Is Diagnostic Performance of Quantitative 2D-Shear Wave Elastography Optimal for Clinical Classification of Benign and Malignant Thyroid Nodules?: A Systematic Review and Meta-analysis.

RATIONALE AND OBJECTIVE: This study is a dedicated 2D-shear wave elastography (2D-SWE) review aimed at systematically eliciting up-to-date evidence of its clinical value in differential diagnosis of benign and malignant thyroid nodules. METHODS: PubMed, Web of Science, and Scopus databases were searched for studies assessing the diagnostic value of 2D-SWE for thyroid malignancy risk stratification published until December 2016. The retrieved titles and abstracts were screened and evaluated according to the predefined inclusion and exclusion criteria. Methodological quality of the studies was assessed using the Quality Assessment of Studies of Diagnostic Accuracy included in Systematic Review 2 (QUADAS-2) tool. Extracted 2D-SWE diagnostic performance data were meta-analyzed to assess the summary sensitivity, specificity, and area under the receiver operating characteristic curve. RESULTS: After stepwise review, 14 studies in which 2D-SWE was used to evaluate 2851 thyroid nodules (1092 malignant, 1759 benign) from 2139 patients were selected for the current study. Study quality on QUADAS-2 assessment was moderate to high. The summary sensitivity, specificity and area under the receiver operating characteristic curve of 2D-SWE for differential diagnosis of benign and malignant thyroid nodules were 0.66 (95% confidence interval [CI]: 0.64-0.69), 0.78 (CI: 0.76-0.80), and 0.851 (Q* = 0.85), respectively. The pooled diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio were 12.73 (CI: 8.80-18.43), 0.31 (CI: 0.22-0.44), and 3.87 (CI: 2.83-5.29), respectively. CONCLUSION: Diagnostic performance of quantitative 2D-SWE for malignancy risk stratification of thyroid nodules is suboptimal with mediocre sensitivity and specificity, contrary to earlier reports of excellence.

Synovial Haemangioma of the Elbow: A rare paediatric case and imaging dilemma.

Synovial haemangiomas are rare benign vascular proliferations arising in synovium-lined surfaces. While the knee is by far the joint most commonly involved, this condition can also occur in the elbow. We report an eight-year-old boy who presented to the National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia, in 2016 with a left elbow swelling of one year's duration. Magnetic resonance imaging showed a lobulated intra-articular mass with intermediate signal intensity on T1-weighted imaging and low signal punctate and linear structures within the hyperintense mass on T2-weighted imaging. In addition, there was heterogeneous yet avid contrast enhancement on post-gadolinium contrast images. The mass had juxta-articular extension and bony erosion to the coronoid process and the head of the radius. Synovial haemangiomas present a diagnostic dilemma. This report highlights certain imaging characteristics to distinguish this entity from other differential diagnoses.