The Value Of 2D And Color Doppler Ultrasonography In Differential Diagnosis Of GD And HT

ObjectiveTo explore the diagnostic value of 2D and Color Doppler ultrasonography in the differential diagnosis of Graves' disease and Hashimoto's thyroiditis.MethodsFifty-seven people in Shandong provincial hospital were selected for this study, which contain nineteen patients with Graves' disease(GD group),eighteen patients with Hashimoto's thyroiditis(HT group) and twenty normal persons(N group).All of the patients visited the hospital for thyroid disease for the first time without any kind therapy including anti-thyroid drug therapy,I¹³¹ therapy and surgical therapy.None of the normal persons had thyroid disease history before.All of the selected persons had US examination and laboratory test to gain the parameters as follows:(1) the parameters of thyroid volume:anterioposterior diameter of bilateral lobe and the thickness of the isthmus;(2)the parameters of echo characters of the thyroid:the echogenecity of the thyroid,the pattern of the hypoechoic distribution,the intraparenchma of the thyroid had hyperechoic septia or not;(3)the pattern of intraparenchma blood flow;(4)the parameters of bilateral superior thyroid artery:the intradiameter,SPV,EDV,RI;(5) the endocrinal parameters:the value of fT3,fT4,TSH,Anti-TG,Anti-TPO.Calculate everyone's PSVmean,PSVmax,PSVmin according to PSVright,PSVleft。Statistical analysis:Statistical data-processing applies package SPSS 13.0.χ²-test is applied for enumeration data statistical analysis,and t-test is applied for numberic data statistical analysis.LSD method is applied for comparison between any two groups of the three groups.To P＜0.05 for the differences are statistically significant.ROC curve is applied to explore the differential diagnosis value of PSV.Results1.The anterioposterior diameters of bilateral lobe and the thickness of the isthmus are longer in GD group and HT group than N group(P＜0.05),but there isn't statistical difference between GD group and HT group in any parameters(for P=0.114,0.096,0.412).2.The echogenecity of GD group and HT group is lower than N group.The low echo distribution is sporadic in most of GD patients and diffuse in most of HT patients (χ²=6.19 0.025＜P＜0.01).Most HT patients have hyperechoic septia(χ²= 13.77 P＜0.005).3.The blood flow in the intraparenchma is more in GD group and HT group than N group,and there isn't statistical difference between GD group and HT group.A big part of the patients show thyroid infero.We observe that the blood flow aggregate in the anterior 2/3 parts in GD and HT groups.4.The same results happen to the diameter and EDV of superior thyroid artery as the blood flow(P＜0.001).The sequence of the PSV is N group,GD group,HT group from low to high.The most valuable parameters of bilateral superior thyroid arteries are PSVmean and PSVmax.There cut-off points are 71cm/s and 85cm/s.There differential diagnosis sensitivity and specificity are PSVmean:94.7%,83.3%,PSVmax:89.5%,88.9%.There isn't any difference in RI in the three groups (right P=0.739,0.814,0.578,left P=0.429,0.996,0.438).Conclusions1.Hyperechoic septia is most valuable in all of parameters of 2D untrasonography in differential diagnosis between GD and HT,but it could not distinguish HT in early stage from GD because the hyperechoic septia is not visible when HT is just begun which correlated with the pathologic course.2.The distributional pattern of wide spread low echo is valuable for differential diagnosis.The application is limited in many other instruments because PHLIP HDI 5000 equiped with X-Res and Sono-CT and the photographs is more distincter.3.The obvious thicken isthmus was not unique for HT,so it could not distinguish HT from GD.4.The most valueable parameters of bilateral superior thyroid arteries are PSVmean and PSVmax.There cut-off points are 71cm/s and 85cm/s.There differential diagnosis sensitivity and specificity are PSVmean:94.7%,83.3%, PSVmax:89.5%,88.9%.We could measure only one side superior thyroid artery to save the time and other resources when the first PSV measured was greater than or equal to 85cm/s,We should measure bilateral superior thyroid arteries when the first PSV lower than 85cm/s to decrease the rates of misdiagnosis and missed diagnosis.