elastosonography scoring and strain index of thyroid nodules with hurthle cells background this study evaluated the effectiveness of elastosonography es scoring and strain index si in diagnosing patients with thyroid nodules composed primarily of hurthle cellsmethods this study retrospectively analyzed 57 patients with thyroid nodules composed predominantly of hurthle cells on fine needle aspiration cytology fnac patients were evaluated by thyroid ultrasonography us es scoring si us guided fnac and histopathologyresults histopathologically 12 211 nodules were malignant and 45 789 were benign mean age sex distribution thyroid function tests and morphologic features on us were similar in the malignant and benign groups mean si 40983128 vs 21242547 p0027 and thyroid peroxidase antibody antitpoab positivity p0004 were significantly higher in malignant than in benign nodules receiver operating curve roc analysis showed that an si cutoff of 10326 had a sensitivity of 917 and a specificity of 49 and an si cutoff of 64807 had a specificity of 911 and a sensitivity of 25 the optimal si cutoff value 17877 had a sensitivity of 667 a specificity of 667 a positive predictive value ppv of 348 a negative predictive value npv of 882 and an area under the roc curve of 7310074 95 ci 5878765 the sensitivity specificity ppv npv and diagnostic accuracy of es scoring were 416 911 555 854 and 807 respectivelyconclusions this is the first study to investigate es scoring and si in nodules composed predominantly of hurthle cells on fnac es scoring and si may add some contribution to ultrasonography in the characterization of thyroid nodules with hurthle cells