Study Of Ultrasound Elastography In Diagnosis Of Thyroid Nodules With Hashimoto’s Thyroiditis

BackgroundHashimoto’s thyroiditis (Hashimoto’s thyroiditis, HT) is a kind of lymphocyteinfiltration mainly autoimmune diseases, With the progression of showing a differentimage, especially when combined nodules, image is more complex, more difficult todiagnose. Conventional ultrasound is one of the clinical assessment and treatment ofthyroid disease first screening method, For the diagnosis of benign and malignantthyroid nodules accumulated some experience, but there are not enough, you can notmake a judgment on the nature of the lesion.Ultrasound elastography is a subject byapplying external pressure leaving the tissue deformation and can objectively reflectthe softness of a new technical organization, The technology to make up shortage ofthe X-ray, magnetic resonance imaging (MRI), computed tomography inadequate(CT), and other traditional medical imagingand are widely used in clinical, Especiallyshows its superiority in the diagnosis of thyroid, breast and other superficial organsdiseases, but few reports about diffuse thyroid disease.Currently, the elasticity scoreand elastic strain rate ratio method are two methods commonly used in ultrasoundelastography, the former likely to affect the results of operator error is mainly affectedby subjective factors, the latter to avoid the influence of subjective factors.Purposes 1Summary of benign and malignant of thyroid nodules with Hashimoto′sThyroiditis ultrasound image characteristics.2To investigate ultrasound elastography in application of Hashimoto’sthyroiditis, to contrast the difference of Hashimoto’s thyroiditis and normal thyroidelastography score picture rating, to arrive ultrasound elastography helps tounderstand the progress of the course of HT.3To investigate the diagnostic value of ultrasound elastography for Hashimoto’sthyroiditis merger identification of benign and malignant nodules, analysis of elasticstrain rate nodule ultrasound elastography images and measuring the ratio of the score,ultrasound elasticity score and elastic strain rate ratio method accuracy combinedwith Hashimoto’s thyroid nodules properties were compared.Objectives and methods1objectivesExperimental group:90cases of Hashimoto’s thyroiditis patients, including41cases of Hashimoto’s thyroiditis (18cases localized and23cases diffuse),49cases oftuberous (both single nodule),5males and85females, aged22-56years, their meanage was(38±9) years.All patients underwent routine ultrasound and elastographyexamination and clinical has been confirmed by surgery or pathology41cases ofHashimoto’s thyroiditis and combined49benign and malignant nodules.Normal thyroid tissue: to select the41cases of normal thyroid function tests andultrasound images of normal healthy subjects,3males and38females, aged25-55years, their mean age was（39±9）years. Exclude abnormal lesions, such asHashimoto’s thyroiditis, subacute thyroiditis, simple goiter, nodular goiter,hyperthyroidism, hypothyroidism, Graves disease, thyroid tumors, etc.2MethodsUsing real-time elastography feature and related post-processing softwareHITACHI HV900and HITACHI Preirus Ultrasound probe frequency3-13MHZ.Allsubjects underwent conventional ultrasonic longitudinal and cross-sectionalexamination, observation thyroid size, shape, echo, without nodules, nodules bloodflow and the location, size, shape, border, envelope, aspect ratio, and internal echoblood flow, determine the nature of the initial nodule.After obtaining two-dimensional images cut elastography mode ultrasound elastography scoring with5points method,elastic image features observed in the experimental group and the normal thyroidgroup, For Hashimoto’s thyroiditis patients and normal thyroid tissue elastic score ofHashimoto’s thyroiditis tuberous score and elastic elastic strain rate ratios weremeasured.Results141cases of Hashimoto’s thyroiditis ultrasound elastography figure shows thelimitations of type1or2points mainly diffuse to2or3points-based；normal thyroidtissue elasticity images primarily for1point.249cases of Hashimoto’s thyroiditis combined49patients with nodularpathology results showed17adenomas,8nodular goiter,8nodular Hashimoto’sthyroiditis,15papillary carcinoma,1medullary carcinoma. Conventional ultrasounddiagnosis of HT combined malignant nodules sensitivity, specificity, and accuracywere81.3%,63.6%,69.4%; Elastic score≥3into a vicious predictors, ultrasoundelastography diagnosis of HT combined malignant nodules sensitivity, specificity, andaccuracy were86.7%,91.2%.89.8%: Conventional ultrasound combined withultrasound elastography diagnosis of HT combined malignant nodules sensitivity,specificity, and accuracy were92.8%,97.1%,95.9%, ultrasound elastographydiagnosis of accuracy of malignant nodules and their combined diagnosis of accuracyof malignant nodules were higher than conventional ultrasound, the differences werestatistically significant (P <0.05). HT merger benign nodules、malignant noduleselastic strain ratios were:1.17±0.43、2.96±0.99, the ratio of benign nodules isgreater than the ratio of malignant nodules, the difference was statistically significant(P <0.05).Ultrasonic Measurement of the elastic strain rate ratio of HT merge benignand malignant nodules the best critical point is2.025,the result is HT combinedmalignant nodules sensitivity, specificity, and accuracy were87.5%,93.9%,91.8%,compare to elastic strain scores on ultrasonography diagnosis of malignant nodulessensitivity, specificity, accuracy, the difference was not statistically significant (P>0.05). Ultrasonic elastic strain rate ratio method and elastic strain scores onultrasonography diagnosis of HT merger benign and malignant nodules area of underthe curve were：0.959、0.926, the difference was not statistically significant (P> 0.05).Conclusions1Ultrasound elastography technique capable of Hashimoto’s thyroiditis providecertain information to the diagnosis and differential diagnosis, but must be combinedsonographic comprehensive analysis to improve the diagnosis.2Ultrasound elastography in the diagnosis of Hashimoto’s thyroiditis tuberousnature of significant meaning, elastic strain rate ratio method than elastic strain scoreson ultrasonography diagnosis of Hashimoto’s thyroid merge benign and malignantnodules more objective and accurate, but the difference was not statisticallysignificant.3Ultrasound elastography technique is superior to conventional ultrasound,especially their combination, in determining the nature of Hashimoto’s thyroiditistuberous significant，greatly improves the diagnosis rate.