Clinical Application Of Ultrasound Elastography In The Diagnosis And Treatment Of Subacute Thyroiditis

Part One: The value of ultrasound elastography in the diagnosis ofsubacute thyroiditisObjective: To explore the application value of ultrasound elastography in the diagnosis ofsubacute thyroiditis.Materials and methods: Select63patients with suspected SAT (which diagnosed by clinic andpathology of54patients with SAT or SAT group, non SAT patients of9cases) and20patientswithout thyroid pathology(group control), both conventional gray-scale sonography andcolor Doppler were performed first for all selected thyroid, including:size, shape, innerechogenicity, the pattern of blood flow. The clinical diagnosis and pathology results as thestandard, build the ROC curve separately using two-dimensional ultrasound andtwo-dimensional ultrasound elastography in the diagnosis of SAT, to compare thediagnostic efficacy of two methods. the elasticity scale was obtained both in SAT groupand control group by means of sonoelastography, discuss the differenc between them.TheB-mode and the elastogramme of lesions were displayed side-by-side on the screen. Thenmeasured the areas of lesions in both images using calipers, statistical analysis wasperformed with the two methods. Appling the technique of virtual touch tissuequantification derived from acoustic radiation force impulse imaging to measure thestiffness of thyroid tissue in54SAT patients and20healthy person quantitatively,whichdescribed as shear wave velcocity(SWV), then, data was analysis between SAT group andcontrol group. The clinical diagnosis and pathology results as the standard, build the ROCcurve VTQ quantitative detection of SAT, to find appropriate cut-off point.Results: 1. The clinical diagnosis and pathology results as the standard, making ROC curve,obtained two-dimensional ultrasound diagnosis of SAT area under the curve is0.775, thesensitivity is0.882, specificity is0.667, area combined with ultrasonic elastography in thediagnosis of SAT curve was0.897, the sensitivity is0.906, specificity is0.889.2. The clinical diagnosis and pathology results as the standard, making ROC curve of VTQquantitative detection of SAT, the area under the curve is0.908, the optimal cut-off point:3.485m/s, the sensitivity is0.918, specificity is0.833.3.Normal thyroid ultrasound elasticity imaging figure is main green. control thyroid elasticgraph, Ⅰ level31, Ⅱ level9. SAT ultrasound elasticity imaging figure is main blue. in54cases altogether85SAT early lesion,55lesions was rated grade elastic Ⅲ,28lesions wasrated grade Ⅳ,2lesions was rated grade Ⅱ, which has a statistical difference (P <0.0001).4. Two-dimensional ultrasound showed the lesion size range of0.42~4.20cm2, theaverage area was (1.35±0.90) cm2, elasticity imaging shows the lesion size is0.49~4.57cm2, the average area was (1.77±0.91) cm2, elasticity imaging shows bigger thantwo-dimensional ultrasound image shows the focus of the area, the focus of the differencewas statistically significant (t=2.29, P <0.05).5. For the control group of normal SWV average (1.88±0.16) m/s (0.98~2.78m/s), theSAT group of SWV average was4.45±1.06m/s (2.75~9.00m/s), the two comparativedifference was statistically significant (t=15.7, P <0.01).Conclusion:1.SAT early lesion elastic class more focused on Ⅲ-Ⅳ, show that the hardness SAT inpatients with thyroid tissue generally increased;2.Ultrasound elasticity imaging more accurately than two-dimensional ultrasound imagingcan show the actual SAT the scope and size of lesions and more truly reflect thepathological changes of evolution;3. ARFI elasticity imaging VTQ technology can quantitatively reflect the characteristics ofthe elasticity of the SAT, with3.485m/s as the cut-off point, can obtain better diagnosticresults; 4. ultrasound elastograph combined with two-dimensional ultrasonography is better thanthe single use of two-dimensional ultrasound in the diagnosis of SAT, the combination ofthem can improve the diagnosis efficiency.Part Two: Clinical study of ultrasound elastography to evaluate thetherapeutic effects of subacute thyroiditisObjective: By analyzing the whole elastographic image of subacute thyroiditis in thetherapy process,the aim of this study was to explore the value of ultrasound elastographyin the treatment and effectiveness of subacute thyroiditis.Materials and methods:54confirmed clinically-SAT Patients were divided into twosubgroups randomly (elasticity group:27patients with45lesions, application of ultrasoundelasticity imaging follow-up effect; clinic group:27patients with40lesions, follow-upcurative effect according to the clinical manifestation and laboratory examination results),each patient was given Prednisone Acetate (chen xin pharmaceutical incorporatedcompany, Approval number: H37021900)30mg/d for the first time,10mg tid, fordetermining the decline or discontinue of corticosteroid, two groups ad different criterias,elastic group was determined according to elastogrammes, while clinic group wasdetermined according to symptoms and lab indicators, finally, comparing the effectivenessand prognosis of two groups. The software package SPSS13.0was used for statistical dataanalysis.Results:1. Elastic group were45, cure43, recurrence2;Clinical groups were40, cure31, relapse9,is similar between the two groups was statistically significant (P <0.05),2. To observe the lesion in the acute stage, medium, the recovery period of different courseperiod the grade of blood flow increased; in the elastic stage Ⅰ, Ⅱshowed an increasingtrend, Ⅲ, Ⅳshowed a decreasing trend; SWV value which is decreased, the difference wasstatistically significant (P <0.05).Conclusion:Application of ultrasound elasticity imaging guide clinical use of prednisone treatment SAT the cure rate of medicine according to clinical symptoms guidance is significantlyhigher than the control group cure rate, and the recurrence rate is lower than the controlgroup obviously; Elastic ultrasonic image SAT lesion were showed with the course of theevolution of the hardness decreased, Proposed when lesion ultrasound elasticity imagingpicture (a grade III or IV lesions) start reducing about down to50%primary lesions, whenlesions disappeared, elastic rendering is green hints drug can be given to stop.