Shabana et H e a d a n d N e c k I m a g i n g Te c h n i c a l I n n o v a t i o n

al.
Measuring
Thyroid
Gland
Volume

A C E N T U
R Y O F Measuring Thyroid Gland Volume:
Should We Change
MEDICAL IMAGING
the Correction Factor?
Wael Shabana1 OBJECTIVE. In the assessment of thyroid volume with sonography (formula of an ellip-
Els Peeters1 soid), a correction factor is used. Whereas previously 0.524 was used, the World Health Organi-
Michel De Maeseneer1,2 zation has recently changed (after the first review) this correction factor to 0.479. We compare
volume measurement of the thyroid using different correction factors to automated volume mea-
surement using MDCT, and we define an optimal correction factor in thyroid volume assessment.
CONCLUSION. Acceptable correction factors are situated in the range of 0.4940.554.
We propose a correction factor of 0.529 when using the ellipsoid formula.

n recent decades, sonography has WHO has used 0.479 as the correction factor

I become the gold standard for as-

sessment of the thyroid gland [1].
Sonography has improved with the
development of high-frequency transducers,
which allow a more detailed study of the thy-
roid gland [2]. As a result, the World Health
Organization (WHO) and the International
Council for the Control of Iodine Deficiency
Disorders (ICCIDD) now consider sonogra-
phy the diagnostic method for assessment of
goiter [3]. Sonography is used for calculation
of iodine-131 treatment. It is most often used in
assessing the incidence of goiter in third-world
populations, especially in children [4]. Intra-
and interobserver variation can lead to differ-
ences in volume calculation, irrespective of the
correction factor. Nevertheless, a more optimal
correction factor will give a more realistic
measurement of thyroid volume.
Keywords: correction factor, MDCT screening, thyroid Volumetric evaluation of the thyroid gland
volume is based on the use of an ellipsoid model.
Hence, a value is obtained that replaces clini-
DOI:10.2214/AJR.04.0816
cal evaluation of volume. With the ellipsoid
Received May 24, 2004; accepted after revision model, the height, width, and depth of each
March 9, 2005. lobe are measured and multiplied. The ob-
tained result is then multiplied by a correction
factor, which is / 6, or 0.524 [5].
1Department of Radiology, AZ-Vrije Universiteit Brussels,
Brussels, Belgium.
The work of Brunn et al. [6] in 1981 was
2Department of Radiology, University of Michigan Medical based on volume measurement of cadaver
Center, 1500 E Medical Center Dr., TC-2910G, Ann Arbor, MI glands subsequently immersed in water.
48109-0326. Address correspondence to M. De Maeseneer. Brunn et al. concluded that a modified correc-
AJR 2006; 186:234236
tion factor of 0.479 resulted in a more accu-
rate assessment of thyroid volume compared
0361803X/06/1861234
with the previously accepted correction factor
American Roentgen Ray Society of / 6, or 0.524. Based on these findings, the
in the assessment of thyroid volume.
With the advent of MDCT, volume scan-
ning became possible [7, 8]. In this study, we
used reconstructed CT images of the thyroid
gland to calculate thyroid volume, and we
compared that volume with the volume calcu-
lated by using the ellipsoid formula with dif-
ferent correction factors. Our purpose was to
propose an optimal correction factor.
Materials and Methods
Nineteen patients underwent MDCT for disor-
ders unrelated to the thyroid gland (Somatom Vol-
ume Zoom Plus 4, Siemens Medical Solutions).
Imaging parameters were as follows: 120 kV, 150
mAs, 0.5-sec scanning time; detector collimation,
2.5 mm; slice thickness, 5 mm; table speed, 15 mm
per rotation; pitch, 6.
CT showed normal thyroid glands in all these pa-
tients. The ethics committee waived informed con-
sent because our analysis consisted of postprocess-
ing of existing images, and identification of the
patients was not possible from the images analyzed.
Images of the neck were reconstructed with a slice
thickness of 3 mm and a collimation of 0.1 mm. Each
lobe was evaluated separately. Thyroid gland vol-
ume was automatically calculated using software to
obtain volume measurements (Wizard, Siemens)
(Fig. 1). The height, width, and depth of each lobe
were measured on the same workstation by the prin-
cipal investigator. On these data, we applied the vol-
umetric ellipsoid method (height width depth
correction factor 0.524) (Fig. 2). Volumetry was also
performed using the correction factor 0.479. Other
correction factors were used for statistical analysis

234 AJR:186, January 2006

 Measuring Thyroid Gland Volume

with SPSS software (SPSS, Inc.). A paired Students significant difference between a correction
t test was used for evaluating statistically significant factor of 0.479 and the automated CT volume
differences between the volumes calculated with dif- measurement (p = 0.007).
ferent correction factors versus the volumes calcu- Other correction factors were used for sta-
lated automatically using CT. tistical testing, and a p value for each correc-
tion factor was obtained. In the range of
Results 0.4940.554, paired Students t tests showed
The mean age of the patients was 51 years no statistically significant differences be-
(range, 2775 years). There were 10 women tween the calculated volumes and the auto-
and nine men. A total of 38 thyroid lobes were mated CT volume measurements (Fig. 3).
evaluated using volume calculation software.
Measured thyroid volumes were normally Discussion
distributed. The mean volume of thyroid High-resolution real-time sonographic
lobes was 8.91 mL (range, 1.3321.96 mL; assessment of thyroid volume is a noninva-
SD, 5.1 mL). A paired Students t test showed sive method that has been shown to be more
no statistically significant difference between precise than clinical inspection and palpa-
a calculated volume using a correction factor tion. Assessment of thyroid volume is used
of 0.524 and the automated CT volume mea- as a method for follow-up after treatment of
surement (p = 0.748). In contradistinction, a enlarged thyroid glands with radioactive io-
paired Students t test showed a statistically dine (I-131) [9].

