Die Bedeutung der Sonografie bei der Abklärung von Schilddrüsenerkrankungen

Zusammenfassung

Schilddrüsenknoten und Schilddrüsenveränderungen sind häufige Befunde in der Allgemeinbevölkerung. Die Sonografie ist dabei das wichtigste bildgebende Instrument der Schilddrüsendiagnostik. In Zusammenschau des sonografischen Befunds mit basalen Schilddrüsenhormonparametern und dem klinischen Bild lässt sich in der überwiegenden Zahl der Fälle bereits eine korrekte Diagnose stellen – wie z. B. Hashimoto-Thyreoiditis, eine diffuse Struma oder ein Morbus Basedow – und eine entsprechende Therapie einleiten. Eine sichere Unterscheidung hormonaktiver und inaktiver Knoten sowie insbesondere benigner und maligner Knoten ist jedoch sonografisch nicht sicher möglich. In der Diffenzialdiagnose der Hormonaktivität von Schilddrüsenknoten hat die Szintigrafie ihre klinische Bedeutung. Zur Risikostratifizierung des Malignitätsrisikos von Knoten wurde in den vergangenen Jahren versucht, durch standardisierte Befunderhebung evaluierter Risikofaktoren eine bessere Selektion von Patienten, die einer weiteren Diagnostik zugeführt werden sollen, zu erzielen. Entsprechend des „Breast Imaging Reporting and Data System“ (BI-RADS), das standardisierte Malignitäts- bzw. Benignitätskategorien mit evaluierten prozentualen Malignitätswahrscheinlichkeiten als Grundlage für das weitere klinische Management definiert, wurde analog ein „Thyroid Imaging Reporting and Data System“ (TI-RADS) vorgeschlagen. Neuere technische Verfahren, wie die Elastografie, zeigen ebenfalls vielversprechende Daten und könnten Eingang in den klinischen Alltag gewinnen. Die sonografisch gesteuerte Feinnadelpunktion ist das zentrale Element in der Diagnostik sonografisch suspekter Schilddrüsenknoten und trägt wesentlich zur Sicherung der Diagnose Malignität vs. Benignität bei.

Abstract

Thyroid nodules and thyroid abnormalities are common findings in the general population. Ultrasonography is the most important imaging tool for diagnosing thyroid disease. In the majority of cases a correct diagnosis can already be made in synopsis of the sonographic together with clinical findings and basal thyroid hormone parameters and an appropriate therapy can be initiated thereafter. A differentiation of hormonally active versus inactive nodes, and in particular benign versus malignant nodules is sonographically, however, not reliably possible. In this context, radioscanning has its clinical significance predominantly in diagnosing hormonal activity of thyroid nodules. Efforts of the past years aimed to improve sonographic risk stratification to predict malignancy of thyroid nodules through standardized diagnostic assessment of evaluated risk factors in order to select patients, who need further diagnostic work up. According to the "Breast Imaging Reporting and Data System" (BI-RADS), "Thyroid Imaging Reporting and Data Systems" (TI-RADS) giving standardized categories with rates of malignancy were evaluated as a basis for further clinical management. Recent technological developments, such as elastography, also show promising data and could gain entrance into clinical practice. The ultrasound-guided fine-needle aspiration is the key element in the diagnosis of sonographically suspicious thyroid nodules and significantly contributes to the diagnosis of malignancy versus benignity.

