| Thyroid nodule is a common clinical disease,and its detection rate is increasing year by year.As the characteristics of the nodules are different,the clinical treatment methods are different.Ultrasound is the first choice of imaging method for thyroid examination,and whether it can diagnose the nodules correctly,is important for the reduction of excessive examination and treatment.Thyroid imaging reporting and data system(TI-RADS),a comprehensive imaging system of multiple benign and malignant nodules,is widely applied in ultrasound field and surgery.It plays a good role in the evaluation of benign and malignant nodules..In the TI-RADS system,the 3 and 4 grade nodules are at the junction of benign and malignant nodules.The higher or lower grading of them will affect the clinical diagnosis and treatment plan.Therefore,how to identify exactly nodules between TI-RADS 3 and 4 grade is particularly important.Based on the conventional two-dimensional ultrasound,we combined the application together of ultrasound Micro Pure imaging and monochrome super micro vascular imaging(m SMI),and explored the usage combination of them in differential diagnosis of TI-RADS3 and grade 4 nodules.This study collected 286 nodules of patients with TI-RADS grade 3 and 4 who underwent conventional ultrasound examination at the First Affiliated Hospital of Hebei North University from December 2015 to September 2017.Ultrasound Micro Pure imaging,color doppler flow imaging(CDFI)and m SMI were used to observe the micro-calcification,blood flow distribution and blood vessels in all nodules.The ultrasound findings were recorded.Ultrasound-guidedsurgical pathology,ultrasound-guided fine-needle aspiration biopsy(US-FNAB)and short-term follow-up results were used as the gold standard.SPSS 17.0 software was used for statistical analysis.Chi-square test was used to compare the two groups.conventional two-dimensional ultrasound and Micro Pure imaging were used to evaluate the nodular micro-calcification and CDFI and m SMI classification and classification of benign and malignant nodules using the diagnostic value of the ROC curve are used;using sensitivity,specificity,accuracy compared with ultrasound Micro Pure imaging technology m SMI TI-RADS3 and 4 grade nodules differential diagnosis parallel Kappa Consistency check,and P<0.05 was considered as statistically significant.The results of this study showed that:(1)286 thyroid nodules were confirmed by surgical pathology,US-FNAB and short-term follow-up results,75 were malignant and 211 were benign;(2)The Micro Pure system showed a higher testing capability compare to grey-scale ultrasonography in thyroid nodules micro-calcification(3)The grading results of CDFI and m SMIshowed that m SMI could detect the low-speed blood flow that CDFI can not show in the nodules.There was a statistically significant difference between the two groups(P<0.05).There was no significant difference in Adler blood flow classification between benign and malignant thyroid nodules in CDFI and m SMI models(P>0.05).(4)According to the results of CDFI and m SMI,Benign thyroid nodules are more common in mixed blood flow,malignant nodules with internal blood flow-based,the two nodular nature of the differential diagnosis value,the area under the ROC curvewere AUCCDFI=0.564±0.058(95%CI0.451~0.678),AUCm SMI=0.651±0.057(95%CI0.539~0.672),thedifferencewasstatistically significant(P<0.05);(5)In the differential diagnosis of TI-RADS grade 3 and 4 nodules with m SMI technique,(1)the TI-RADS grade 3 is a benign nodule and the TI-RADS grade 4 is a malignant nodule with increased risk.TI-RADS Level 3 and 4 nodal differential diagnosis: conventionaltwo-dimensional ultrasound combined with ultrasound Micro Pure imaging and m SMI technology compared with conventional two-dimensional ultrasound alone,the former increased sensitivity,and the difference was statistically significant(P<0.05).In pathological?US-FNAB and short-term follow-up as the gold standard tests of consistency check,the consistency of Micro Pure system with ultrasonographycombined with m SMI is better than which of two-dimensional ultrasound or conventional two-dimensional ultrasound combined with ultrasound Micro Pure imaging(Kappa2D-US+Micro Pure+m SMI=0.464;Kappa2D-US=0.316;Kappa2D-US+Micro Pure=0.311);(2)the TI-RADS 3+4a grade as benign nodules and TI-RADS 4b+4c grade as malignant nodules,The combination of the two in the classification of TI-RADS grade 4 thyroid nodules benign and malignant: Conventional two-dimensional ultrasound combined with ultrasound Micro Pure imaging and m SMI technology compared with conventional two-dimensional ultrasound alone compared the former sensitivity and accuracy,The difference was statistically significant(P<0.05);In pathological?US-FNAB and short-term follow-up as the gold standard tests of consistency check,the consistency of Micro Pure system with ultrasonography combined with m SMI is better than which of two-dimensional ultrasound or conventional two-dimensional ultrasound combined with ultrasound Micro Pure imaging(Kappa2D-US+Micro Pure+m SMI =0.695;Kappa2D-US=0.466;Kappa2D-US + Micro Pure =0.638).In summary,The Micro Pure system showed a higher testing capability compareto grey-scale ultrasonography in thyroid nodules micro–calcifications,contribute to the qualitative diagnosis of nodules;m SMI can be more clearly visualized microvascular morphology,walking,Distribution and other conditions,the blood flow typing of benign and malignant thyroid nodules have some value;Combining Micro Pure system and m SMI can improve the discreminability of TI-RADS3?4 class thyroid nodules,for the clinical diagnosis of the patient's condition Assessment and treatment methods to provide accurate imaging information. |
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