Diagnostic Value Of Color Doppler Ultrasound And Contrast Enhanced Ultrasound In Thyroid Carcinoma

Objective: To investigate the diagnostic value of Color Doppler Ultrasound and Contrast Enhanced Ultrasound in thyroid carcinoma .Methods: Retrospectively analyzing sonograms cf eighty patients (twenty-one males,fifty-nine females) with thyroid carcinoma visiting at our division during the period 2008.5~2009.10, the diagnosis of which were confirmed by surgery or biopsy.Observation was made on the nodules'location , size, shape,boundary, internal echo, microcalcification and cystic formation, and also on the degree and morphous of the blood flow. Contrast enhanced ultrasound was applied in 40 cases (nine males,thirty-one females),analyzing their contrast enhanced images,summarizing nodules'image properties after contrast,calculating the parameter of Time-Intensity Curve(TIC)'s ascending branch and reviewing the shape of TIC's descending branch.The relationships between contrast enhanced ultrasonic reports and common ultrasonic reports and pathological reports were analyzed.Date were analyzed using statistical program SPSS16.0 for Windows.And count data were expressed as x±s.p values less than 0.05 were considered to be significant.Results: 1.Sonographic characteristics of Color Doppler of thyriod carcinoma.⑴The characteristics of two-dimensional sonogram: In this investi- gation ,68.63%(35/51) of malignant nodules showed irregular shape,78.43%(40/51) of malignant nodules'periphery had no acoustic halo,82.35%(42/51) of malignant nodules showed unclear border,92.16%(47/51) of malignant nodules displayed low echo, 88.24%(45/51) of malignant nodules'internal echo showed heterogeneous, 72.55%(37/51) of malignant nodules had no cystic formation, 68.63%(35/51) of malignant nodules revealed microcalcification.Above characteristics of thyroid malignant nodules were significant difference comparing with innocent nodules(p<0.05).As an index, microcalcification had the highest specificity(78.05%).⑵The flow feature of Color Doppler : In this investigation ,92.16%(47/51) of malignant nodules showed 2 or 3 level flow(among this,60.78%(31/51) of nodules showed 3 level flow),70.59%(36/51) of malignant nodules'flow patterns displayed branch-like(typeⅠ) or block -like(typeⅡ) or perforating branch-like (typeⅢ), the degree and morphous of the blood flow of thyroid carcinoma were significantly different comparing with innocent nodules .While using the degree of blood flow as yardstick,we could get higher sensitivity(92.16%) and lower specificity(34.15%). But while using the flow patterns as yardstick,we can get both higher sensitivity and specificity(72%,70.27%).⑶The ultrasonic manifestations of lymph nodes:47.06%(24/51) of thyroid carcinoma could be detected intumescent lymph nodes in cervical part, and this feature was significantly different comparing with innocent nodules (p<0.05). There were 52.63%(10/19) of metastatic lymph nodes bing discovering microcalcification. ,and it was significantly different comparing with lymph nodes without metastasis,p<0.05.When using cystic formation or microcalcification of lymph nodes to judge that whether lymph nodes of neck of thyroid carcinoma had metastasis or not,the specificity would be higher.2.The characteristics of contrast enhanced ultrasound of thyroid carcinoma and analyzing TIC⑴The characteristics of thyroid carcinoma after contrast: In the Contrast-enhanced ultrasound part of this study,there were 18/21(85.71%) of thyroid malignant nodules showed entire diffuse uniform or nonuniform enhancement,mostly high-enhanced.And after peak intensity , they became low-enhanced along with the constrast medium subsidised;There were 17/24(70.83%) of thyroid innocent nodules showed marginal rim-like high-enhancement,and their interior showed sparse slightly high-enhancement. After peak intensity,the interior of nodules became low-enhanced along with the constrast medium subsidised,but still,the periphery of nodules could be discovered a rim-like slightly high-enhancement. Above characteristics of thyroid malignant nodules were significantly different comparing with innocent nodules,p<0.001. ⑵Analyzing TIC:The Ascending Slope(AS)(0.93±0.26) of the central part of thyroid malignant nodules was significantly steeper than the AS(0.70±0.19) of the peripheral part of innocent nodules, the equation between Arrive Time and Peak Time( it's expressed by△T in this article.) (5.74±1.30) of the central part of thyroid malignant nodules was significantly shorter than the△T (6.86±1.36) of the peripheral part of innocent nodules. Additionally , with regard to the Peak Intensity (PI) of innocent nodules ,the PI(18.40±4.54dB) of the peripheral part was significantly higher than the PI(16.14±3.99) of the central part,p<0.05,but there was no difference between the PI (16.79±4.38) of the peripheral part of malignant nodules and the PI(17.10±4.23) of the central part of malignant nodules.For the shape of descending branch,19/21(90.48%) of thyroid malignant nodules revealed irregular multphase,14/24(58.33%) of innocent nodules revealed regular single-phase,and these two groups were markedly different(p<0.05).3. The results of conventional ultrasound and contrast-enhanced ultrasound in diagnosing thyroid malignant nodules.The sensitivity and specificity of conventional ultrasound was respectively 66.67% and 41.67%, and Youden index was 0.08;When we combined the conventional ultrasound and the enhanced way of contrast-enhanced ultrasound together to diagnose thyroid carcinoma,the sensitivity and specificity was respectively 57.14% and 70.83%, and Youden index was 0.28; When we combined the conventional ultrasound and the shape of descending branch of TIC together to diagnose thyroid carcinoma,the sensitivity and specificity was respectively 61.90% and 75%, and Youden index was 0.37;When we combined the three together to diagnose thyroid carcinoma,the sensitivity and specificity was respectively 57.14% and 87.50%, and Youden index was 0.45.Conclusion: 1.Thyroid carcinoma has some characteristics of two-dimensional images and color flow ,and Color Doppler Ultrasound possesses a certain value while used in diagnosing thyroid carcinoma.2.As for the enhanced way of thyroid carcinoma,some parameters of ascending branch of TIC,and the shape of descending branch of TIC,there are differences between malignant nodules and benign nodules.Contrast-Enhanced Ultrasound helps to differentiate benign and malignant thyroid nodules.3.The conventional ultrasound combined with Contrast-enhanced Ultrasound will improve the diagnosis rate of thyroid carcinoma.