Schlüsselwörter

Empfehlungen - Leitlinien - Bildgebung

Key words

recommendation - guidelines - imaging

• Literatur

• 1 Dietrich CF, Riemer-Hommel P. Challenges for the German Health Care System. Z Gastroenterol 2012; 50 (06) 557-572
• 2 Dietrich CF, Mäurer M, Riemer-Homme P. Challenges for the German Health Care System – Pharmaceuticals. Endo heute 2014; 27: 1-9
• 3 Dietrich CF, Schneider JG, Ignee A. Schilddrüsensonographie: Eine Übersicht. Endoskopie heute 2007; 20: 17-27
• 4 Blank W, Braun B. Sonography of the thyroid – Part 1. Ultraschall in Med 2007; 28 (06) 554-568
• 5 Gharib H, Papini E, Paschke R et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. J Endocrinol Invest 2010; 33 (Suppl. 05) 51-56
• 6 Leenhardt L, Erdogan MF, Hegedus L et al. 2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J 2013; 2 (03) 147-159
• 7 Su HK, Dos Reis LL, Lupo MA et al. Striving Toward Standardization of Reporting of Ultrasound Features of Thyroid Nodules and Lymph Nodes: A Multidisciplinary Consensus Statement. Thyroid 2014; 24: 1341-1349
• 8 Willms A, Bieler D, Wieler H et al. Correlation between sonography and antibody activity in patients with Hashimoto thyroiditis. J Ultrasound Med 2013; 32 (11) 1979-1986
• 9 Piraino P, Sepulveda A, Cavada G. Hashimoto chronic thyroiditis. Retrospective analysis of 228 patients. Rev Med Chil 2010; 138 (07) 827-831
• 10 Bohuslavizki KH, Henze E, Schwaiger M et al. Standardized annotation of nuclear medicine images. J Nucl Med Technol 2000; 28 (02) 96-103
• 11 Isik S, Gokay F, Ozuguz U et al. Comparison of the prevalence and sonographic features of thyroid nodules accompanying autoimmune thyroid diseases. Endokrynol Pol 2010; 61 (06) 658-664
• 12 Zuhur SS, Ozel A, Kuzu I et al. The Diagnostic Utility of Color Doppler Ultrasonography, Tc-99m Pertechnetate Uptake, and TSH-Receptor Antibody for Differential Diagnosis of Graves' Disease and Silent Thyroiditis: A Comparative Study. Endocr Pract 2014; 20 (04) 310-319
• 13 Donkol RH, Nada AM, Boughattas S. Role of color Doppler in differentiation of Graves' disease and thyroiditis in thyrotoxicosis. World J Radiol 2013; 5 (04) 178-183
• 14 Kunz A, Blank W, Braun B. De Quervain's subacute thyroiditis -- colour Doppler sonography findings. Ultraschall in Med 2005; 26 (02) 102-106
• 15 Frates MC, Marqusee E, Benson CB et al. Subacute granulomatous (de Quervain) thyroiditis: grayscale and color Doppler sonographic characteristics. J Ultrasound Med 2013; 32 (03) 505-511
• 16 Ruchala M, Szczepanek E, Sowinski J. Sonoelastography in de Quervain thyroiditis. J Clin Endocrinol Metab 2011; 96 (02) 289-290
• 17 Tuma J, Tosoni I. CME ultrasound diagnosis 52. Pain in the neck area. Subacute de Quervain thyroiditis. Praxis (Bern 1994) 2013; 102 (12) 756-758
• 18 Kujat C, Dyck R, Brederhoff J et al. The diagnosis and therapy of de Quervain's subacute thyroiditis. Dtsch Med Wochenschr 1991; 116 (38) 1439-1443
• 19 DINSMORE RS, HAZARD JB. Carcinoma of the thyroid gland apparently in struma fibrosa (Riedel). Cleve Clin Q 1948; 15 (02) 104-108
• 20 Beham A, Langsteger W, Schmid C et al. Chronic invasive fibrous thyroiditis (Riedel struma). Case report with special reference to preoperative diagnosis. Wien Klin Wochenschr 1988; 100 (07) 210-215
• 21 Papi G, LiVolsi VA. Current concepts on Riedel thyroiditis. Am J Clin Pathol 2004; 121: S50-S63
• 22 Cameselle-Teijeiro J, Ladra MJ, Abdulkader I et al. Increased lymphangiogenesis in Riedel thyroiditis (Immunoglobulin G4-related thyroid disease). Virchows Arch 2014; 465 (03) 359-364
