The Study Of Contrast-enhanced Ultrasound And Elastography Characteristics Of Thyroid Carcinoma

Objective:To study the different pattern of contrast-enhanced ultrasound, quantitative parameters and elastic hardness grading, elastic index ratio of thyroid carcinoma to assess the value of contrast-enhanced ultrasound and real-time elastography in the diagnosis of thyroid carcinoma.Methods:117 thyroid nodules of 95 cases adopted real-time elastography technique to determine the hardness grading and elastic ratio; of which 40 patients with 52 thyroid nodules underwent contrast-enhanced ultrasound before the operation, by low mechanical index real-time ultrasound with bolus injection of Sono Vue via the elbow vein and QLAB quantitative analysis software, observing the enhancement pattern and measuring the quantitative parameters of thyroid carcinoma. With pathologic results as the gold standard, we calculated the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the elastic hardness grading and elastic ratio methods in the diagnosis of thyroid carcinoma separately.Resluts:(1) 95 patients with 117 nodules underwent real-time elastography: which thyroid cancer a total of 81: papillary carcinoma in 52, 23 papillary microcarcinoma, 2 follicular variant of papillary carcinoma, 1 follicular variant of papillary microcarcinoma and 3medullary carcinoma; benign thyroid nodules, a total of 36: nodular goiter in 34(3 of themwith adenomatoid nodule formation), 1 piercing microscopically for thyroid follicular epithelium, inflammatory cells and 1 hashimoto’s thyroiditis.①The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasound elastography grading method in the diagnosis of thyroid cancer were 86.42%, 55.56%, 76.92%, 81.40% and 64.52% respectively.②The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasound elasticity index ratio in the diagnosis of thyroid cancer were82.72%, 61.11%, 76.07%, 82.72% and 61.11% respectively.③Thyroid cancer overall softer( less than or equal to 3), but local harder accounted for 54.55%; small nodules(maximum diameter < 1cm) elastic hardness softer(less than or equal to 3) accounted for 13.04%.④More than 4 of the nodules hypoechoic nodules accounted for 96.51%, of which79.07% were thyroid cancer, isoechoic, hyperechoic nodules accounted for only 3.49%.(2)40 patients with 52 nodules underwent contrast-enhanced ultrasound before the operation: which thyroid cancer a total of 39: papillary carcinoma 29, papillary microcarcinoma of 8, follicular variant of papillary microcarcinoma of 1 and 1 medullary carcinoma; benign thyroid nodules, a total of 13: nodular goiter 12( including 1 with adenomatoid nodule formation) and 1 piercing microscopically for thyroid follicular epithelium, inflammatory cells.①Thyroid nodules contrast-enhanced ultrasound enhancement pattern can be divided into 4 types( hyper-enhancement pattern, iso-enhancement pattern, hypo-enhancement pattern and ring-enhancement pattern), there were 39 thyroid carcinomas in this study( 2nodules showed hyper-enhancement pattern, 10 nodules were iso-enhancement pattern, 27 nodules showed hypo-enhancement pattern), benign nodules, a total of 13( hyper-enhancement pattern 4, iso-enhancement pattern 2, hypo-enhancement pattern 1,ring-enhancement pattern 6).②69.23%(27/39) of the thyroid carcinomas showed hypo-enhancement pattern, the sensitivity and specificity of hypo-enhancement pattern in the diagnosis of thyroid carcinoma were 69.23%, 92.3% separately; thyroid benign nodules mostly showedring-enhancement pattern 46.15%(6/13) and hyper-enhancement pattern 30.77%(4/13).The sensitivity and specificity of ring-enhancement pattern in the diagnosis of thyroid benign nodule were 46.15%, 100% separately.③Compared with peripheral glandular tissue, the peak intensity of thyroid carcinoma was lower and its wash in slope was smaller, the difference was statistically significant(P<0.05).④Compared with thyroid benign noudules, the microvascular density of thyroid carcinoma was lower, the difference was statistically significant(P<0.05).Conclusions:(1)Thyroid cancer 86.42% overall hardness is more than or equal to 4; the overall of part of the malignant nodules is softer(less than or equal to 3), but the local harder accounted for 54.55%; small nodules(diameter < 1cm) soft elastic hardness(less than 3)accounted for 13.04%.(2)69.2%(27/39) of the thyroid carcinomas showed hypo-enhancement pattern,76.92%(10/13) of the thyroid benign nodules showed ring-enhancement pattern and hyper-enhancement pattern.(3)The microvascular density of thyroid carcinoma is lower than thyroid benign nodules.(4) Contrast-enhanced ultrasound and ultrasound elastography are helpful to the diagnosis of thyroid carcinoma, provide more useful information for clinical diagnosis and treatment and are a useful complement and development of conventional ultrasound.