Doppler ultrasound is nonspecific as these nodules can present with a varied pattern of blood flow figure 4. When it is time for the imaging to begin, you will sit in a chair facing a stationary probe positioned over the thyroid gland in. Objective to quantify the risk of thyroid cancer associated with thyroid nodules based on ultrasound imaging characteristics. From a registry of the records of 1,232 fineneedle aspiration biopsies performed jointly by the cytology and radiology departments at a single institution between 2005 and 2007, the cases of 650 patients. Papillary thyroid cancer radiology reference article. Pubmed and scopus were searched using keywords that included ultrasound. Thyroid, parathyroid, and neck ultrasound radiology key. Despite the high prevalence of thyroid nodules up to 12% of adults, the incidence of thyroid cancer is relatively low 3. The thyroid gland is located in front of the neck above your clavicle collar bones.
Risk of thyroid cancer based on thyroid ultrasound imaging. When a mass is found in the neck, the origin may not be obvious from a clinical examination. Mar 07, 2014 thyroid ultrasonography us plays a key role in the diagnosis and management of thyroid related diseases. Pdf thyroid ultrasonography has established itself as a popular and useful tool in the evaluation and management of thyroid disorders. Improved quality of thyroid ultrasound reports after implementation of the acr thyroid imaging reporting and data system nodule lexicon and risk stratification system. Thyroid cancers were identified through linkage with the california cancer registry. Sonographic evaluation of the major vasculature of the neck is addressed in a separate practice parameter.
Thyroid ultrasound is also indicated for thyroid volume estimation in patients about to undergo radioactive iodine treatment. Ultrasound findings in the acute phase include irregular and illdefined hypoechogenic areas, predominantly in the subcapsular region figure 3. Thyroid imaging with radioactive iodine and technetium 99m tc was the monopoly of nuclear medicine for over a quarter of a century with hot nodules interpreted to be benign and cold possibly malignant, figure 1. The thyroid gland is located in front of the neck just below the adams apple and is shaped like a butterfly, with two lobes on either side of the neck. Thyroid ultrasonography has established itself as a popular and useful tool in the evaluation and management of thyroid disorders. Highresolution ultrasound us is the gold standard test for the identification of thyroid nodules. Neckthyroid ultrasound fairfax radiological consultants. Limitations of laryngeal ultrasonography are thyroid cartilage ossification and the air contained in the larynx. Thyroid ultrasound from simple to complex alexander. Up to 70 percent of adults have these lumps, also called nodules. Advanced ultrasound techniques in thyroid imaging have not only. The diffuse form can initially present as an enlarged thyroid gland, with ultrasound imaging identifying multiple small. Cureus ultrasound classification of thyroid nodules.
Methods retrospective casecontrol study of patients who underwent thyroid ultrasound imaging from january 1, 2000, through march 30, 2005. In most instances, these nodules are benign and pose no health risk. Mtc is frequently aggressive and metastasizes to cervical and mediastinal lymph nodes, lungs, liver, and bones. For example, you may have uptake measurements at four to six hours and 24 hours. Review of imaging features and biopsy techniques with radiologicpathologic correlation. Expectations are high because sonography is exquisitely sensitive to thyroid abnormalities. The most common indication for an ultrasound of your neck is a palpable neck mass. Thyroid malignancies of other histologic types, such as lymphoma and follicular carcinoma, were excluded. Show full abstract appearance of metastatic lymph nodes in thyroid cancer, you will find that ultrasound is a more specific tool for separating benign from malignant lymph nodes than it is for. Synoptic reporting of thyroid ultrasound in an effort to improve quality and decrease variability of radiology reports, structured thyroid us reporting has been adopted by efw radiology. Appropriate cleaning solution for transducer procedure for thyroid ultrasound. A diffusely enlarged thyroid gland with an isthmus width of 1. Smil radiologists perform a thyroid ultrasound exam to help diagnose a lump in the thyroid or a thyroid that is not functioning properly.
