| Objective Contrast-enhanced ultrasound(CEUS) was performed on solitary thyroid nodules classified by ? class and above in TI-RADS, which in order to observe the enhanced patterns of thyroid nodules and the value of CEUS in differential diagnosis of benign and malignant thyroid nodules.Methods63 solid thyroid nodules classified by ? class and above in conventional ultrasonography TI- RADS were recruited during December 2014 to February 2016.These nodules were performed by gray-scale CEUS examination in using PHILIPS IU ELITE ultrasonic diagnostic instrument, L12-5 linear array probe and Sono Vue.All nodules were confirmed by needle biopsy and surgery one week later. Firstly,conventional ultrasound scanning was performed on all patients for observing several characteristics such as boundary, margin, internal echo, surrounding edge of low echo halo, aspect ratio, tiny calcifications, internal and surrounding blood flow signals.Before CEUS examination, we selected the section to observe the contrast agent'enhancement phase, enhancement pattern and enhance strength in thyroid nodules. At the same time, dynamic images of CEUS were stored in hard disk. According to the results of pathology, the thyroid nodules were divided into malignant and benign groups. The malignant nodules were 44 which consist of 42 PTC(95.45%) and 2FTC(4.55%). The benign nodules were 19 which were made of 6FTA(31.58%), 5 nodular goiter(26.32%), 8 other benign tissues(42.10%). The thyroid nodules were divided into four groups according to the diameter of nodules(maximum diameter <5 mm, ?5 mm ~<10mm, ?10 mm ~< 15 mm and?15 mm groups). The patients' height,weight, age, heart rate and other general information were collected for calculating correlation between general data and CEUS intensity of thyroid parenchyma. Pearson relevant analysis and SPSS19.0 statistical analysis software were adopted in this research, P<0.05 showed statistically significant difference.Results1. TI-RADS classification & pathologic malignant rate results: 17 class 3(33.33%), 13 class 4a(69.23%), 23 class 4b(91.30%), 6 class4c(100.00%) and 3 class5(100.00%)respectively.2. Results of CEUS2.1 The results were statistically significant difference between CEUS characteristics on the boundary, margin, gradient enhancement, enhanced integration, enhanced strength, enhanced uniformity, enhanced phase, washing out phase and rim-like enhancement parameters in benign and malignant thyroid nodules2.2(1). Malignant thyroid nodules mainly showed gradient enhancement and suggest that malignant nodule with a sensitivity/specificity/PPV/NPV of81.82%/78.95%/90.00%/65.22%.(2). Malignant thyroid nodules mainly showed wash in late and suggest that malignant nodule with a sensitivity/ specificity/ PPV/ NPV of 84.09%/ 84.21%/92.50%/69.57%.(3). Malignant thyroid nodules mainly showed wash out early suggest that malignant nodule with a sensitivity/ specificity/ PPV/ NPV of 81.82%/ 57.89%/81.82%/57.89%.(4). Malignant thyroid nodules mainly showed low degree enhancement suggest that malignant nodule with a sensitivity/ specificity/ PPV/ NPV of 86.36%/ 68.42%/86.36%/68.42%.(5). Benign thyroid nodules mainly showed comprehensive rim-like enhancement suggest that malignant nodule with a sensitivity/ specificity/ PPV/ NPV of 100.00%/47.37% /81.48%/100.00%.3 CEUS differential diagnosis accuracy rate in different thyroid nodule groups from high to low in turn was 96.88%(5 mm- 10 mm group), 92.30%(?15 mm group),69.23%(10 mm to 15 mm group) and 50.00%(< 5 mm group).4. Diagnostic accuracy rate by conventional ultrasound, CEUS and conventional ultrasound combining with CEUS was 79.31%, 85.71% and 93.65%, statistically significant difference between conventional ultrasound and conventional ultrasound combining with CEUS.5.The coefficient of correlation between thyroid parenchyma and common carotid artery enhanced strength with weight and body mass index were0.459, 0.387and0.318, 0.346, respectively,P<0.05.Conclusions1.The CEUS can reflect the characteristics of the nodule blood supply, the nodules which mentioned above all with unique characteristics:(1)The classic characteristics of PTC CEUS were wash in late, gradient enhancement,low degree enhancement, wash out early, unclear enhancement and Irregular enhancement shape.(2)The characteristics of FTC CEUS were wash in early, integral enhancement,homogeneous enhancement,high degree enhancement, wash out late.(3)The classic characteristics of FTA CEUS were wash in early, comprehensive rim-like enhancement and wash out late.CEUS combined with conventional high frequency ultrasound could further good for the ultrasound differential diagnosis benign and malignant thyroid nodules.2.The CEUS diagnosis efficiency was effected by too small(<5mm) thyroid nodule or inappropriate section.3. Preliminary results of this study remains validation by big groups of cases further. |
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