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AJR Am J Roentgenol. 2018 Sep;211(3):649-654. doi: 10.2214/AJR.17.19164. Epub 2018 Jul 11.

Diagnostic Accuracy of Real-Time Sonography in Differentiating Diffuse Thyroid Disease From Normal Thyroid Parenchyma: A Multicenter Study.

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1 Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
2 Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan, South Korea 47392.
3 Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea.
4 Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.



The purpose of this multicenter study was to assess the diagnostic accuracy of real-time sonography (US) for differentiating diffuse thyroid disease (DTD) from normal thyroid parenchyma among radiologists blinded to patients' clinical, serologic, and imaging history and to determine the differences in diagnostic accuracy among radiologists from different institutions.


From January to March 2017, 214 patients underwent preoperative thyroid US and subsequent thyroid surgery at four participating institutions. Real-time US was performed at each institution by an attending radiologist, who classified US diagnoses into one of the following four categories based on US findings: no DTD, indeterminate, suspicious for DTD, and DTD. The outcomes of US diagnoses were compared with histopathologic results to determine the diagnostic accuracy of real-time US at each institution.


Histopathologic results included normal thyroid parenchyma (n = 143), Hashimoto thyroiditis (n = 29), non-Hashimoto lymphocytic thyroiditis (n = 37), and diffuse hyperplasia (n = 5). Normal thyroid parenchyma and DTD exhibited statistically significant differences in echogenicity, echotexture, size, glandular margin, vascularity of thyroid, and US classification. There was positive correlation between US classification and histopathologic results at all institutions for detecting DTD. The highest diagnostic indexes were obtained when the cutoff criterion was suspicious for DTD. There was favorable diagnostic accuracy, with statistically significant differences, at all institutions for the diagnosis of DTD.


Real-time US can be helpful for differentiating DTD from normal thyroid parenchyma.


diffuse thyroid disease; real-time; sonography; thyroid

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