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Abstract Abstract Background: Thyroid nodule definite characterization is usually done using a fine needle aspiration cytology/biopsy. The aim of this study was to evaluate the role of ultrasound strain elastography & diffusion weighted imaging to differentiate benign from malignant thyroid nodules. Methods: Our study is a prospective. 59 patients (20 males and 39 females, mean age 37.9 years) with 59 thyroid nodules were included in the study. Conventional ultrasound, ultrasound strain elastography and diffusion-weighted MR imaging with its quantitative parameter apparent diffusion coefficient (ADC) were done for all cases. Histopathological samples results were the standard reference. Results: We found that ACR TI-RADS scoring system had (80 %) sensitivity ,(89.8%) specificity and (84.9 %) diagnostic accuracy. Regarding the 4-points Asteria's criteria for elastography score; we found that it had (70 %) sensitivity, (91.8 %) specificity and (80.9 %) diagnostic accuracy. When a cutoff value of 1.65 was used for strain ratio; 90 % sensitivity, 71.4 % specificity and diagnostic accuracy of about 91.8 % noted. When a cutoff value of 1.45 x10-3 was used for ADC value; 80 % sensitivity, 95.9 % specificity and overall accuracy of about 98% were detected. The best diagnostic performance was achieved in our study by adding diffusion ADC value to the ACR TI-RADS with sensitivity 100%, specificity 95.9% and accuracy 98% in differentiation of benign and malignant thyroid nodules. Conclusion: Strain elastography and diffusion ADC value enhanced diagnostic performance of thyroid ultrasound. The best diagnostic performance was achieved by adding diffusion ADC to the ACR TI-RADS. Key words: Thyroid nodules, conventional ultrasound, ultrasound strain elastography , strain ratio , TI-RADS , diffusion-weighted magnetic resonance imaging , apparent diffusion coefficient. |