• 23 Zimmermann-Belsing T, Ronn AM, Feldt-Rasmussen UF et al. Invasive fibrous thyroiditis--Riedel's goiter. A review of the literature and a case report. Ugeskr Laeger 1993; 155 (15) 1121-1125
• 24 Perez FontanFJ, Cordido CF, Pombo FF et al. Riedel thyroiditis: US, CT, and MR evaluation. J Comput Assist Tomogr 1993; 17 (02) 324-325
• 25 Slman R, Monpeyssen H, Desarnaud S et al. Ultrasound, elastography, and fluorodeoxyglucose positron emission tomography/computed tomography imaging in Riedel's thyroiditis: report of two cases. Thyroid 2011; 21 (07) 799-804
• 26 Dietrich CF, Nuernberg D. Lehratlas der interventionellen Sonographie. Thieme Verlag; 2011
• 27 Dietrich CF. Ultraschall-Kurs. 6. Aufl. Deutscher Ärzteverlag; 2012
• 28 Dietrich CF, Schneider JG. Schilddrüse. Dietrich CF, In: editor. Ultraschall-Kurs. Köln: Deutscher Ärzteverlag; 2006: 259-273
• 29 Shahbazian HB, Sarvghadi F, Azizi F. Ultrasonographic characteristics and follow-up in post-partum thyroiditis. J Endocrinol Invest 2005; 28 (05) 410-412
• 30 Creagh FM, Parkes AB, Lee A et al. The iodide perchlorate discharge test in women with previous post- partum thyroiditis: relationship to sonographic appearance and thyroid function. Clin Endocrinol (Oxf) 1994; 40 (06) 765-768
• 31 Triggiani V, Ciampolillo A, Guastamacchia E et al. Prospective study of post-partum thyroid immune dysfunctions in type 1 diabetic women and in a healthy control group living in a mild iodine deficient area. Immunopharmacol Immunotoxicol 2004; 26 (02) 215-224
• 32 Nakamura S, Kosaka J, Sugimoto M et al. Silent thyroiditis following rubella. Endocrinol Jpn 1990; 37 (01) 79-85
• 33 Miyakawa M, Tsushima T, Onoda N et al. Thyroid ultrasonography related to clinical and laboratory findings in patients with silent thyroiditis. J Endocrinol Invest 1992; 15 (04) 289-295
• 34 Bogazzi F, Tomisti L, Bartalena L et al. Amiodarone and the thyroid: a 2012 update. J Endocrinol Invest 2012; 35 (03) 340-348
• 35 Bogazzi F, Bartalena L, Martino E. Approach to the patient with amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab 2010; 95 (06) 2529-2535
• 36 Bojunga J. Management von Nebenwirkungen bei der Therapie der chronischen Hepatitis C: Schilddrüsenfunktionsstörungen. Med Welt 2007; 58: 96-100
• 37 Friedrich-Rust M, Theobald J, Zeuzem S et al. Thyroid function and changes in ultrasound morphology during antiviral therapy with pegylated interferon and ribavirin in patients with chronic hepatitis C. J Viral Hepat 2009; 16 (03) 168-177
• 38 Gottschalk U, Ignee A, Dietrich CF. Ultrasound-guided interventions and description of the equipment. Z Gastroenterol 2010; 48 (11) 1305-1316
• 39 Gottschalk U, Ignee A, Dietrich CF. Ultrasound guided interventions, part 1, diagnostic procedures. Z Gastroenterol 2009; 47 (07) 682-690
• 40 Wienhold R, Scholz M, Adler JR et al. The management of thyroid nodules: a retrospective analysis of health insurance data. Dtsch Arztebl Int 2013; 110 (49) 827-834
• 41 Robert Koch Institut. RKI – Schilddrüsenkrebs. In: Krebs in Deutschland 2013: 108 – 111. http://www.rki.de/Krebs/DE/Content/Krebsarten/Schilddruesenkrebs/schilddruesenkrebs_node.html
• 42 Wienhold R, Scholz M, Adler JR et al. The management of thyroid nodules: a retrospective analysis of health insurance data. Dtsch Arztebl Int 2013; 110 (49) 827-834
• 43 Becker D, Bair HJ, Becker W et al. Thyroid autonomy with color-coded image-directed Doppler sonography: internal hypervascularization for the recognition of autonomous adenomas. J Clin Ultrasound 1997; 25 (02) 63-69
