Study On Ultrasonographic Multimodality Diagnosis Pathway Of Thyroid Nodules

ObjectiveTo evaluate the ultrasonic diagnostic efficiency of multimodal ultrasound imaging technology for TI-RADS type 4 nodules in order to improve the accuracy of ultrasound diagnosis and promote clinical management.MethodsProspective collection of 62 patients with thyroid nodules diagnosed as TI-RADS type 4 by conventional ultrasound examination,ultrasound contrast and shear wave elastography at the affiliated hospital of Yan’an University from October 2018 to October 2019.A total of 68 lesions were included by inclusion exclusion criteria,image quality screening,and confirmed by histopathology.There were 12 males and 50 females,aged 26-72 years(mean age 45.80 ± 10.76).All routine ultrasound,CEUS,and elastography examinations were performed independently by two experienced sonographers without knowledge of pathological findings.Qualitative analysis of parameters such as enhancement time,enhancement degree,enhancement morphology,and Young’s modulus of TI-RADS type 4 nodules.Using the puncture or surgical pathology as the gold standard,construct ROC curves and compare the diagnostic efficacy of three different ultrasound diagnostic methods of conventional ultrasound,ultrasound contrast and elastography for benign and malignant thyroid nodules.ResultsAmong the 68 TI-RADS type 4 lesions,45 cases were diagnosed as benign(66.2%)and 23 cases were malignant(33.8%).In conventional ultrasound,with TI-RADS 4c as the diagnostic criterion,the difference between benign and malignant nodules was statistically significant(P <0.05).In ultrasound contrast,there are statistically significant enhancement features between benign and malignant thyroid nodules: degree of enhancement,enhanced morphology,and enhancement speed(P <0.05);benign and malignant nodules have no statistical difference in clearance time(p == 0.963).Among them,slow progression,non-uniformity and low enhancement are the main features of ultrasound contrast enhancement in the identification of benign and malignant nodules.The proportions of slow progression,unevenness and low enhancement in benign nodules were 74.41%(32/43),62.79%(27/43),55.81%(24/43),slow progression,uneven,malignant nodules The proportion of low enhancement was 56%(14/25),72%(18/25),and 88%(22/25).In shear wave elastography,there are statistically significant Young’s modulus values between benign and malignant thyroid nodules: maximum,average,and minimum(p <0.05).All Young’s modulus values of malignant thyroid nodules are significantly higher than benign nodules.The maximum,average,and minimum Young’s modulus values of benign nodules are(38.00 ± 12.45)kPa,(23.69 ± 7.49)kPa,(13.61 ± 3.75)kPa,the maximum,average and minimum Young’s modulus values of malignant nodules are(59.74 ± 26.52)kPa,(34.37 ± 21.09)kPa,(19.51 ± 15.80)kPa.Shear wave elastography is used alone to diagnose benign and malignant thyroid nodules.The area under the curve of the Young’s modulus maximum,mean,and minimum values are 0.806,0.720,and 0.554,respectively(P <0.05).Emax is used to identify benign and thyroid nodules.The best cutoff value for malignant nodules is 44.8kPa.2.The sensitivity,specificity,accuracy,PPV and NPV of diagnosing benign and malignant thyroid nodules are 61.5%,96.6%,68.4%,96% when using high-resolution ultrasound,ultrasound contrast,and shear wave elastography alone.,65.1%;66.7%,96.9%,80.8%,96%,72%;78.6%,92.5%,86.8%,88%,86%;HRUS and CEUS,HRUS and SWE,CEUS and SWE combined diagnosis,judgment The sensitivity,specificity,accuracy,PPV and NPV of benign and malignant thyroid nodules were 79.3%,94.9%,88.2%,92% and 86.1%;88%,93%,91.2%,88% and 93.2%;78.6%,92.5%,86.8%,88%,86.1%;the sensitivity,specificity,accuracy,PPV,NPV of 91.7%,93.2%,92.6%,88%,95.3 for the diagnosis of benign and malignant thyroid nodules when connected in parallel %.The comparison found that the multimodal ultrasound technology combined with qualitative diagnosis of TI-RADS type 4 nodules is more valuable,and the area under the ROC curve is 0.899,which is larger than the single examination(conventional ultrasound 0.791,ultrasound contrast 0.815,elastography 0.850).ConclusionMultimodal ultrasound can improve the sensitivity and accuracy of the diagnosis of TI-RADS type 4 nodules,reduce unnecessary biopsy,and has guiding significance in clinical diagnosis and management.