Epidemiology papillary thyroid cancer as is the case with follicular thyroid cancer typically occurs in. Cardiology, radiology, and ultrasound cpt code list. Specific management guidelines from various professional societies are covered in. The earliest ultrasound imaging consisted of a sound transmitted into the body, with the reflected sound waves displayed on an oscilloscope. A thyroid ultrasound may be ordered if a thyroid function test is abnormal or if you doctor feels a growth on your thyroid while examining your neck. Although a number of new imaging modalities for directing the management of oncologic patients evolved over the last two decades, the clinical. Ata guidelines for assessment of thyroid nodules radiology. Article imaging of thyroid nodules applied radiology. This exam can assess the size and shape of this gland to help your doctor discover any alteration in its function. Raham bacha md kmu msc sonologygold medalist uol the university of lahore 4.
Referred to as amode ultrasound, these images in the 1960s and 1970s were capable of providing measurements of internal structures such as thyroid lobes, nodules, and cysts. However, ultrasound of thyroid may be useful in patients who fail medical therapy and in whom other causes of thyroiditis is suspected. Thyroid imaging including vascular flow, when performed. Ultrasound thyroid thyroid ultrasound uses sound waves to produce pictures of the thyroid gland within the neck.
Clinical practice management n grant et al n thyroid ultrasound reporting lexicon. The reliability of thyroid nodule ultrasound features and size to predict. The two best known in the united states are from the american thyroid association ata and the society of radiologists in ultrasound. Knowledge of the normal and abnormal imaging appearances of the thyroid gland is essential for appropriate identification and diagnosis of thyroid lesions. The characteristic ultrasound findings of the normal thyroid and a wide range of thyroid diseases and disorders are described with the aid of hundreds of highquality images. Ultrasound us based classification systems exist for the stratification of thyroid nodules based on the risk for malignancy.
The literature regarding thyroid nodule characterization with ultrasound is expansive, and several professional organizations have put forth position or consensus statements. Mar 15, 2014 in the longitudinal view of the thyroid, the length l is measured from the cranial to the caudal ends of the lobe 5. The task force on thyroid nodules of the ksthr has revised the recommendations for the ultrasound diagnosis and imaging based management of thyroid. In addition to hearing major speeches and awards, attendees can view the following posters and oral presentations on thyroid imaging and thyroid nodules and goiter. Diffuse changes and thyroid lesions are discussed in depth, paying close attention to aspects of importance for early detection and differential diagnosis. Department of radiology this web tutorial is designed to serve as an interactive and highyield source regarding the challenges facing radiologists in dealing with thyroid nodules that are so commonly seen in daily practice and especially more and more commonly found incidentally. Reduction in thyroid nodule biopsies and improved accuracy with american college of radiology thyroid imaging. An autopsy study found 50% of patients with no clinical history of thyroid disease had thyroid nodules, and the majority were multiple 1. The patient should be in the supine position with the neck extended by cloth, roll or bolster. Unfortunately, us findings are rarely specific for any disease. Thyroid scans are functional tests that assess the activity of the thyroid.
Pdf this talk will focus on thyroid us for characterization of focal nodules. Early thyroid scans were done with radioactive iodine. It does not use ionizing radiation and is commonly used to evaluate lumps or nodules found during a routine physical or other imaging exam. Thyroid ultrasound remains the best imaging modality for evaluating thyroid nodules thyroid ultrasound suffers from low specificity tirads guidelines are now being utilized to help standardize interpretation, with clearer recommendations tirads may improve specificity without significant loss of sensitivity. Thyroid ultrasound images of normal and enlarged thyroid. Imaging has long been established as an essential element in the workup of clinically suspected lesions of the thyroid gland. Thyroid ultrasound remains the best imaging modality for evaluating thyroid nodules thyroid ultrasound suffers from low specificity tirads guidelines are now being utilized to help standardize interpretation, with clearer recommendations tirads may.
