The Diagnostic Value Of TI-RADS 4 And Real-time Shear-wave Elastography Imaging In Benign And Malignant Thyroid Nodules

Background and ObjectiveUltrasound has become the preferred method for the thyroid examination.Cytological puncture is more valuable for diagnosis of thyroid nodular,but it is a invasive examination technique,which cost more money.However some of them are still need to considered of radiographic assessment.Shear wave elastography(SWE)is more intuitive to show an objective hardness information with the current international most recognized,and it is also the most mature elastic imaging technology form now on.The MicroPure imaging technique improves the display of microcalcifications with higher diagnostic value of thyroid cancer in order to achieve the purpose of providing more information for diagnosis of the thyroid nodules.This study intends to explore whether a part of the TI-RADS4 nodules can be transferred to Level 3 or Level 5 more accurately with the combination of the two technologies.Materials and Methods1.The first part of the study is the collection of the thyroid nodules from June 2016 to December 2016 in our hospital,who performed thyroid ultrasound examination at our department and found 82 patients with a total of 122 cases of nodules,which were included in the Horvath version of TI-RADS grade 4.The results were confirmed by postoperative pathology.The SWE is used to measure the Young's modulus value,and the ROC curve is drawn with the pathological results as the gold standard to determine the best cutoff.2.The second part is the examnation of the 122 cases of nodules,by the two-dimensional and MicroPure imaging technology,to observe whether there is microcalcification in the nodules or not.We need observe the microcalcification whether can be observed by the MicriPure imaging technology under the situation of which can not identify the microcalcification by naked eye.Then make the assessment of thyroid nodules.3.In the last part,we get the reference boundary value for identifying benign and malignant nodules.We turn the nodules down to grade 3 when the nodules meet the standards of SWE determines that the maximum Young's modulus is lower than the boundary value + MicroPure imaging microcalcification-negative nodules;and turn up to grade 5 when they meet the standards of the SWE determines the maximum Young's modulus At the confinement + MicroPure imaging microcalcificationpositive nodules,then the test are unchanged.To investigate whether the combination of shear wave technique and MicroPure imaging technique can improve the accuracy of diagnosis of thyroid TI-RADS4 nodular and reduce the puncture rate.Results:1.122 cases of thyroid nodular lesions,with 71 cases of malignant and 51 cases of benign.The average of the maximum Young's modulus of benign nodules is(39.13 ± 17.78)kPa.The average of maximum Young's modulus of malignant nodules was(79.40 ± 33.76)kPa.Both of them had the maximum Young's modulus Differences were statistically significant by t test,P <0.05.The area under the curve(AUC)was 0.85 with the best cutoff value was 58.67 kPa.2.The detection rate of microcalcification in thyroid nodules by the MicroPure was higher than that in conventional ultrasound(P<0.05).Conventional two-dimensional ultrasonography and MicroPure imaging showed the sensitivity,the specificity,accuracy of microcalcification were 47.9%,58.8%,52.4%;67.6%,58.8%,63.9%.3.According to the modified shear wave imaging technique combined with MicroPure imaging technique,eighty-four cases of thyroid TI-RADS grade 4 nodules were diagnosed.Forty-three cases of SWE Young's modulus greater than the boundary value + MicroPure imaging microcalcification positive 31 cases,of which 30 cases were malignant;SWE Young's modulus of the maximum value of less than the boundary value + MicroPure imaging microcalcification negative in 29 cases,of which 26 cases were benign.Conclusion:1.SWE imaging technique can quantitatively evaluate the hardness of nodular lesions by Young's modulus,and the resulting Young's modulus cut-off contribute to further judgment of thyroid nodules.2.MicroPure imaging technology have a better display of microcalcification than by two-dimensional ultrasound,and it can provide more information to the evaluation of thyroid nodules.3.The combination of the two technologies can be successful to determine the nature of the TI-RADS grade 4 nodules with a higher accuracy.