| 1. Purpose:(1) To research,analyze,and compare the diagnostic methods for Hashimoto’s Thyroiditis (HT) at this stage.(2)To investigate the features of ultrasonic echogenicity and color doppler flow imaging(CDFI) for HT patients.(3) To assess the performance of Grey-Scale Intensity(GSI) in diagnosis of Hashimoto’s Thyroiditis (HT).2. Materials and Methods:(1)Object of Study:1.55 patients from January 2012 to June 2014, who were diagnosed with hashimoto’s thyroiditis(HT) at the Second Hospital of Shanong University enrolled in HT group. The standard of into group:A. Significantly higher TPOAb and TgAb of serum with increased thyroid volum.Reference value for TPOAb:0.00-4.6 IU/ML, reference value for TgAb: 0.00-35.00 IU/ML.B. Diagnosis after fine needle aspiration cytology or postoperative pathology;C. Grey-Scale ultrasonic image shows diffuse changes of thyroid in both Aand B, and exclusion of thyroid nodules, cysts or mass are essential.Of all these patients, ultrasonography and color Doppler flow imaging were underwented.And then grey-scale intensity quantitative analysis was performed. All data were collected by retrospective chart review. 11.50 healthy person were included in this study as contrast group for grey-scale intensity quantitative analysis,no patients with throid nodules, cysts or masses were enrolled in this group.(2)Equipment and Methods Ⅰ. Equipmenta.GE LOGIQ E9 for ultrasonography and color Doppler flow imaging(CDFI),Linear transducer 9L with frequency from 5.5 to 10 MHZ.Preset of thyroid and 9MHZ for ransducer were chosen for echogenicity exam, and with depth in 4.5cm,gain in 50db,TGC buttons were set in line.For color Doppler flow imaging(CDFI),9MHZ thansducer,4.5cm depth(the same as for echogenicity exam),and 50db for color gain,10 cm/s～-10cm/s for pulse repetition frequency(PRF).b.GE LOGIQ E9 with built-in intensity technique for Grey-Scale Intensity quantitative evaluation.Keep scanning conditions consistent with echogenicity exam.c. Serum drops of TPOAb and TgAb were measured by Access immunoassay system and accessory kits of BECKMAN COULTER company, usingchemiluminescence immunoassay method.Ⅱ. Examination Methods:A.Ultrasonography:The patients were positioned in supine position with dorsal flexion of the head.Thyroid were first underwent by B mode Gray-Scale to get the volum and echogenicity,then color Doppler flow imaging was performed to observe the vascular density and then recorded the flow grades. While the length of a side lobe≥55mm、width≥20mm、thickness≥20 mm、thickness of isthmus≥5 mm,respectively,we regarded it as increased;while the length of a side lobe< 40mm, we regarded it as decreased. Thyroid echogenicity was graded under grading system created by Sostre and Reyes as follows:G1:Diffusely enlarged gland with a normoechoic (similar to normal tissue) pattern;G2:Multiple hypoechoic foci or patches scattered throughout an otherwise normoechoic gland; a pattern suggestive of focal rather than diffuse involvement;G3:Enlarged gland with diffuse but mild hypoechogenicity;G4:Enlarged gland with diffuse and marked hypoechogenicity.The vascular density of thyroid was graded into four levels(0,Ⅰ, Ⅱ,Ⅲ).Grade0(G0):no blood flow in thyroid parenchyma,color blood flow can only be visible in larger vascular branchs,which is normal thyroid blood flow.Grade Ⅰ (G Ⅰ):dot, strips and small patchy color signals, no fusion, color area is less than 1/3 of the thyroid gland area;Grade Ⅱ (GⅡ):patchy color signals spreading within the thyroid parenchyma, and partly integrated into large color Mosaic shape, color area is about 1/3-1/2 of thyroid area;GradeⅢ(GⅢ):the thyroid is full of color blood flow signals, colorful Mosaic shape into large fusion, color area is greater than the2/3 of the thyroid gland. The propotion of above grades between HT and control groups were comparedrespectively.B.GSI Value:On transverse section with both thyroid cross-section and Sternocleidomastoid muscle shown together,Grey-scale quantitative evaluation involved targeting of an anatomic region to be interrogated for intensity property with a region of interest(ROI).Activate the Intensity button to draw a ROC on both left and right side of thyroid,with the ROC greater than 1/2 of the thyroid showed on screen,so does the isthmus part on transverse, and ROC of isthmus was within the two side walls of trachea;The same ROC was measured five times respectively,and average values were recorded.