The Value Of High-frequency Ultrasound With Acoustic Palpation Tissue Imaging And Quantitative Techniques In The Diagnosis Of Mummified Thyroid Nodules

Objective:(1)To investigate the value of various different sonographic features in highfrequency ultrasonography in the diagnosis of thyroid mummification nodules.(2)To explore the application value of different shear wave velocity values(SWV)in acoustic palpation tissue imaging and virtual touch image quantification(VTIQ)techniques in the diagnosis of thyroid mummified nodules.Methods:Patients from August 2020 to December 2021 were employed in this study,which contains thyroid gland mummified nodules as confirmed by fine needle aspiration(FNA)or surgical pathology and pathology verified papillary thyroid carcinoma(PTC)in the second weihai municipal hospital affiliated to Qingdao university.The results of highfrequency ultrasonography and VTIQ technical testing before FNA or preoperatively in each patient were reviewed.The sonographic features of the nodule such as boundary,longitudinal/transverse,internal echogenicity,calcification,presence of acoustic corona,and the internal blood flow condition of the nodule assessed by color doppler flow imaging(CDFI)were recorded in the high-frequency ultrasound findings.Using VTIQ technology,SWV values were measured in the effective area several times,and the maximum(SWV Max),minimum(SWV min),median(SWV median),and mean(SWV mean)were obtained.Meanwhile,ROC curves of the subject operating characteristics were drawn and obtained according to the measured data,so as to obtain the SWV cut-off value,estimate the area under curve(AUC)and speculate the application value of different SWV in the diagnosis of thyroid mummified nodules.Results:(1)A total of 64 patients with thyroid nodules were finally included in this study.Among these,31 cases of mummy nodules and 33 cases of PTC.Among 31 mummy nodules patients,21 cases(67.74%)had clear boundaries,and 10 cases(32.26%)had blurred boundaries;14 cases(45.16%)were longitudinal/transverse>1,17 cases(54.84%)were longitudinal/transverse < 1;12 cases(38.71%)had very low echo,18 cases(58.06%)had low echo,and 1 case(3.23%)had isoechoic or hyperechoic;Speckle calcification was observed in 10 cases(32.26%),eggshell-like calcification was observed in 14 cases(45.16%),and no calcification was observed in 7 cases(22.58%).Black and white double halo signs were observed in 17 cases(54.84%).Blood flow signal could be detected in 8cases(25.81%),and no blood flow signal could be detected in 23 cases(74.19%).Among33 cases of PTC,21 cases(63.64%)had a clear boundary and 12 cases(36.36%)had a fuzzy boundary.18 cases(54.55%)were longitudinal/transverse > 1,and 15 cases(45.45%)were longitudinal/transverse < 1.11 cases(33.33%)had very low echo,20cases(60.61%)had low echo,and 2 cases(6.06%)had isoechoic or hyperechoic.17 cases(51.52%)had spotted calcification,5 cases(15.15%)had eggshell-like calcification,and11 cases(33.33%)had no calcification.Black and white double halo ring sign were observed in 7 cases(21.21%).Blood flow signal was detected in 21 cases(63.64%),and no blood flow signal could be detected in 12 cases(36.36%).Comparing the data between the thyroid mummy nodule group and the PTC group,the corresponding P values in terms of boundary definition,aspect ratio,nodule echo strength,presence or absence of combined calcification and type of combined calcification,black and white double halo sign,and blood flow signal.The values are 0.73,0.453,0.808,0.032,0.005,0.002,respectively.There were significant differences in eggshell-like calcification,black and white bilayer halo sign and internal blood flow in the nodules between the two groups(P<0.05).(2)In the SWV data measured by the VTIQ technique,SWV min,SWV max,SWV median and SWV mean were(2.68±0.21),(2.99±0.21),(2.83±0.21)and(2.83±0.20)respectively in the mummy nodule group.In the PTC group,SWV min,SWV max,SWV median and SWV mean in the control group were(3.02 ±0.31),(3.29±0.24),(3.17±0.27)and(3.16±0.26),respectively.The P values of the four corresponding items were all <0.01.There are significantly differences.The ROC curves corresponded to the following AUCs: 0.835,0.868,0.878,and 0.891.The closer the AUC to 1,the better the diagnostic efficacy,and the ROC curve showed that SWV mean had the highest diagnostic value,with a corresponding cut-off value of 3.005m/s and sensitivities and specificities of90.3% and 84.8%,respectively.Conclusion:(1)The ultrasound features of eggshell-like calcification,black and white double-layered halo sign,and no internal blood flow of the nodule were observed by high-frequency ultrasonography,which provided a strong basis for the diagnosis of mummified thyroid nodules.(2)VTIQ obtained different tissue hardness values by measuring SWV values,which are important in the diagnosis of identifying mummified thyroid nodules or papillary carcinoma.