Application Of Acoustic Radiation Force Impulse(ARFI)Imaging In Differential Diagnosis Of Benign And Malignant Thyroid Nodules

Objective:This study was to explore virtual touch tissue image(VTI) technique and virtual touch tissue quantification(VTQ) technology of the acoustic radiation force impulse(ARFI) in the diagnosis of benign and malignant thyroid nodule best diagnostic point;Comparing two kinds of technology value in differential diagnosis of benign and malignant thyroid nodule.Method:142 thyroid nodules in 120 patients were examined by conventional ultrasound and acoustic radiation force impulse elastic imaging(ARFI).Routine ultrasound examination, observe the basic morphological characteristics of nodules, internal echo, calcification, blood flow etc. For VTI inspection, self circle technology under the VTI elastography area,Then circle the gray-scale image under thyroid nodule area, both the software automatically calculates the area ratio(VTI area / 2D area value,AR), The same nodule was measured three times, and its mean value was measured, And draw out the ROC curve, get the best diagnosis point of the diagnosis of benign and malignant thyroid nodules. Through the AR of each nodule and plot the receiver operating characteristic curve(ROC curve), the area under the curve(AUC) was calculated. draw the diagnosis boundary point. When the VTQ technology was examined, the shear wave velocities(SWV) of each thyroid nodule was measured 7times, Measure the SWV of each nodule 7 times, take the median of numbers, through the SWV of each nodule to draw the ROC curve, to obtain the best diagnostic point of differential diagnosis of benign and malignant thyroid nodules SWV. The histopathological findings of the biopsy under ultrasound guidance were used as criteria for final diagnosis.After statistical treatment, <0.05 P was considered to have statistical significance.Result:Pathological examination of 142 nodules in 120 patients with thyroid nodules: 93 benign nodules and 49 malignant nodules. 76 nodular goiter, 14 adenoma, 2 chronic lymphocytic thyroiditis(hashimoto’s thyroiditis), 1 subacute granulomatous thyroiditis in 93 benign nodules.46 papillary carcinoma, 2 follicular carcinoma, 1 medullary carcinoma in49 malignant nodules.The sensitivity and specificity of conventional ultrasound in the diagnosis of benign and malignant solitary or multiple solid nodules were61.22%(30/49) and 79.57%(74/93), respectively; When the area ratio of VTI was 1.31, the sensitivity and specificity of diagnosis of malignant solitary or multiple solid nodules were 91.84%(45/49) and 83.87%(78/93), respectively; When the value of SWV was 2.66, the sensitivity and specificity of diagnosis of solitary or multiple solid nodules were81.63%(40/49) and89.25%(83/93), respectively. Conventional ultrasound were compared with VTI and VTQ technology, and there was no statistical significance(P>0.05); There was no significant difference in the area under the curve of VTI area(0.862) and SWV of the area under the curve(0.878)(P>0.05).Conclusion:1.VTI technology and VTQ technology of ARFI technology can complement each other, for the differential diagnosis of benign and malignant thyroid nodules provide a new method and make up for the lack of conventional ultrasound.2.ARFI technique analyze the hardness of thyroid nodules, the optimal critical value of AR is 1.309 by VTI technology. Therefore, AR≥1.309, suggesting nodules suspicious for malignancy. the optimal critical value of SWV is 2.655 by VTQ technology. Therefore, SWV≥2.655, suggesting nodules suspicious for malignancy,Provide objective,dynamic and good index for clinical.