Guidelines and recommendations on the clinical use of shear wave elastography for evaluating thyroid nodule1.

Ultrasound elastography has been introduced into clinical practice for a decade and arisen continuous increasing attention worldwide. Shear wave elastography (SWE) is a further extension of ultrasound elastography on the basis of strain elastography, providing a two-dimensional distribution map of tissue stiffness and quantitative measurement of the tissue stiffness in Young's modulus (kPa) and/or shear wave speed (m/s). The Society of Ultrasound in Medicine, Chinese Medical Association (CMA) has recently released a series of guidelines for the use of SWE, including the technique and principle of SWE, and use of SWE in liver fibrosis, breast, thyroid, and musculoskeletal system. Herein, a part of SWE in thyroid nodules is presented. In this guideline, the background, classification and technology of SWE, examination methods, diagnostic performance, prognosis evaluation, reproducibility, and limitations are discussed and recommendations are given. The recommendations are based on the published literatures with regard to SWE with different levels of evidence, particularly a mid-term result of the prospective multi-center clinical trial of SWE in thyroid, as well as the Society of Ultrasound in Medicine, CMA expert's consensus. The document provides an overall analysis of SWE in thyroid from clinical perspective, which aimed to provide recommendations to the clinicians with regard to the management of thyroid nodules by the assistance of SWE.

Papillary thyroid carcinoma on sonography.

OBJECTIVE: The purpose of this study is to investigate the characteristics of papillary thyroid carcinomas (PTCs) on color duplex sonography (CDUS). METHODS: We retrospectively reviewed 115 nodules (104 patients) with PTC confirmed by pathology from February 1, 2005, to August 31, 2008. The size, border, calcification, echotexture, hemodynamics (peak systolic velocity and resistance index) of the thyroid nodules and cervical lymph nodes on CDUS were analyzed. RESULTS: There was a close relationship between the size of the nodule and the vascularity of the thyroid carcinoma (P=.000). Microcalcification increased the suspicion for malignancy of the thyroid nodule. A hypoechoic thyroid nodule with abundant internal vascularity, ill-defined border and microcalcification was highly suggested PTC. CONCLUSION: CDUS plays an important role in the early detection of PTC and cervical lymph node metastasis, which would provide surgeons with valuable information for planning surgical intervention. Mastering manifestations of PTC on CDUS will improve the accuracy in the diagnosis of PTC. CDUS-guided fine needle aspiration of the thyroid nodule is the standard in the diagnosis of thyroid carcinoma and metastasis pre- and postthyroidectomy.

[Non-dilated coronary artery lesion and myocardial perfusion in children with Kawasaki disease: analysis of 43 cases].

OBJECTIVE: The study was designed to investigate the impact of non-dilated coronary artery wall lesion on myocardial perfusion. METHODS: Doppler tissue image (DTI) was used to measure regional ventricular wall motion in 43 Kawasaki children with non-dilated coronary arterial wall echocardiographic abnormalities (rough intima and arterial wall thickening) detected by two-dimensional echocardiography (2DE) at acute phase. A total of 31 cases who had both non-dilated coronary lesion and lowered ventricular wall motion velocity at subacute and convalescence phase underwent submaximal exercise single photon emitting computerized tomography (SPECT) for the evaluation of myocardial perfusion. RESULTS: In 43 cases of Kawasaki disease with non-dilated coronary arterial wall abnormalities, 36 cases (83.7%) still had such lesions at subacute phase and 32 (74.4%)at convalescence. At the same time, lowered regional ventricular wall motion (RVWM) was found in 34 cases at subacute phase and in 31 cases at convalescence. DTI and 2DE had a very good correlation in the detection of such abnormalities (chi(c)2 = 9.64, P < 0.01 in subacute period, and chi(c)2 = 7.14, P < 0.01 in convalescence). In 31 cases accepting SPECT, 17 were positive. A total of 22 ischemic regions were detected. Eighteen out of 22 cases having ischemic regions had abnormal RVWM on DTI. SPECT ischemic regions were significantly in accordance with lowered RVWM in ventricular septum and anterior wall (chi(c)2=5.07 and 7.48, P < 0.05 and P < 0.01, respectively) noted in DTI. CONCLUSION: Non-dilated coronary arterial wall abnormality is one of the forms of coronary artery wall lesions which could reduce myocardial flow perfusion. Its clinical significance is worthy of attention.