and methods International guidelines and recent publications on elastography were selectively assessed.

Results Elastography provides additional information compared to conventional B-mode sonography. The change in shear stiffness is the essential physical mechanism for tissue contrast in all elastograms. In addition to the qualitative assessment of elasticity in SE, quantification is possible with SWE. In the international literature, elastography was analyzed as a single method or in comparison or combination with conventional B-mode sonography and especially with standardization using a risk stratification system (RSS, TIRADS). The results are quite controversial. In nodules with unclear findings on fine-needle biopsy (Bethesda III/IV), the combination of morphologic criteria and elastography improved diagnostic accuracy. In particular, the high negative predictive value of soft nodules represents a relevant added value. This strength of the method can play an important role in the clarification of nodules with intermediate malignancy risk or of unclear FNB results.

Elastography has previously only been incorporated into French-TIRADS. Although the procedure is mentioned in the EU-TIRADS as a complementary method, integration has not been described. Limitations of the method are idealized basic assumptions, dependence of manufacturer and examiner, and artifacts.

Conclusion Elastography can be a useful adjunct to standard diagnostic procedures in the evaluation of thyroid nodules, especially in nodules with intermediate risk of malignancy and unclear results on fine needle aspiration.

Schlüsselwörter

Schilddrüsenknoten - Ultraschall - Elastografie - Strain-Elastografie - Scherwellen-Elastografie - TIRADS

Keywords

thyroid nodule - ultrasound - elastography - strain elastography - shear wave elastography - TIRADS

Publication History

Article published online:
26 May 2023

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