Компрессионная эластография в диагностике постлучевого гипотиреоза: современное состояние вопроса

Представлен обзор применения эластографии в диагностике различных заболеваний щитовидной железы. Обсуждаются возможности и ограничения компрессионной соноэластографии (КСЭГ) как дополнительного неинвазивного метода в дифференциации доброкачественных и злокачественных узловых образований; подчеркивается, что изолированное применение КСЭГ без количественных параметров эластографии сдвиговой волной имеет существенные ограничения вследствие высокой аппаратной и операторской зависимости метода. Освещены возможности КСЭГ в диагностике постлучевого гипотиреоза. Рассматривается необходимость проведения научных работ по интеграции эластографических методов для динамического наблюдения за пациентами после радиотерапии злокачественных новообразований головы и шеи, местнораспространенного рака молочной железы.

1. Забровская С.А., Геворков А.Р., Зайцева Н.А., Федосеева А.А., Бойко А.В., Хмелевский Е.В., Каприн А.Д. Постлучевые изменения функции щитовидной железы при лечении опухолей головы и шеи: современное состояние проблемы. Опухоли головы и шеи. 2025; 15 (2): 92–98. https://doi.org/10.17650/2222-1468-2025-15-2-92-98

2. Cantisani V., Lodise P., Grazhdani H. et al. Ultrasound elastography in the evaluation of thyroid pathology. Current status. Eur. J. Radiol. 2014; 83 (3): 420–428. http://doi.org/10.1016/j.ejrad.2013.05.008

3. Andrioli M., Persani L. Elastographic techniques of thyroid gland: current status. Endocrine. 2014; 46 93): 455–461. http://doi.org/10.1007/s12020-014-0178-1

4. Lin Z., Wu V.W.C., Lin J. et al. Pattern of radiation-induced thyroid gland changes in nasopharyngeal carcinoma patients in 48 months after radiotherapy. PloS One. 2018; 13 (7), e0200310. http://doi.org/10.1371/journal.pone.0200310

5. Bamber J., Cosgrove D., Dietrich C.F. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall. Med. 2013; 34 (2): 169–184. http://doi.org/10.1055/s-0033-1335205

6. Shiina T., Nightingale K.R., Palmeri M.L. et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med. Biol. 2015; 41 (5): 1126–1147. http://doi.org/10.1016/j.ultrasmedbio.2015.03.009

7. Kratky J., Veverka L., Hana V. et al. Neck muscles and content of carotid artery as reference tissue for strain ratio – A novel approach to improve the diagnostic performance of thyroid elastography? Exp. Clin. Endocrinol. Diabetes. 2016; 124 (3): 192–197. https://doi.org/10.1055/S-0035-1569359

8. Asteria C., Giovanardi A., Pizzocaro A. et al. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008; 18 (5): 523–531. http://7.doi.org/10.1089/thy.2007.0323

9. Борсуков А.В., Морозова Т.Г., Ковалев А.В., Сафронова М.А., Иванов Ю.В., Казакова О.П. Стандартизированная методика соноэластографии щитовидной железы. Эндокринная хирургия. 2014; 8 (1): 55–61. https://doi.org/10.14341/serg2014155-61

10. Сенча А.Н., Могутов М.С., Беляев Д.В., Сергеева Е.Д. Ультразвуковая эластография в диагностике рака щитовидной железы. Ультразвуковая и функциональная диагностика. 2010; 3; 8–17.

11. Luo Y. Ultrasound Thyroid Elastography as a Pre-FNA Screening Tool: Algorithms and Clinical Evaluation. University of Washington, 2012. 100 p.

12. Dighe M., Bae U., Richardson M.L. et al. Utility of the ultrasound elastographic systolic thyroid stiffness index in reducing fine-needle aspirations. J. Ultrasound Med. 2010; 29 (4), 565–574. https://doi.org/10.7863/JUM.2010.29.4.565

13. Mahmoud A.A., Abdelaziz M.S., Zidan A.M. et al. Comparison of the accuracy of thyroid sono-elastography vs. ultrasound-guided fine needle aspiration cytology with thyroid malignancy diagnosis histopathology. Endocr. Regulations. 2024; 58 (1): 120–130. https://doi.org/10.2478/enr-2024-0014