• 44 Leenhardt L, Erdogan MF, Hegedus L et al. 2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J 2013; 2 (03) 147-159
• 45 Cappelli C, Castellano M, Pirola I et al. Thyroid nodule shape suggests malignancy. Eur J Endocrinol 2006; 155: 27-31
• 46 Papini E, Guglielmi R, Bianchini A et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab 2002; 87 (05) 1941-1946
• 47 Horvath E, Majlis S, Rossi R et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab 2009; 94 (05) 1748-1751
• 48 Friedrich-Rust M, Meyer G, Dauth N et al. Interobserver agreement of Thyroid Imaging Reporting and Data System (TIRADS) and strain elastography for the assessment of thyroid nodules. PLoS One 2013; 8 (10) e77927
• 49 Kwak JY, Han KH, Yoon JH et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology 2011; 260 (03) 892-899
• 50 Frates MC, Benson CB, Doubilet PM et al. Can color Doppler sonography aid in the prediction of malignancy of thyroid nodules?. J Ultrasound Med 2003; 22 (02) 127-131
• 51 Fukunari N, Nagahama M, Sugino K et al. Clinical evaluation of color Doppler imaging for the differential diagnosis of thyroid follicular lesions. World J Surg 2004; 28 (12) 1261-1265
• 52 Bozbora A, Erbil Y, Ozarmagan S et al. Color Doppler sonography in cold thyroid nodules for malignancy prediction. Acta Chir Belg 2002; 102 (04) 259-262
• 53 Ivanac G, Brkljacic B, Ivanac K et al. Vascularisation of benign and malignant thyroid nodules: CD US evaluation. Ultraschall in Med 2007; 28 (05) 502-506
• 54 Hocke M, Ignee A, Topalidis T et al. Contrast-enhanced endosonographic Doppler spectrum analysis is helpful in discrimination between focal chronic pancreatitis and pancreatic cancer. Pancreas 2007; 35 (03) 286-288
• 55 Etzel M, Happel C, von Muller F et al. Palpation and elastography of thyroid nodules in comparison. Nuklearmedizin 2013; 52 (03) 97-100
• 56 Bamber J, Cosgrove D, Dietrich CF et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall in Med 2013; 34 (02) 169-184
• 57 Cosgrove D, Piscaglia F, Bamber J et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall in Med 2013; 34 (03) 238-253
• 58 Dietrich CF, Cantisani V. Current status and perspectives of elastography. Eur J Radiol 2014; 83 (03) 403-404
• 59 Dietrich CF. Elastography, the new dimension in ultrasonography. Praxis (Bern 1994) 2011; 100 (25) 1533-1542
• 60 Asteria C, Giovanardi A, Pizzocaro A et al. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid 2008; 18 (05) 523-531
• 61 Friedrich-Rust M, Sperber A, Holzer K et al. Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules. Exp Clin Endocrinol Diabetes 2010; 118 (09) 602-609
• 62 Bojunga J, Herrmann E, Meyer G et al. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a meta-analysis. Thyroid 2010; 20 (10) 1145-1150
• 63 Trimboli P, Guglielmi R, Monti S et al. Ultrasound sensitivity for thyroid malignancy is increased by real-time elastography: a prospective multicenter study. J Clin Endocrinol Metab 2012; 97 (12) 4524-4530
• 64 Bojunga J, Dauth N, Berner C et al. Acoustic radiation force impulse imaging for differentiation of thyroid nodules. PLoS One 2012; 7 (08) e42735
• 65 Friedrich-Rust M, Romenski O, Meyer G et al. Acoustic Radiation Force Impulse-Imaging for the evaluation of the thyroid gland: a limited patient feasibility study. Ultrasonics 2012; 52 (01) 69-74
• 66 Kim I, Kim EK, Yoon JH et al. Diagnostic role of conventional ultrasonography and shearwave elastography in asymptomatic patients with diffuse thyroid disease: initial experience with 57 patients. Yonsei Med J 2014; 55 (01) 247-253
