Clinical Studies Of Real-time Gray Scale Ultrasound Imaging Of Thyroid Nodules

PartⅠThe Research of Thyroid Nodules by Using Real-time Gray Contrast-enhanced Ultrasound Purpose1.To observe the enhancement pattern and time-intensity curve of thyroid nodules by using contrast-enhanced ultrasound,and compare with conventional ultrasound.2.To assess the value of contrast-enhanced ultrasound in differentiating thyroid benign and malignant nodule.Material and methodsNinety-five patients scheduled for surgical removal of the nodule were evaluated with real-time gray-scale contrast-enhanced ultrasound under a low mechanical index.The microbubble contrast agent was Sono Vue.Of the 104 lesions,53 lesions were benign,51 were malignant.The enhancement of the thyroid nodules were characterized from five aspects, including margin,shape,level,orientation and the proportion of enhancement.There are five patterns of enhancement,including non,homogenous,heterogeneous, regional and rim-like enhancement.Analyzing the off-line dynamic images to create the Time-intensity curves in different parts of the thyroid nodules.To analyze the enhancement findings of thyroid nodules with repect to the histological results.To compare time-intensity curves of different parts of the nodule and between benign and malignant nodules.In addition,the sensitivity,specificity,PPV(positive predictive value),NPV(negative predictive value) of the contrast-enhancement ultrasound were calculated and compared with conventional ultrasound.Results1.Unclear enhancement-margin was suggestive of malignant with a sensitivity/specificity/PPV/NPV of 47%/87%/77%/63%.2.Irregular enhancement-shape was suggestive of malignant with a sensitivity/specificity/PPV/NPV of 55%/94%/90%/68%.3.Enhancement-proportion＞50%was suggestive of malignant with a sensitivity/specificity/PPV/NPV of 84%/42%/58%/73%.4.Centripetal and Centrifugal enhancement was suggestive of malignant with a sensitivity/specificity/PPV/NPV of 61%/77%/72%/67%.5.heterogeneous enhancement was suggestive of malignant with a sensitivity/specificity/PPV/NPV of 31%/98%/94%/60%.6.Region enhancement was suggestive of malignant with a sensitivity/specificity/PPV/NPV of 57%/94%/91%/69%.7.Rim-like enhancement was suggestive of benign with a sensitivity/specificity/PPV/NPV of 83%/94%/94%/83%.8.Multiphase and irregular wash-out was suggestive of malignant with a sensitivity/specificity/PPV/NPV of 62%/94%/94%/79%.9.The baseline intensity signal was lower and the rising time was shorter in malignant than in benign nodule.The rate of rising of intensity signal in the parenchyma around malignant nodule was greater than in benign.10.With a sensitivity of 98.0%and a specificity of 96.2%,contrast-enhanced ultrasound combining conventional ultrasound is superior to conventional ultrasound.ConclusionsContrast-enhanced ultrasound is of great value in diagnosing and differentiating thyroid nodules.Combining conventional ultrasound with contrast-enhanced ultrasound is superior to conventional ultrasound. PartⅡExpression of CD34,CD105,VEGF,CK19 and Ki67 in thyroid nodules and correlation with Contrast-enhanced Ultrasound findings PurposeTo assess the correlation between the quantitative and qualitative imaging findings on contrast-enhanced ultrasound images and the intensity of CD34,CD105, VEGF,CK19 and Ki67 expression in thyroid nodules.Material and methodsSixty-two patients with 62 nodules were evaluated with real-time gray-scale contrast-enhanced ultrasound under a low mechanical index.The microbubble contrast agent was Sono Vue.Of the 62 lesions,30 lesions were thyroid papillary carcinoma,51were goiter,4 were adenoma,1 was Hashimoto's thyroiditis.The paraffined specimens were selected for immunohistochemical staining for CD34, CD105,VEGF,CK19 and Ki67.Comparing the intensity of CD34,CD105,VEGF, CK19 and Ki67 expression between the benign and malignant nodules,correlating them with the characters and patterns of the enhancement of the thyroid nodules.ResultsHigher MVD and VEGF expression was noted in thyroid papillary carcinoma than benign nodules.Angiogenesis is more heterogeneous in malignant than benign nodules,MVD of the margin of the lesions is higher than center.CD105 is superior than CD34 in labeling the tumor newly formed vessel.Positive correlations have been found in CD34 and unclear enhancing margin, irregular enhancing shape,centreipetal and centrifugal enhancement and reigional enhancement.No correlation was found between CD105 and the findings of the enhancement.Positive correlations have been found in VEGF and unclear enhancing margin,irregular enhancing shape,centreipetal and centrifugal enhancement,a negative correlation has been found between VEGF and rim-like enhancement.The difference of CD34 between the margin and center is positively correlated with the rising rate of the margin and multi-phase and irregular wash-out.Negative correlations have been found in VEGF and arrival time,peak time, rising time of nodule and around parenchyma.Positive correlations have been found between VEGF and rising rate,multi-phase and irregular wash-out of nodule.Positive correlations have been found in CK19 and unclear enhancing margin, irregular enhancing shape,centreipetal and centrifugal enhancement and heterogeneous enhancement.Negtive correlations have been found in CK19 and homogeneous enhancement and rim-like enhancement.Conclusion1.MVD and VEGF expression was noted higher in thyroid papillary carcinoma than benign nodules.2.Contrast-enhanced ultrasound is of great value in assessing angiogenesis in thyroid nodules.There are correlations between MVD,VEGF和CK19 and contrast enhanced ultrasound findings.