Clinical Study Of Ultramicrovascular Imaging In Thyroid Nodules

Objective:To evaluate whether Superb micro-vascularimaging(SMI)is superior to power Doppler flow imaging(PDFI)and color Doppler flow imaging(CDFI)indepicting thyroid nodular vascularity.To explore the diagnostic performance ofdifferent vascularity pattern in the diagnosis of malignant thyroid nodules.Methods:Fifty resident patients(male-to-female ratio was 23:27;median age,44 years,range 26-75 years)with 58 nodules for surgery were included in the study.Twenty-seven nodules were benign,and 31 nodules were malignant.The capacityof SMI、PDFI and CDFIto detect vascular features of nodules was compared to determine the superior one on diagnosing malignancy.vascularity pattern was classified as none,only peripheral,mixed-predominantlyperipheral,mixed-predominantly central,and only intra-nodular.Criteria including central vessel,predominantly central vessel and only central vessel were used to determine which is the best criterion.Intra-nodular vessel’s features including irregular distribution,a large penetratingvessel,winding vessel,irregular branch,grading of blood flow volume,the angle and depth of penetratingvessels were included.Results:Malignant signs including type Ⅲ pattern,irregulardistribution,distorted vessel,abnormal branching.There was no significant difference in blood volume and penetrating angle and depth between benign and malignant groups.But the fourth grad volume and a single large penetrating vessel were only seen in the malignancy.Only central vascularity was the best for determining cancers.SMI only central vascularity performed96.3%specificity and 77.4%sensitivity,which was superior to PDFI or CDFI(P<0.01).We owe this to the fact that peripheral vessels of many nodules on PDFI/CDFI were actually intense small penetrating vessels around the lesion on SMI.SMI and PDFI showed more flow volume than CDFI.SMI and CDFI performed better on vascular distribution than PDFI.SMI was superior to CDFI and PDFI on showing distorted vessels and abnormal branches.Conclusion:Internal blood flow alonecan be used to diagnose thyroid cancer.SMI shows better than CDFI/PDFI on thyroid nodule vascular characteristics and can be used to differential diagnosis of thyroid nodules.Objective:To detect independent risk factors for thyroid malignancy.To primarily explore the diagnostic performance of vascularity on SMI integrated with gray-scale ultrasonography features in the diagnosis of malignant thyroid nodules.Methods:Ninety-two resident patients(male-to-female ratio was 12:11;median age,42 years,range 20-75 years)with 113 nodules for surgery were included in the study.Thirty-four nodules were benign,and 79 nodules were malignant.Vascularity was classified as none,peripheral,mixed,and intra-nodular.Gray-scale features including calcification,echogenicity,margins,shape and internal components were evaluated.Multivariate logistic regression analysis was used to evaluate the accuracy of SMI combined with gray-scale US for thyroid malignancy.Compare the diagnostic efficacy of different diagnostic criteria and the logistic model.Results:Taller than wide shape,micro-calcification and SMI intra-nodular vascularity were independent risk factors for thyroid malignancy.The area under the ROC curve for the logistic regression model was 0.92,which is higher than any other criterion(p<0.05).Conclusion:A combination of SMI and gray-scale features by logistic analysis performs the best in the diagnosis of thyroid malignancy.Objective:To investigate the expression of Ang1,Ang2 and VEGF in papillary thyroid carcinoma(PTC)and the role of them in angiogenesis of PTC.To explore the relationshipbetween the expression of Angl,Ang2 and VEGF and SMI features.Materials and Methods:Thirty-seven specimens of PTC including 19CPTC and 18FVPTCwere included,20 benign nodulesincluding 6 adenomatous goiters,5 adenomas,9 nodular goiters were included as the control group.All thyroid nodules were examined by SMI before operation and stained with CD34 antibody,Ang1 antibody,Ang2 antibody and VEGF antibody after operation.CD34 marked micro-vessel density(MVD)was counted.The expression levels of Ang1,Ang2 and VEGF in benign and malignant nodules were analyzed.The relationship between the expression of Ang1,Ang2 and VEGFand MVD was analyzed in benign and malignant groups,as well as the relationship of Ang1,Ang2,VEGF and SMI features.Results:The expression of Ang2 and VEGF in papillary thyroid carcinoma was significantly higher than that in benign nodules,while the levelof Ang1was lower.There was a significant positive correlation between MVD and Ang2 in papillary thyroid carcinoma.There was a significant positive correlation between lymph node metastasis and the expression of VEGF in papillary thyroid carcinoma.The sign of tiny vessels running along the edge of PTC was significantly positive correlatedwith the level of Ang2 and the level of Ang2 subtracting Ang1.Abnormal branching was significantly positive correlatedwith the level of Ang2.A single large penetrating vessel was significantly negative correlatedwith the level ofAng2 subtracting Ang1.Conclusion:Ang2 may play a key role in angiogenesis of PTC.The higher the level of VEGF,the more possible of lymphatic metastasis will happen.Ang2 level and the sign of tiny vessels running along the edge were positively correlated,suggesting that the latter was the result of angiogenesis.The negative correlation between the level of Ang2 subtract Angl with single large penetrating vessel,suggesting that the later was more likely to be co-option vessel.The level of Ang2 and Angl was closely related to SMI features.