Thyroid ultrasound exam in arizona smil medical imaging. Often, two separate uptake measurements are obtained at different times. To visualize the thyroid gland optimally, the patient is placed in the supine position with a pillow underneath the shoulders to extend the neck slightly, allowing the head to rest on the examination table. All currently employed techniques are covered, from conventional grayscale and doppler imaging to elastography and contrastenhanced ultrasound. The aim of this article was to illustrate various pitfalls that can occur in utilizing thyroid us and techniques to prevent them. As more specific imaging developed, the utility of iodine and technetium scanning declined so that it is no longer a preferred investigation when a thyroid nodule is. Thyroid nodules are a frequent finding on neck sonography. In laryngeal imaging, highresolution ultrasound provides anatomical detail in the superficial anatomy of the neck and has become the firstline imaging investigation for neck mass. Evaluation for causes of relevant laboratory abnormalities, such as abnormalities of thyroid or parathyroid. Assessment of thyroid lesions ultrasound radiology. Papillary thyroid carcinoma ptc is the most common malignancy of the thyroid gland, and frequently has nodal metastases at presentation. Medullary thyroid carcinoma mtc, arising from the parafollicular c cells of the thyroid, accounts for 12% of thyroid cancers.
Referred to as amode ultrasound, these images in the 1960s and 1970s were capable of providing measurements of internal structures such as thyroid. It includes indications and recommendations to consider as well as cpt codes to use. Common and uncommon sonographic features of papillary thyroid. Ultrasound of the thyroid gland is a technique for diagnosing, treating and dynamically controlling thyroid diseases by ultrasound imaging of the thyroid gland tissues.
The american thyroid association ata guidelines for assessment of thyroid nodules are meant to improve inter and intrareader consistency during assessment of thyroid nodules on ultrasound, and to facilitate communication with referring endocr. Uspstf recommendation a revised ata management guidelines for patients with thyroid nodules and differentiated thyroid cancer, ata task force, david cooper, chair, thyroid, 2009 in all patients with palpable thyroid nodules or. From a registry of the records of 1,232 fineneedle aspiration biopsies performed jointly by the cytology and radiology departments at a single institution between 2005 and 2007, the cases of 650 patients were identified for whom both a pathology report and ultrasound images were available. The thyroid uptake will begin several hours to 24 hours later. Ultrasonography us is the modality of choice for initial characterization of a thyroid nodule. White paper of the acr thyroid imaging, reporting and data system tirads committee. Pattern recognition of benign nodules at ultrasound of the thyroid.
If your physician has identified lumps in your thyroid or neck during a routine physical, you are not alone. Nov 26, 2015 thyroid nodules are a common occurrence in the general population, and these incidental thyroid nodules are often referred for ultrasound us evaluation. Blum, 2016 chaudhary, 20 normal thyroid lobe dimensions are. Standard ultrasound assessment and reporting epidemiology thyroid nodules are a common clinical problem. Thyroid, parathyroid, and neck ultrasound sonography of the thyroid gland is one of the more frustrating areas of us imaging. The american thyroid association will hold its 89 th annual meeting on october 30november 3, 2019, at the sheraton grand chicago in chicago, illinois. In some age groups, nodules are seen on ultrasound. Aiumacrsprsru practice parameter for the performance. Thyroid imaging reporting and data system tirads by american college of radiology is licensed under a creative commons attributionnoncommercialnoderivatives 4. Thyroid sonography should be performed in all patients with known or suspected thyroid nodules. In contrast, highresolution ultrasound us can detect thyroid nodules in 19%68% of randomly selected individuals, with higher frequencies in women and the elderly 3,4. Thyroid ultrasound reporting lexicon professional radiology.