0.1
Fig. 1Transverse CT image in 32-year-old man (right
lobe of thyroid). Measurements obtained in transverse
plane using ellipsoid method are shown.
p Values Using Paired Students t Test

0.05

0
9

4
45

47

47

49

49

51

52

52

53

54

55

56

57

58

59
0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

0.

Correction Rotation Factor

Correction
Factor 0.459 0.474 0.479 0.494 0.499 0.514 0.529 0.524 0.534 0.549 0.554 0.569 0.574 0.584 0.594

p Values 0.0002 0.003 0.01 0.06 0.11 0.83 0.96 0.75 0.28 0.19 0.054 0.03 0.01 0.005 0.002
Fig. 2Transverse CT image in 32-year-old man (right
lobe of thyroid). Tracings obtained with automated CT
volumetry software. Fig. 3Different correction factors used to estimate thyroid volume and resulting p values are shown.

AJR:186, January 2006 235


In recent decades, the WHO has changed
the diagnostic criteria for goiter. The diagno-
sis of goiter used to be based on palpation, but
now it is based on volume measurement using
sonography. Volume measurement of the thy-
roid gland is especially easy to obtain because
the gland has a different echogenicity com-
pared with adjacent soft tissues [6]. Because
of its conical morphology, a thyroid lobe is as-
sumed to resemble an ellipsoid, and its vol-
ume is approximated using height width
depth a correction factor. Other methods
such as 3D sonography and the automated
transverse surface area method have been
proposed to evaluate thyroid volume [10, 11].
Thyroid lobes, however, show variations in
shape as is evident in anatomic and imaging
studies [12, 13]. The study of Brunn et al. [6]
correlated results of volume of the thyroid
calculated by sonography with the volume of
the thyroid assessed after dissection of the
gland and immersion in water. This method-
ology, however, does not take into account in-
complete dissection, dissection of connective
tissue not part of the thyroid gland, and drying
of tissue after dissection.
With the advent of MDCT, volume mea-
surement has become routine in CT body im-
aging and has been shown to be highly accu-
rate [14]. MDCT enables us to postprocess
the scanned body part in different planes and
obtain accurate volume measurements [15].
Brunn et al. [6] in 1981 suggested the use of
a correction factor of 0.479 instead of the ac-
cepted 0.524. According to the results of our
analysis, estimated thyroid lobe volume is not
statistically significantly different from the CT
volume measurement with the latter correction
factor (0.524). Our results, however, indicate
that there is a statistically significant difference
of thyroid lobe volume assessment compared
with CT volume measurement when a correc-
tion factor of 0.479 is used.
The strengths of our analysis include au-
tomated measurement using CT, which cor-
responds to a calibrated measurement, and
the use of the parametric Students t test
compared with the kappa test used in the
Brunn et al. [6] study. Given our results, we
suggest the use of a mean correction factor
between 0.494 and 0.554, which corre-
sponds to 0.529. The correction factor 0.524
( / 6) also is acceptable because it lies in
236
Shabana et al.
this range. A centrally located correction
factor (Fig. 3) may best take into account
anatomic variability. Indeed, when using
lower or higher correction factors, the
chance of obtaining erroneous measure-
ments seems increased. Our results indicate
that the correction factor 0.479 should be
avoided for measurement of thyroid volume
using the ellipsoid model.
Our investigation has some limitations. Our
study was based on volume measurement by
MDCT. However, given the difference in den-
sity between the thyroid gland and adjacent
soft tissue, tracing of the thyroid is easy on CT
images. Also, previous studies have shown that
CT volume measurement is highly accurate
[15]. At sonography, the thyroid gland has an
echo pattern different from adjacent soft tis-
sues, simplifying measurements with this tech-
nique. Our study focuses, however, on the op-
timal correction factor, and since MDCT is a
calibrated method, we considered this the most
optimal approach. We acknowledge that the
shape of the thyroid may vary in ways such as
the nodular glands, and the overall shape may
then be different from an ellipsoid.
In conclusion, we compared different
correction factors for calculating thyroid
gland volume using the ellipsoid method
with volume measurements using MDCT
images. The recently proposed correction
factor of 0.479 leads to statistically signifi-
cantly different measurements compared
with CT volume measurements. This latter
correction factor, used by the WHO, may
not be optimal for volume assessment of the
thyroid. Acceptable correction factors are
situated in the 0.4940.554 range. We sug-
gest the use of a mean value of 0.529 to cal-
culate the volume of the thyroid lobe when
using the ellipsoid formula.
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