| ObjectiveTo investigate the value of ultrasonic elastography(UE) in diagnosing thyroid solid nodules by using improved elasticity scores compared with the old ones.At the same time compared the value in diagnosing thyroid solid nodules with conventional ultrasound and color Doppler flow imaging(CDFI).Furthermore,to explore the value of combined conventional scale ultrasound with UE. Then evaluated the value of UE in differential diagnosis of malignant and benign thyroid solid nodules.Methods120 in-patients with 181 thyroid solid nodules from December 2009 to February 2011 were retrospectively analyzed.All of the nodules were examined by conventional ultrasound and UE.The size of nodules is between 0.6×0.4cm and 3.5×2.6cm.There are 31 males and 89 females, the age ranged from 21 to 69 ,the average age i(s39.78±11.45)years old.The standard of investigating is a nodule with more than 80% solid component. Exclude the nodules with a diameter more than 4cm or with a shell calcification.Every patient underwent surgery and had pathology data. The ultrasonic instrument is GE LOGIQ E9,the probe type is ML6-15 ,frequency ranged from 8 to 15MHZ,the instrument equipped with the technology of color ultrasonic elastography.First,under the conventional ultrasound condition obtained the satisfying scale and CDFI image.Then switch to UE mode, when examining the region of interest(ROI) should include the lesion and some normal tissue surrounding it. The area of the ROI about 1.5 to 2 times than the lesion. When collecting the images should according to the pressure feedback bar, at the same time, observe the pressure changing curve in the bottom of the screen, the standard is the curve saturation steady. All patients examined transverse and vertical respectively. Copy the images to computer disc for analyse.Two experienced ultrasonic doctor retrospectively analyzed them with surgery pathology. At the aspect of planar scale image via the model of binary Logistic regression analysis found the risk factors of malignant thyroid nodules. Compared with UE which used improved elasticity scores and the old scores separately. Compared the accuracy conventional ultrasound combined with UE and used each one respectively. Statistical analysis was obtained with SPSS 13.0 software, and statistically significant difference is P<0.05.ResultsVia the model of binary Logistic regression analysis we can found the risk factors of malignant thyroid nodules.They are blurry border ,hypoechoic and microcalcifications.The malignant of a nodule's possibility P=1 / ( 1+exp-z ) ,At the expressions, Z=-4.944+3.612×border+2.780×echo+4.273×microcalcifications.We drew ROC curves of improved elasticity scores and old ones respectively and compared the areas under curves,they are 0.975 and 0.938. The sensitivity, specificity and accuracy of ultrasonic elastography for diagnosing malignant thyroid nodules were 81.0%,90.6%and 88.95%,respectively using old elasticity scores,while 88.1%,96.4%and 94.48%,when using improved elasticity scores.The accuracy compared between old and improved scores,χ2=4.269,P=0.039.The sensitivity, specificity and accuracy of scale ultrasound were 78.6%,92.8% and 89.5%.Compared with UE,χ2=3.036,P=0.081,the accuracy had no significant difference. But the accuracy of combined conventional ultrasound and UE was high than scale ultrasonography,χ2=5.967, P=0.015, there are significant difference between them.Conclusions1.The sensitivity, specificity and accuracy of UE in diagnosis thyroid solid nodules are all high than scale ultrasonography,combined with them two can improve the accuracy in diagnosis.2.Improved elasticity scores can reduce subjectivity, it is more convenient, accurate and helpful in differentiating malignant from benign thyroid nodules.3.UE is a helpful supplement measurement to conventional ultrasound; it cannot replace conventional ultrasound absolutely. |
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