The Applicational Value Of Multimodel Ultrasound In Diagnosing Thyroid Nodules

Thyroid nodules are a common finding in the general population,and the detection rate is increasing with the widespread use of US.Since the clinical treatment of benign and malignant nodules is not the same,it is of great significance to distinguish malignant nodules from benign nodules.The location of thyroid gland is superficial,ultrasonic examination is often used as the preferred examination method due to its advantages of economy,convenience and no radiation.Conventional ultrasonography includes two-dimensional ultrasonography and color doppler flow imaging,there are limitations in the identification of benign and malignant thyroid nodules.TI-RADS classification system summarizes the two-dimensional ultrasonic characteristics to obtain the malignant probability.At the same time,it can also unify the diagnostic criteria for thyroid nodules and facilitate the communication between different physicians.However,there is some overlap in the judgment of atypical benign and malignant.With the emergence of new ultrasound technologies,such as contrast-enhanced ultrasound and elastography,nodules can be described and diagnosed in many aspects,which constitute the multi-mode ultrasound and play a complementary role for two-dimensional ultrasound.Contrast-enhanced ultrasound can more accurately display the perfusion of the microvascular level and enhance the blood flow imagines by injecting ultrasound contrast agent intravenously.According to the different pathogenesis of benign and malignant microvessels,the purpose of diagnosis can be achieved.It is generally acknowledged that benign nodules are soft and malignant nodules are hard,and shear wave elastography is used to evaluate the hardness of nodules and diagnosis.Multi-mode ultrasonography is consists of two or more ultrasonography methods for multi-angle analysis,so as to improve the differential diagnosis of benign and malignant thyroid nodules,and has been well recognized by many studies.The first part The Applicational Value of Contrast-enhanced Ultrasound Score in 2017 ACR TI-RADS StratificationObjective:To explore the value of contrast-enhanced ultrasound(CEUS)score in ACR TI-RADS stratification in differentiating thyroid benign and malignant nodules.Methods:223 thyroid nodules confirmed by pathology from surgery or biopsy were retrospectively analyzed.All nodules have two-dimensional ultrasound and contrast-enhanced data.ACR TI-RADS score and CEUS score were obtained for each nodule,and nodules were divide into ?1cm and <1cm two groups,meanwhile,according to ACR TI-RADS stratification,nodules ?1cm were divided into FNA and the follow-up group.CEUS score were combined for all groups,analyzed the application value of CEUS score in ACR TI-RADS stratification.Results:For nodules that in ?1cm group,the optimal diagnostic point of A CR TI-RADS and CEUS score were 6 points and 3 points.The area u nder curve of ROC of ACR TI-RADS that combined CEUS score was0.932(95%CI:0.875-0.968),larger than single use,differences were statist ically significant(P<0.05).The unnecessary biopsy rate of FNA group is26.3%,and the unnecessary FNA rate was 3.8% after combined CEUS score,showed statistically significant difference(P<0.05).For nodules th at in <1cm group,the optimal diagnostic point of ACR TI-RADS strat ification and CEUS score were 7 points and 3 points.The area under c urve of ROC of TI-RADS system combined CEUS score was 0.896(95%CI:0.814-0.951),larger than the area under curve of ROC of ACR TI-RADS,difference was statistically significant(P<0.05),no significant difference was found when compared with CEUS score(P>0.05).Conclusion:ACR TI-RADS stratification showed certain value in differentiating benign and malignant thyroid nodules,CEUS score had effectively improved the diagnostic performance and reduced the rate of biopsy for ACR TI-RADS stratification.The second part The Diagnosis Value of Multimodel Ultrasound in Diagnosing Thyroid Benign and malignant NodulesObjective:To explore the value of multimodel ultrasound consisted of TI-RADS,CEUS and SWE in differentiating thyroid benign and malignant nodules.Method:Retrospect analysis of 194 thyroid nodules confirmed by pathological,all nodules had complete two-dimensional ultrasound,CEUS and SWE data.TI-RADS,PI ratio(nodule divide perinodule area)and SWE-mean were obtain for each nodule.Result:ROC curve showed that the optimal diagnostic of TI-RADS,PI ratio and SWE were 6 point,0.88 and 43.4Kpa,area under the curve were 0.859,0.819,0.842,no significant differences were found between them(P>0.05),area under the curve of multimodel ultrasound was 0.948,larger than TI-RADS,CEUS and SWE(P<0.05).Conclusion:Multimodel ultrasound supplied a new method for diagnosing thyroid nodules,and had a important value.