Discuss The Diagnostic Value Of Multimodal Ultrasound In Thyroid Solid Nodules

Objective:Through the application of conventional ultrasound,shear wave elastography（SWE）and contrast-enhanced ultrasound（CEUS）,the most sensitive indicators of thyroid nodules were analyzed,which provided more comprehensive information for the differential diagnosis of thyroid solid nodules,and explored the diagnostic value of multimodal ultrasound for benign and malignant thyroid solid nodules.Methods:（1）A total of 122 patients with thyroid solid nodules（122 nodules in total）who were treated in our hospital were enrolled from November 2021 to May 2022.The conventional ultrasound,SWE and CEUS images were prospectively analysis and follow-up to obtain postoperative/biopsy pathological results.According to the pathological results,they were divided into benign group and malignant group.（2）Conventional ultrasound:Observe the five indicators of nodule composition,echogenicity,shape,margin,and echogenic focal.Classification was performed according to the Thyroid Imaging Reporting and Data System（TI-RADS）released by the American College of Radiology（ACR）in 2017;SWE examination:Young’s modulus values including maximum,minimum,mean and standard deviation of nodules and 1mm Shell around nodules were obtained.CEUS examination:Observe the contrast perfusion of nodules,record relevant qualitative indicators,and obtain relevant quantitative parameters after analysis by external perfusion quantitative analysis software Vue Box^?.（3）The ROC curve of each parameter of benign and malignant thyroid nodules was constructed with pathological results as the gold standard,and the area under the curve was calculated and the optimal cut-off value was determined.The best one to evaluate the efficacy of thyroid nodules were combined between ACR TI-RADS classification,CEUS（including qualitative indicators and quantitative parameters）and SWE parameters.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of single diagnosis and combined diagnosis of thyroid carcinoma were calculated.Results:（1）Conventional ultrasound results:ACR TI-RADS classification of type 3nodules 20,type 4 nodules 62,type 5 nodules 40.（2）SWE results:There were significant differences in the maximum elasticity,mean value and standard deviation of nodules and1mm Shell around nodules（P<0.05）,and the parameters of malignant group were higher than those of benign group.（3）CEUS results:There were statistically significant differences in the qualitative indicators between the benign and malignant groups of thyroid solid nodules（P<0.05）.When the nodules showed centripetal,uneven low enhancement,late enter,and early regression,it was malignant,and vice versa.Compared with the benign group,the peak enhancement（PE）,the wash-in rate（Wi R）,wash-out rate（Wo R）,wash-in area under the curve（Wi AUC）,wash-in perfusion index（Wi PI）,wash-out area under the curve（Wo AUC）,wash-in and wash-out area under the curve（Wi Wo AUC）of the malignant group decreased,and the difference was statistically significant（P<0.05）.（4）Multimodal ultrasound results:ACR TI-RADS 5,1mm Shell maximum elasticity,low enhancement and peak enhancement were included in the regression equation.The combined diagnosis showed the best efficiency in diagnosis of benign and malignant thyroid solid nodules,with an area under the curve of0.938（ACR TI-RADS 5 is 0.787,1mm Shell maximum elasticity is 0.761,low enhancement is 0.766,PE is 0.716,P<0.05）,and the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of 96.30%,79.41%,86.89%,78.79%and 96.43%,respectively.Conclusion:The independent use of ACR TI-RADS classification system,SWE or CEUS has certain value in evaluating the benign and malignant thyroid solid nodules,but there are still some shortcomings.Multimodal ultrasound could integrate the sensitive indicators of a single examination and effectively improve the diagnostic value of differentiating the nature of thyroid nodules.