14. Latia A., Elhomsy G., Saponaro F. et al. OC12 – Stiffness matters: Elastography enhances detection of thyroid cancer across histologic subtypes. Eur. J. Endocrinol. 2025; 192 (Suppl. 1), lvaf168.021. https://doi.org/10.1093/ejendo/lvaf168.021

15. Omar M., Mostafa M., Morad M. et al. Evaluation of thyroid nodule by US including elastography versus MRI T2W and diffusion sequences. QJM: Int. J. Med. 2024; 117 (Suppl. 1), hcae070.594. https://doi.org/10.1093/qjmed/hcae070.594

16. Pandit A., Pandey P., Singh S. et al. Thyroid nodules evaluation by strain ultrasound elastography and histocytological correlation. J Med. Sci. 2016; 1 (2): 69–73. https://doi.org/10.21761/JMS.V1I2.7124

17. Reginelli A., Urraro F., Sangiovanni A. et al. Conventional ultrasound integrated with elastosonography and B-flow imaging in the diagnosis of thyroid nodular lesions. Int. J. Surg. 2014; 12 (Suppl. 1): S117–S122. https://doi.org/10.1016/j.ijsu.2014.05.033

18. Friedrich-Rus M., Sperber A., Holzer K. et al. Evaluation of strain elastography for differentiation of thyroid nodules: Results of a prospective DEGUM multicenter study. Ultraschall. Med. 2016; 37 (3): 262–270. https://doi.org/10.1055/S-0042-104647

19. Saftoiu A., Gilja O.H., Sidhu P.S. et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Elastography in Non-Hepatic Applications: Update 2018. Ultraschall. Med. 2019; 40 (4): 425–453. https://doi.org/10.1055/a-0838-9937

20. Sebag F., Vaillant-Lombard J., Berbis J. et al. Shear Wave Elastography: A New Ultrasound Imaging Mode for the Differential Diagnosis of Benign and Malignant Thyroid Nodules. J. Clin. Endocrinol. Metab. 2010; 95 (12): 5281–5288. https://doi.org/10.1210/jc.2010-0766

21. Liu B.J., Li D.D., Xu H.X. et al. Quantitative Shear Wave Velocity Measurement on Acoustic Radiation Force Impulse Elastography for Differential Diagnosis between Benign and Malignant Thyroid Nodules: A Meta-analysis. Ultrasound Med. Biol. 2015; 41 (12): 3035–3043. https://doi.org/10.1016/j.ultrasmedbio.2015.08.003

22. Fukuhara T., Matsuda E., Endo Y. et al. Correlation between quantitative shear wave elastography and pathologic structures of thyroid lesions. Ultrasound Med. Biol. 2015; 41 (9): 2326–2332. https://doi.org/10.1016/j.ultrasmedbio.2015.05.001

23. Anvari A., Dhyani M., Stephen A.E. et al. Reliability of shear-wave elastography estimates of the young modulus of tissue in follicular thyroid neoplasms. Am. J. Roentgenol. 2016; 206 (4): 609–616. https://doi.org/10.2214/ajr.15.14676

24. Xu H.X., Yan K., Liu B.J. et al. Guidelines and recommendations on the clinical use of shear wave elastography for evaluating thyroid nodule. Clin. Hemorheol. Microcirc. 2019; 72 (4): 363–375. https://doi.org/10.3233/ch-180452

25. Fukuhara T., Matsuda E., Fujiwara K. et al. Phantom experiment and clinical utility of quantitative shear wave elastography for differentiating thyroid nodules. Endocr. J. 2014; 61 (10): 1003–1011. https://doi.org/10.1507/endocrj.ej14-0061

26. Hu L., He N., Ye L. et al. Evaluation of the stiffness of tissues surrounding thyroid nodules with shear wave elastography. J. Ultrasound Med. 2018; 37 (12): 2903–2909. https://doi.org/10.1002/jum.14578

27. Hang J., Li F., Qiao X.H. et al. Combination of Maximum Shear Wave Elasticity Modulus and TIRADS Improves the Diagnostic Specificity in Characterizing Thyroid Nodules: A Retrospective Study. Int. J. Endocrinol. 2018; 2018: 4923050. https://doi.org/10.1155/2018/4923050

28. Durante C., Hegedüs L., Na D.G. et al. International Expert Consensus on US Lexicon for Thyroid Nodules. Radiology. 2023; 309 (1): e231481. https://doi.org/10.1148/radiol.231481

