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Sonography of the Thyroid Gland

Sonography of the Thyroid Gland. Nagesh Ragavendra, M.D. Professor of Radiology Department of Radiological Sciences David Geffen School of Medicine at UCLA. Thyroid Imaging Techniques. CT & MRI No functional information. NO role in evaluation of thyroid structure. Tumor staging

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Sonography of the Thyroid Gland

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  1. Sonography of the Thyroid Gland Nagesh Ragavendra, M.D. Professor of Radiology Department of Radiological Sciences David Geffen School of Medicine at UCLA

  2. Thyroid Imaging Techniques • CT & MRI • No functional information. NO role in evaluation of thyroid structure. Tumor staging • Ultrasound Modality of choice for evaluation of thyroid structure No functional information • Isotope & PET Functional information Limited structural information

  3. Sonography • Noninvasive medical imaging • High frequency sound waves (ultrasound) • Visualize internal body structures Utility: • Diagnosis • Biopsy Guidance • Treatment Planning • OR - Tumor Localization

  4. SONAR Sound Navigation and Ranging • Speed of Sound in Water • 1540 m/sec > Known • Distance > >>>Calculated Echo Brightness >>> Intensity “B” Mode

  5. Sonography Advantages Disadvantages • No Radiation • No IV Injection • Portable • Painless • Operator Dependence • Bone, air/gas • Obesity

  6. Real Time Ultrasound Scanner Linear Sector Transducers

  7. Liver Trachea Kidney Diaphragm Transverse View Thyroid Gland

  8. Transducer: Linear • Clinical Uses: • Superficial Structures • Thyroid • Parathyroid • Breast • Testes

  9. Transducer: Sector • Clinical Uses: • Deeper Structures • Liver • Pancreas • Uterus • Ovary

  10. Transducer Frequency Typical: 3 MHz – 12 MHz Trade-off Depth of Penetration High frequency >> Shallow Low Frequency >> Deep Resolution High Frequency >> Higher Low Frequency >> Poorer

  11. Patient Positioning

  12. Anatomic Scanning Planes Sagittal (Longitudinal) Transverse Coronal

  13. Thyroid Anatomy

  14. Thyroid Anatomy Esophagus Longus

  15. Thyroid Nodule – Characterization Solid Complex Cyst • Characteristics of a Cyst • Echo free center • Smooth back wall • Acoustic enhancement

  16. Characteristics of a Solid Nodule • Many echo reflections • Back wall indistinct • No acoustic enhancement • Characteristics of a Complex Nodule • Cyst + Solid Features Combined

  17. Characteristics of a Cyst • Echo free center • Smooth back wall • Acoustic enhancement Longitudinal Right Lobe

  18. Characteristics of a Solid Nodule • Many echo reflections • Back wall indistinct • No acoustic enhancement Longitudinal Right Lobe

  19. Characteristics of a Complex Nodule • Cyst + Solid Features Combined Longitudinal Right Lobe

  20. Hypoechoic Isoechoic Hyperechoic

  21. Shape 1 cm Typical features of a malignant thyroid nodule Micro-calcification 0.6 cm

  22. Dec 2005- Feb 2009 [Total = 1668 FNA ] Solid Nodules (788) • Benign 630 • Malignant 158 ********** NonSolid (880) • Benign 854 • Malignant 26 Solid NonSolid

  23. Take home points… • Relevant: • Solidity of the nodule • Border characteristics • Punctate calcifications • Irrelevant: • Size • Color Doppler features

  24. What is solidity?

  25. Darci T. Butcher, Tamara Alliston & Valerie M. Weaver Nature Reviews Cancer 9, 108-122 (February 2009)

  26. Example: Two nodules BOTH with solid US features • Nodule 1: Soft and not stiff • Nodule 2: Hard and stiff

  27. Ultrasound Elastography The New Sonic Boom ShearWave Elastography Supersonic Imagine US System

  28. The End

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