Ultrasound imaging has replaced nuclear medicine as the most frequently used imaging test of the thyroid. The thyroid scan and thyroid uptake provide information about the structure and function of the thyroid. Review of imaging features and biopsy techniques with radiologicpathologic correlation1 knowledge of the normal and abnormal imaging appearances of the thyroid gland is essential for appropriate identification and. The american thyroid association ata guidelines for assessment of thyroid nodules are meant to improve inter and intrareader consistency during assessment of thyroid nodules on ultrasound, and to facilitate communication with referring endocrinologists the 2015 guidelines stress the importance of the sonographic pattern of the nodule for risk stratification. Pdf ultrasound is the firstline diagnostic tool for diagnosis of thyroid diseases. Aiumacrsprsru practice parameter for the performance and. In the longitudinal view of the thyroid, the length l is measured from the cranial to the caudal ends of the lobe 5.
The two best known in the united states are from the american thyroid association ata and the society of radiologists in ultrasound 5,6. Thyroid ultrasound technique sonography technique to visualize the thyroid gland optimally, the patient is placed in the supine position with a pillow underneath the shoulders to extend the neck slightly, allowing the head to rest on the examination table. Permissions beyond the scope of this license may be available here. Pdf thyroid ultrasonography us plays a key role in the diagnosis and management of. This article is an overview on ultrasonographic features of thyroid nodules, which are used to determine the need for biopsy with fine needle aspiration. A thyroid ultrasound uses high frequency sound waves to examine the thyroid gland, a small endocrine gland that lies at the front of your neck below the adams apple. The thyroid is a gland in the neck that controls metabolism, a chemical process that regulates the rate at which the body converts food to energy. This procedure requires little to no special preparation.
Ultrasound scan allows to assess the location, shape, contours, structure, size of the thyroid gland, available intraorganic pathology and its nature diffuse, focal, number of. This is in contrast to ultrasound, which provides information on gross morphology or biopsy that provides histological information. This comprehensive guide to imaging services was developed to help in prescribing and ordering the correct testing for your patients. Pattern recognition of benign nodules at ultrasound of the. Although the majority of thyroid nodules are asymptomatic, it is recommended that all patients with palpable nodules undergo us imaging to determine whether. Tirads classification of thyroid nodules based on a score modified. Establishment of nomograms and reference ranges for intracranial ventricular dimensions and ventriculohemispheric ratio in newborns by ultrasonography.
Acr thyroid imaging, reporting and data system tirads. The diffuse form can initially present as an enlarged thyroid gland, with ultrasound imaging. Mar 20, 2018 in 2017, the thyroid imaging reporting and data system tirads committee of the american college of radiology acr published a white paper that presented a new riskstratification system for classifying thyroid nodules on the basis of their appearance at ultrasonography us. Thyroid ultrasound basic american thyroid association. The korean society of thyroid radiology ksthr published their first. Interpreting the thyroid ultrasound report michael neuman, md radiology specialists of the northwest february 2, 2018. These include the society of radiologists in ultrasound, 18 the american thyroid association ata, 16 the american association of clinical endocrinologists aace, 19 the national comprehensive cancer network, 20 the acr, 21 and the korean society of thyroid radiology ksthr. Diagnostic imaging can also reveal subclinical thyroid nodules. Ultrasonography diagnosis and imagingbased management of. Measure the volume of a thyroid nodule using the same formula used to calculate the volume of a thyroid lobe. This superbly illustrated, uptodate book provides a wealth of guidance on the use and interpretation of thyroid ultrasound. Ultrasound is the first line imaging modality for assessment of thyroid nodules found on clinical examination or incidentally on another imaging modality. Lately, the application of us has been further emphasized for the personalized management of patients with thyroid nodules. In the setting of thyroid cancer preoperative or postoperative, detailed neck ultrasound examination protocol is more appropriate.
217 222 1075 690 486 894 1286 1489 60 871 912 914 595 290 529 227 1315 853 273 202 364 554 451 1211 726 1505 954 1031 1071 1168 715 1461 844 798 422 112