29. Tan S., Sun X., Xue H. et al. Evaluation of thyroid micro-carcinoma using shear wave elastography: Initial experience with qualitative and quantitative analysis. Eur. J. Radiol. 2021; 142: 109571. https://doi.org/10.1016/j.ejrad.2021.109571

30. Petersen M., Schenke S., Firla J. et al. Shear Wave Elastography and Thyroid Imaging Reporting and Data System (TIRADS) for the Risk Stratification of Thyroid Nodules. Diagnostics. 2022; 12 (1): 109. https://doi.org/10.3390/diagnostics12010109

31. Cantisani V., David E., Grazhdani H. et al. Prospective Evaluation of Semiquantitative Strain Ratio and Quantitative 2D Ultrasound Shear Wave Elastography (SWE) in Association with TIRADS Classification for Thyroid Nodule Characterization. Ultraschall. Med. 2019; 40 (4): 516–524. https://doi.org/10.1055/a-0853-1821

32. Yoon J.H., Yoo J., Kim E.K. et al. Real-time elastography in the evaluation of diffuse thyroid disease: a study based on elastography histogram parameters. Ultrasound Med. Biol. 2014; 40 (9): 2012–2019. http://doi.org/10.1016/j.ultrasmedbio.2014.03.033

33. Öztürk M., Çelebi İ., Polat A. et al. The usefulness of strain elastography in the diagnosis and grading of Hashimoto’s thyroiditis in children. Radiol. Med. 2017; 122 (12): 960–966. https://doi.org/10.1007/S11547-017-0801-3

34. Menzilcioglu M.S., Duymus M., Gungor G. et al. The value of real-time ultrasound elastography in chronic autoimmune thyroiditis. Br. J. Radiol. 2014; 87 (1044): 20140604. https://doi.org/10.1259/BJR.20140604

35. Cepeha C.M., Laza R.F., Duma M. et al. The value of strain elastography in predicting autoimmune thyroiditis. Diagnostics. 2020; 10 (11): 874. https://doi.org/10.3390/DIAGNOSTICS10110874

36. Gül A.E., Çetin F.A., Özdemir Z.M. et al. The utility of strain elastography in differentiation between healthy thyroid parenchyma and residual/recurrent thyroid parenchyma disorders. Eur. Research J. 2022; 8 (4): 505–512. https://doi.org/10.18621/eurj.909077

37. Arslan S., Durmaz M.S., Yardımcı A.H. et al. Contribution of ultrasound strain elastography to the differentiation of benign and malignant thyroid lesions: Randomized controlled study. Van. Tıp. Dergisi. 2018; 25(3): 276–283. https://doi.org/10.5505/VTD.2018.87587

38. Gasic J., Nikin Z., Ivanac G. et al. The importance of compression elastography in the evaluation of thyroid nodule malignancy. Srpski Arhiv za Celokupno Lekarstvo. 2017; 145 (1–2): 29–34. https://doi.org/10.2298/SARH161020087G

39. Solak A., Genç V., Yıldırım Ö. et al. The value of strain elastography in the distinction between benign and malignant thyroid nodules in patients with Hashimoto thyroiditis. Cyprus J. Med. Sci. 2023; 8 (3): 360–365. https://doi.org/10.4274/cjms.2022.2021-176

40. Yang Y., Yan L., Wang Y. et al. Comparison of the effectiveness of ultrasound elastography with that of conventional ultrasound for differential diagnosis of thyroid lesions with suspicious ultrasound features. Oncol. Lett. 2017; 14 (3): 2923–2930. https://doi.org/10.3892/OL.2017.6644

41. Karaca L., Yılmaz R., Teke M. et al. Examining the contribution of elasticity score and strain ratio to the diagnosis and evaluation of malignant and benign thyroid nodules. Turkiye Klinikleri Tip Bilimleri Dergisi. 2016; 36 (3): 139–145. https://doi.org/10.5336/MEDSCI.2016-51629

42. Korkusuz H., Happel C.M., Koch D.A. et al. Diagnostic accuracy of elastography and scintigraphic imaging after thermal microwave ablation of thyroid nodules. RöFo. 2015; 187 (5): 353–361. https://doi.org/10.1055/S-0034-1385827