(3) Statistical AnalysisStatistical analysis was performed by SPSS version 17.0. The results of measured values were recorded in the format of mean size ± SD. p< 0.05 was considered statistically significant, and p< 0.001 was considered highly statistically significant. ROC analysis was used to analysis the diagnostic value of GSI for HT.3. Results:(1) Sizes:During the group with Hashimoto’s Thyroiditis (HT),16.36% of 55 patients had normal thyroid sizes(9/55),76.36% with increased sizes(42/55),7.27% with smaller (atrophy) sizes(4/55).39 cases with normal size in the control group, accounting for 78%%(39/50); 6 increased sizes,12%(6/50); 5 smaller sizes,10% (5/50). Compared the propotion between HT and control group with thyroid isthmus thickness, width, thickness and length, t values were:2.7002,2.666,4.4899, 5.3425, respectively, p values were as follows:0.0081,0.0089,0.0000,0.0000, p<0.05. There were statistically significant differences in longitude between those two groups, thyroid enlargement of the HT group constituting the majority.(2)Echogenicity:The results of HT group were as followes:G1(2/55,3.63%), G2(13/55,23.63%), G3(32/55,58.18%),G4(8/55,14.54%); and those results in control group were: G136/50,72%),G29/50,18%),G3(5/50,58.18%),G4(0/50,0).There were statistically significant differences in echogenicity between two groups above(X2=42.812, p=0.000). Hypoechogenicity in the HT group constituting the majority, mainly G3 levels.(3)Color Doppler Flow Grades:The results of grades based on color flow density in HT group were: G0(4/55,7.27%),G Ⅰ(10/55,18.18%),GⅡ (25/55,45.45%),GⅢ (16/55,29.09%); and the results of control group were:G0(28/50,56.0%),G Ⅰ (16/50,32.0%), GⅡ (6/50,12.0%),GⅢ (0/50,0).There were statistically significant differences in color flow density grades between two groups X2=46.898. p=0.000).Increased color flow density constituting the majority in HT group,mainly including GⅡ and GⅢ.(4) GSI values:The GSI minimum and maximum value were -40.7 DB and -30.5 DB in HT group,and those were -33.1 DB,-29.1 DB in control group.The average GSI values of throid right lobe,left lobe and isthmus were-31.95±7.89 DB,-31.89±7.48 DB,-31.99±7.94 DB in HT group and -29.22±6.12 DB,-30.01±6.12 DB,-30.08±6.25 DB in control group,respectively. There were statistically significant differences in GSI values between two groups, t values were:2.0523,2.164,1.9876, p values were 0.0427,0.0342,0.0495, respectively.(5) ROC curve: Receiver operator characteristic (ROC) analysis was used to assess overall confidence in the diagnosis of HT by GSI. According to the ROC curve, the largest area under the curve is 0.870, chose Youden index (sensitivity+specificity-1) as the dignosis critical point, GSI value of -31.55 DB was the point, and the corresponding sensitivity, specificity and accuracy were 85.5%、72.0% and 80.0%, respectively. The average GSI values were lower in HT group than control group.4. Conclusions:(1).HT patients have increased thyroid volume compared with normal control group, especially characterized by thickening of the isthmus, HT patients who has extensive fibrosis in thyroid,the volume can be reduced.(2). Hypoechogenicity of thyroid in HT group was the salient features,it may be associated with higher strip-like echogenicity.Focal hypoechoic, Leopard-like and diffuse hypoechoic may shown according to the different levels of progression.(3). Increased blood flow density constituting the majority in patients with HT,in early or later stages of HT (gland atrophy), blood flow can be normal or reduced.(4). The ultrasonic gray-scale intensity (GSI) quantitative analysis had significant differences between HT and normal groups, GSI quantitative analysis could provide a new assistant way for diagnosis of Hashimoto’s Thyroiditis and with high clinical values.(5).ROC curves showed that GSI at -31.55DB, its sensitivity and specificity of diagnosis for HT were the best. |
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