Contrast-enhanced Ultrasound And Elastography In The Study Of Benign And Malignant Thyroid Nodules Of TI-RADS Type 4

Part Ⅰ Diagnostic Value of CEUS Score Combined with Elastography in TIRADS Type 4 Thyroid NodulesObjective:The purpose of this study was to investigate whether the combined application of CEUS score and elastography can improve the diagnostic ability of thyroid imaging reporting and data system(TI-RADS)type 4 thyroid nodules.Methods:Sixty-two patients with TI-RADS type 4 thyroid nodules were studied by conventional ultrasound.CEUS,real-time elastography(RTE)and virtual touch tissue imaging quantification(VTIQ)techniques were performed before surgery and shear wave velocity(SWV)was obtained.Using the pathological results as the gold standard,draw the receiver operating characteristic curve(ROC)and compare the area under the curve(AUC)to evaluate the single and combined application of the three methods for the diagnosis of TI-RADS type 4 nodules.Results:1.62 patients with 66 thyroid nodules,45 malignant and 21 benign.2.When CEUS score is used to diagnose TI-RADS type 4 malignant thyroid nodules,it is divided into 4 as the best cut-off point,and its sensitivity,specificity and accuracy are 86.7%,81.0% and 84.8%,respectively.3.The sensitivity,specificity and accuracy of RTE diagnosis of TI-RADS type 4 malignant thyroid nodules were 84.4%,81.0% and 83.3%,respectively.4.In the VTIQ technology,the average SWV 2.70m/s is the best cut-off value,and the sensitivity,specificity and accuracy of diagnosis of TI-RADS type 4malignant thyroid nodules are 80.0%,85.7% and 81.8%,respectively.5.The sensitivity,specificity and accuracy of the combined diagnosis of the three methods were 93.3%,85.7% and 90.9%,respectively.6.The AUC of the combined method,CEUS score,VTIQ technology and RTE are 0.952,0.874,0.847 and 0.800,respectively.The AUC of the combined method is the largest,its sensitivity and accuracy are higher than the single method,and the difference is statistically significant(all p<0.05).Conclusion:The combined application of CEUS score,RTE and VTIQ technology can significantly improve the judgment of the nature of TI-RADS type 4thyroid nodules,in order to make an early diagnosis of malignant nodules.Part Ⅱ Application of Quantitative Analysis of Contrast-enhanced Ultrasound in TI-RADS Type 4 Thyroid NodulesObjective:By analyzing the characteristics of various quantitative parameters of TI-RADS type 4 thyroid nodules,the application value of ultrasound contrast quantitative analysis in thyroid nodules was evaluated.Methods:Sixty-two patients(66 nodules)with TI-RADS type 4 thyroid nodules diagnosed by conventional ultrasound were selected as the research subjects,and all pathological results were used as controls.Contrast-enhanced ultrasound was performed before operation.Dynamic images were stored and processed using contrast analysis software.The central area,marginal area,and glandular area of the same depth as the nodule were manually delineated.Measure quantitative parameters of time-intensity curve(TIC),including peak intensity(PI),area under the curve(AUC),time to peak(TP),and mean transit time(MTT).The parameters of the same part were measured three times and the average value was taken.And then analyze the TIC characteristics of each area.Results:Compared with benign and malignant thyroid nodules,the central area of malignant nodules has lower PI and prolonged TP,the difference is statistically significant(P<0.05).When PI and TP are used as diagnostic criteria,the area under the curve of TP is 0.733(95% CI: 0.610 ~ 0.835),the optimal cutoff value is 25.99 s,the sensitivity is 76%,and the specificity is 67%.Malignant nodules the PI in the marginal zone is low,TP and MTT are prolonged,the difference is statistically significant(P<0.05).When PI,TP and MTT are used as diagnostic criteria,the maximum area under the curve of TP is 0.769(95% CI: 0.649 ~ 0.864),the best cut-off value is24.16 s,sensitive the degree is 76% and the specificity is 71%.PI in the central area of malignant nodules is less than that in the marginal areas,TP is prolonged,and the difference is statistically significant(P<0.05).In benign nodules,PI in the central area of thyroid adenoma is less than marginal area,TP is prolonged,and AUC is higher than marginal area(P<0.05).The marginal area of nodular goiter has no statistical difference compared with the quantitative parameters of central area(P>0.05).Conclusion:Quantitative analysis of contrast-enhanced ultrasound has certain value in the judgment of TI-RADS type 4 thyroid nodules,and the time to peak(TP)can be used as an important reference indicator.