The Application Of High Frequency Color Duppler Ultrasound Combined With A Variety Of Elastography In Differentiating Benign And Malignant Thyroid Nodules

Objective:1.To evaluate the value of of color duppler ultrasound in the differential diagnosis of benign and malignant thyroid nodules.2. To compare the value,of which color duppler ultrasound combined with four kinds of ultrasound elastography imaging (Including SE, EI,VTI,VTQ) Seperately in the diagnosis of benign and malignant thyroid nodules, with the value of color duppler ultrasound and the four kinds of ultrasound elastography imaging alone.3. To compare the value of color duppler ultrasound combined with four kinds of ultrasound elastography imaging (Including SE, EI,VTI,VTQ) seperately in the diagnosis of benign and malignant thyroid nodules.Methods:75 nodules in 57 patients were given color duppler ultrasound. And elastography examination.,Firstly, using HI VisionPreirus (Japan HITACHI) color Doppler ultrasound diagnostic apparatus, color duppler ultrasound characteristics of nodules was observed.secondly, the elastography characteristics of SE imaging was analyzed and classified into 5 point levels. Then using Siemens Acuson s2000 ultrasound diagnostic equipment,the elastography, the characteristics of EI and VTI imaging were retrospectively analyzed, the VTI of the thyroid nodules imaging were classified into 6 point and El imaging were classified into 6 point levels.Last,The shear wave velocities(SWV) of thyroid nodules and were measured using the VTQ technology. Compared with Histopathological result as the gold standard, sensitivity (SEN), specificity (SPE) and the value of Kappa were calculated for color duppler ultrasound and four kinds of ultrasound elasticity imaging alone,Including strain elastography (SE),Elasticity imaging (El), Virtual touch tissue imaging(VT1), Virtual tough tissue qualification (VTQ),and the combination of color duppler ultrasound with four kinds of ultrasound elastography imaging in differential of benign and malignant thyroid nodules. To compare the value, of which color duppler ultrasound combined with four kinds of ultrasound elastography imaging (Including SE, EI,VTI,VTQ) Seperately in the diagnosis of benign and malignant thyroid nodules, with the value of color duppler ultrasound and the four kinds of ultrasound elastography imaging alone. To compare the value of color duppler ultrasound combined with four kinds of ultrasound elastography imaging (Including SE, El,VTI,VTQ) seperately in the diagnosis of benign and malignant thyroid nodules.Result:1.1.Color duppler ultrasound diagnosis:Logistic regression modeles are established for thyroid nodules ultrasound features:-1.939+2.335 echo+2.325 microcalcfication,using the regression model for diagnosis of all nodules in the study,the accuracy was 80.3%.color duppler ultrasonography in diagnosis of 70 thyroid nodules sensitivity (SEN),specificity (SPE), the value of Kappa、AUC accuracy (ACC) were 67.5%,81.5%,0.467,0.745.2.VTQ:(1) 56 thyroid nodules underwent VTQ examination, confirmed by the postoperative pathological results,31 nodules are malignant and 25 nodules are benign, the average SWV value of 31 benign nodules was 2.05+0.39 and that of the malignant group was 6.21+3.07,there was significant difference between them. (2)According to 1- specificity (false positive rate) as the abscissa and sensitivity as Ordinate, drawing ROC curve for VTQ, the area under the curve was 0.874, P<0.001,when sensitivity is 77.4%and specificity is 100%, the VTQ value of 2.84 was considered as the best diagnostic standard,the greater the VTQ value, the greater the likelihood of malignant nodules.3.The result of the combination of color duppler ultrasound with four kinds of ultrasound elastography imaging:In this study,less than or equal to 0.6cm nodules are defined as small nodules,0.7-1.5cm is moderate nodules and more than or equal to 1.5cm nodules are defined as big nodules,the result of the combination of color duppler ultrasound with four kinds of ultrasound elastography imaging in four group nodules(small nodules, moderate nodules,big nodules,all nodules)To different group,the diagnostic value of the combination of color duppler ultrasound with four kinds of ultrasound elastography imaging are different: ﹕ensitivity and specificity:In all nodules,the combination of color duppler ultrasound with VTQ has higher sensitivity (SEN)and specificity (SPE), (SEN=90.0%、SPE=87.5%),In the big nodules group,the combination of color duppler ultrasound with VTQ has higher sensitivity (SEN)and specificity (SPE),etc, (SEN=87.5%、SPE=92.9%)②in the moderate nodules group,the.Combination of color duppler ultrasound with SE has higher specificity (SPE), (SPE=100.0%)③in the small nodules group,the. Combination of color duppler ultrasound with SE has higher sensitivity (SEN), (SEN=88.9%) (2)the value of Kappa:in all nodules group,the value of Kappa of the combination of color duppler ultrasound with VTQ is higher(0.711);in the big nodules group, the value of Kappa of the combination of color duppler ultrasound with VTQ is higher(0.804); in the moderate nodules group, the value of the.Kappa of Combination of color duppler ultrasound with SE is higher(0.824); in the small nodules group, the value of the.Kappa of Combination of color duppler ultrasound with SE is higher (0.418)(3) Using EI technique diagnosis of nodules in each group,indicators of SEN, SPE,and the value of the.Kappa is lowest。Conclusion:1. High frequency color duppler ultrasound is the basic method in differentiating benign and malignant thyroid nodules, the most relevant sonographic characteristics with pathological result is the echo types of internal nodules and the presence of microcalcfications.2.Various ultrasound elasticity imaging methods are helpful to antidiastole benign and malignant thyroid nodules.If color duppler ultrasound combined with elastography, the diagnostic consistency with pathological result is marked improved compared with color duppler ultrasound or elasticity imaging alone.3.To different size of nodules, elasticity imaging methods have different diagnostic value.For small nodules,color duppler ultrasound combined with VTQ is better than that of the other elastic method; For moderate nodules,color duppler ultrasound combined with SE is better than that of the other elastic method; For small nodules, color duppler ultrasound combined with SE is better than that of the other elastic method.Besides,For small nodules,the consistency of all kinds of methods in diagnostic benign and malignant thyroid nodules with pathological result is not satisfactory,...