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Ultrasound Thyroid Elastography Using Carotid Artery Pulsation

Preliminary Study

Departments of Electrical Engineering (U.B.), Radiology (M.D., T.D., S.M.), and Bioengineering (V.S., Y.K.), University of Washington, Seattle, Washington USA.

Address correspondence to Yongmin Kim, PhD, Department of Bioengineering, University of Washington, Box 355061, Seattle, WA 98195-5061, USA. E-mail: ykim{at}u.washington.edu

Objective. The purpose of this study was to evaluate the feasibility of ultrasound thyroid elastography using carotid artery pulsation as the compression source and its potential for differential diagnosis of thyroid nodules. Methods. Baseband sonographic data were acquired for 16 thyroid nodules from 12 patients. The natural pulsation of the carotid artery was used as the compression source, and thyroid strain was estimated offline. For quantitative assessment of thyroid tissue stiffness, a new metric called the thyroid stiffness index (TSI) was computed as the ratio of strain near the carotid artery (high-strain region) to that of a stiff region (low-strain region) inside a thyroid nodule. The stiffness information from elastography was correlated with histopathologic findings. Results. The TSI for papillary carcinoma (n = 9) was higher than the TSI for a benign nodular goiter (n = 6), indicating that papillary carcinoma is stiffer than a benign nodular goiter (P < .05). In 1 patient, we were able to distinguish a papillary carcinoma nodule and a benign nodular goiter located in the same thyroid lobe based on the stiffness information obtained from elastography. This suggests that elastography could be used for guiding fine-needle aspiration biopsy to a thyroid nodule with a high probability of cancer. Conclusions. The results from this preliminary study indicate the feasibility of the pulsation-induced thyroid elastography. Ultrasound thyroid elastography using carotid artery pulsation appears to have the potential for noninvasively differentiating papillary carcinoma from benign nodular goiter. Future studies are needed to evaluate the efficacy of elastography in detecting thyroid cancer and guiding thyroid biopsies.

Key Words: carotid artery pulsation • elastography • thyroid • thyroid stiffness index • ultrasound

Abbreviations: FNA, fine-needle aspiration • ROI, region of interest • TSI, thyroid stiffness index

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