Comparison Of Acoustic Radiation Force Impulse (ARFI) And Contrast-enhanced Ultrasound (CEUS) For Diagnosis Of TI-RADS4 Grade Thyroid Nodules

Objesctive: The aim of this study was to explore and compare the expression of new Acoustic radiation force impulse technique including Virtual touch tissue quantification(VTQ)and Virtual touch tissue imaging & quantification(VTIQ)and contrast-enhanced ultrasound in TI-RADS4 grade thyroid nodules.Methods: In this study 94 TI-RADS4 TNs in 83 patients were enrolled and analyzed.All of them were examined by new ARFI and CEUS.The median and average of shear wave velocity(SWV)were obtained from multiple SWV measurement under the VTQ mode and VTIQ mode.ROC curve were plotted to determine the most accurate SWV value and the cut-off value for differential diagnosis and to evaluate the diagnostic efficacy of VTQ and VTIQ techniques.The lesions were divided into two groups according to nodule size(? 1 cm and> 1 cm),The diagnostic value of VTQ and VTIQ in different thyroid nodules was analyzed and compared.Then all of nodules are examined by CEUS,and observe the enhanced patterns.The accuracy of the new ARFI technique and CEUS technique in the diagnosis of thyroid TI-RADS4 nodules was evaluated by the pathology results as gold standard,and the diagnostic efficacy of the two techniques was compared.Results:94 thyroid nodules included 53 benign nodules and 41 malignant nodules.(1)under VTQ mode,the median and mean of the SWV of the benign nodules are 2.57 ± 0.29m/s,2.59 ± 0.29m/s,malignant nodules SWV are 2.95 ± 0.41 m/s?2.98 ± 0.39 m/s,and VTIQ: the benign nodules are 2.74 ± 0.35 m/s?2.71 ± 0.37m/s.The malignant of the nodules was 3.28 ±0.32 m/s ?3.24 ± 0.29 m/s.The ROC curves were plotted and the VTQ and VTIQ were calculated based on the area under the curve(AUC),The diagnostic thresholds were 2.83m/s and 2.92 m/s respectively.(2)The nodules are divided into two groups(? 1cm and>1cm),using the average as the sampling parameters,drawing the receiver operating characteristics(ROC)curve,nodules ? 1cm,The area under the curve of VTIQ?VTQ are0.816,0.834,when nodule is <1cm,VTQ,VTIQ under the curve area of are 0.756?0.896,respectively(3)CEUS diagnosis of thyroid nodules found that most of the benign nodules are enhance the ring,high enhancement,and equal enhance;the most of the malignant nodules is low-intensity enhancement,The sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 75.6%?84.90%?82.97%?83.78%?82.45%(4)The chi-square test was used to compare the diagnostic efficacy of VTIQ and CEUS in thyroid TI-RADS4 grade nodules,P> 0.05,the difference was not significant statistically.Conclusion:(1)The new ARFI technique and CEUS technique have diagnostic value in TI-RADS4 thyroid nodules,and the accuracy of SWV in the new ARFI is higher when the average is used as sampling parameter.(2)VTIQ is more effective in diagnosis of thyroid TI-RADS4 grade nodules than VTQ,especially lesions ? 1cm.(3)VTIQ technology and CEUS technology in the diagnosis of thyroid TI-RADS4 class nodules diagnostic performance is equivalent.