BACKGROUND: Non-calcified thyroid nodules are relatively difficult to diagnose only relying on features of at conventional US images.

OBJECTIVE: To investigate the diagnostic performances of conventional strain elastography (SE), acoustic radiation force impulse (ARFI) SE and point shear-wave speed (pSWS) measurement for non-calcified thyroid nodules.

METHODS: A total of 201 non-calcified thyroid nodules in 195 patients were studied. They were examined with conventional ultrasound (US), conventional SE, ARFI SE and pSWS measurement. Their diagnostic performances and multivariable models were assessed with receiver operating characteristic (ROC) curve and logistic regression analyses respectively.

RESULTS: There were 156 benign and 45 malignant non-calcified nodules proven by histopathology or cystology. The mean diameters of the nodules were 21.2±10.8 mm. Areas under receiver operating characteristic curve (AUCs) of elastography features (ranged, 0.488–0.745) were all greater than that of US (ranged, 0.111–0.332). At multivariate analysis, there were three predictors of malignancy for non-calcified nodules, including pSWS of nodule (odds ratio [OR], 34.960; 95% CI, 11.582–105.529), marked hypoechogenicity (OR, 16.223; 95% CI, 1.761–149.454) and ARFI SE grade (OR, 10.900; 95% CI, 3.567–33.310). US+SE+pSWS owned the largest AUC (0.936; 95% CI, 0.887–0.985; P < 0.05), followed by US+pSWS (0.889; 95% CI, 0.823–0.955), and the poorest was US (0.727; 95% CI, 0.635–0.819).

CONCLUSIONS: ARFI SE and pSWS measurement had better diagnostic performances than conventional SE and US. When US combined with SE and pSWS measurement, it could achieve an excellent diagnostic performance and might contribute a better decision-making of FNA for non-calcified thyroid nodules.