• 67 Szczepanek-Parulska E, Wolinski K, Stangierski A et al. Comparison of diagnostic value of conventional ultrasonography and shear wave elastography in the prediction of thyroid lesions malignancy. PLoS One 2013; 8 (11) e81532
• 68 Zhang B, Ma X, Wu N et al. Shear wave elastography for differentiation of benign and malignant thyroid nodules: a meta-analysis. J Ultrasound Med 2013; 32 (12) 2163-2169
• 69 Veyrieres JB, Albarel F, Lombard JV et al. A threshold value in Shear Wave elastography to rule out malignant thyroid nodules: a reality?. Eur J Radiol 2012; 81 (12) 3965-3972
• 70 Razavi SA, Hadduck TA, Sadigh G et al. Comparative effectiveness of elastographic and B-mode ultrasound criteria for diagnostic discrimination of thyroid nodules: a meta-analysis. Am J Roentgenol 2013; 200 (06) 1317-1326
• 71 Argalia G, De Bernardis S, Mariani D et al. Ultrasonographic contrast agent: evaluation of time-intensity curves in the characterisation of solitary thyroid nodules. Radiol Med (Torino) 2002; 103 (04) 407-413
• 72 Spiezia S, Farina R, Cerbone G et al. Analysis of color Doppler signal intensity variation after levovist injection: a new approach to the diagnosis of thyroid nodules. J Ultrasound Med 2001; 20 (03) 223-231
• 73 Dietrich CF, Averkiou MA, Correas JM et al. An EFSUMB introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall in Med 2012; 33 (04) 344-351
• 74 Dietrich CF, Cui XW, Barreiros AP et al. EFSUMB guidelines 2011: comment on emergent indications and visions. Ultraschall in Med 2012; 33 (Suppl. 01) S39-S47
• 75 Dietrich CF, Schreiber-Dietrich D, Hocke M. Comments on the EFSUMB non-liver Guidelines 2011. Praxis (Bern 1994) 2012; 101 (18) 1175-1181
• 76 Cui XW, Ignee A, Jedrzejczyk M et al. Dynamic Vascular Pattern (DVP), a quantification tool for contrast enhanced ultrasound. Z Gastroenterol 2013; 51 (05) 427-431
• 77 Cui XW, Pirri C, Ignee A et al. Measurement of Shear Wave Velocity Using Acoustic Radiation Force Impulse Imaging is not Hampered by Previous Use of Ultrasound Contrast Agents. Z Gastroenterol 2014; 52 (07) 649-653
• 78 Ma J, Ding H, Xu B et al. Diagnostic performances of various gray-scale, color Doppler, and contrast-enhanced ultrasonography findings in predicting malignant thyroid nodules. Thyroid 2014; 24: 355-363
• 79 Zhang B, Jiang YX, Liu JB et al. Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules. Thyroid 2010; 20 (01) 51-57
• 80 Kwak JY, Kim EK. Ultrasound elastography for thyroid nodules: recent advances. Ultrasonography 2014; 33 (02) 75-82
• 81 Dietlein M, Dressler J, Grunwald F et al. Guideline for in vivo- and in vitro procedures for thyroid diseases. Nuklearmedizin 2003; 42 (03) 109-115
• 82 Wienhold R, Scholz M, Adler JR et al. The management of thyroid nodules: a retrospective analysis of health insurance data. Dtsch Arztebl Int 2013; 110 (49) 827-834
• 83 Leenhardt L, Erdogan MF, Hegedus L et al. 2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J 2013; 2 (03) 147-159
• 84 Leenhardt L, Erdogan MF, Hegedus L et al. 2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J 2013; 2 (03) 147-159
• 85 Leboulleux S, Girard E, Rose M et al. Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab 2007; 92 (09) 3590-3594
• 86 Park JS, Son KR, Na DG et al. Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. Am J Roentgenol 2009; 192 (01) 66-72
• 87 Kuna SK, Bracic I, Tesic V et al. Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer. J Ultrasound Med 2006; 25 (12) 1531-1537