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Ultrasonographic Evaluation of Diffuse Thyroid Disease: a Study Comparing Grayscale US and Texture Analysis of Real-Time Elastography (RTE) and Grayscale US
Int J Thyroidol 2017;10(1):14-23
Published online May 30, 2017;
© 2017 Korean Thyroid Association.

Jung Hyun Yoon1, Eunjung Lee2, Hye Sun Lee3, Eun-Kyung Kim1, Hee Jung Moon1 and Jin Young Kwak1

Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine1, Department of Computational Science and Engineering, Yonsei University2, Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine3, Seoul, Korea
Correspondence to: Jin Young Kwak, MD, Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: 82-2-2228-7400, Fax: 82-2-393-3035, E-mail:
Received October 20, 2016; Revised February 9, 2017; Accepted February 9, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background and Objectives: To evaluate and compare the diagnostic performances of grayscale ultrasound (US) and quantitative parameters obtained from texture analysis of grayscale US and elastography images in evaluating patients with diffuse thyroid disease (DTD). Materials and Methods: From September to December 2012, 113 patients (mean age, 43.4±10.7 years) who had undergone preoperative staging US and elastography were included in this study. Assessment of the thyroid parenchyma for the diagnosis of DTD was made if US features suggestive of DTD were present. Nine histogram parameters were obtained from the grayscale US and elastography images, from which ‘grayscale index’ and ‘elastography index’ were calculated. Diagnostic performances of grayscale US, texture analysis using grayscale US and elastography were calculated and compared. Results: Of the 113 patients, 85 (75.2%) patients were negative for DTD and 28 (24.8%) were positive for DTD on pathology. The presence of US features suggestive of DTD showed significantly higher rates of DTD on pathology, 60.7% to 8.2% (p<0.001). Specificity, accuracy, and positive predictive value was highest in US features, 91.8%, 84.1%, and 87.6%, respectively (all ps<0.05). Grayscale index showed higher sensitivity and negative predictive value (NPV) than US features. All diagnostic performances were higher for grayscale index than the elastography index. Area under the curve of US features was the highest, 0.762, but without significant differences to grayscale index or mean of elastography (all ps>0.05). Conclusion: Diagnostic performances were the highest for grayscale US features in diagnosis of DTD. Grayscale index may be used as a complementary tool to US features for improving sensitivity and NPV.
Keywords : Thyroid, Ultrasound, Diffuse thyroid disease, Elastography, Texture analysis