The Clinical Application Study Of Contrastenhanced Ultrasound And Fine Needle Aspiration Biopsy In The Diagnosis Of Thyroid Nodules

Part one Study of contrast-enhanced ultrasound(CEUS)patterns of benign and malignant thyroid nodulesObjective To analyze CEUS patterns of benign and malignant thyroid nodules.Methods The ultrasound data of 248 thyroid nodules examined by conventional ultrasound(US)and CEUS were analyzed retrospectively.Using quantitative combined qualitative method,the CEUS characteristics of benign and malignant nodules were compared and analyzed to obtain the CEUS patterns of benign and malignant thyroid nodules.Results Among the CEUS characteristics of thyroid nodules,the shape,degree,ring and boundary of enhancement,entering speed and clearance speed of contrast agent in thyroid nodules all have statistically significance.The main CEUS pattern of benign thyroid nodules are homo-enhancement,hyper(or iso)-enhancement,obvious ring enhancement,well-defined boundary,fast wash-in and slow wash-out,while malignant nodules' are hetero-enhancement,hypo-enhancement,unobvious or discontinuous ring enhancement,ill-defined boundary,slow wash-in and fast wash-out.Conclusion The CEUS patterns of benign and malignant thyroid nodules are different and can provide diagnostic proof for clinic.Part two CEUS in assessing the malignant risk of solid thyroid nodulesObjective To analyze the value of CEUS in assessing the malignant risk of solid thyroid nodules.Methods The ultrasound materials of 113 solid thyroid nodules examined by conventional US and CEUS were analyzed retrospectively.The CEUS characteristics of benign and malignant nodules were compared and analyzed by binary logistic regression to evaluate the malignant risk of solid thyroid nodules.Results Among the CEUS characteristics in solid thyroid nodules,the degree,ring,and boundary of enhancement,entering speed and clearance speed of contrast agent in thyroid nodules all have statistically significance,while the shape of enhancement has no statistical significance.Three characteristics obtained from logistic regression,which were ill-defined boundary,wash-out in late phase and slow wash-in were associated with malignant thyroid nodules independently,with the relative risk degree from high to low in turn.Conclusion CEUS can provide important reference value in assessing the malignant risk of solid thyroid nodules.Part three Revised value of CEUS on TI-RADS gradingObjective To investigate the revised value of CEUS on thyroid nodules using the thyroid imaging reporting and data system(TI-RADS).Methods The study included 135 patients with 135 nodules confirmed by pathology.Every nodule underwent both conventional US and CEUS.Their materials were analyzed retrospectively.The conventional US features and CEUS characteristics were analyzed by binary logistic regression to search the risk factors of solid hypoechoic thyroid nodules.The value of US-TI RADS,CEUS score and the combination of them(CEUS-TI RADS)in differential diagnosis of solid hypoechoic thyroid nodules were compared.Results Binary logistic regression analysis for conventional US features revealed that height greater than width,microcalcification and irregular shape were significant malignant predictive features.Binary logistic regression analysis for CEUS characteristics indicated that hetero-enhancement,an ill-defined enhancement border,slow wash-in and fast wash-out were significantly associated with malignancy.The areas under the curve of the US-TI RADS,CEUS score,and CEUS-TI RADS were 0.806,0.934 and 0.950,respectively.Conclusion CEUS on revising TI-RADS grading can improve the diagnostic accuracy of thyroid nodules.Part four Value of fine needle aspiration biopsy in the differential diagnosis of thyroid nodulesObjective To analyze the value of ultrasound-guided thyroid fine needle aspiration biopsy(US-FNAB)in the differential diagnosis of thyroid nodules.Methods The ultrasound and pathology materials of 213 thyroid nodules examined by US-FNAB were analyzed retrospectively.The diagnostic value of US-FNAB on thyroid nodules was analyzed via comparing with conventional US TI-RADS grading.Results US-FNAB diagnosis and surgical pathology or clinical follow-up results have statistically significance.The sensitivity of US-FNAB in differentiating benign and malignant thyroid nodules was 92.13%,the specificity was 94.74%,the positive predictive value was93.18%,the negative predictive value was 6.09% and the diagnostic accuracy was 93.60%.Conclusion The US-FNAB is a reliable method for the diagnosis of thyroid nodules with the advantages of safety and high diagnostic accuracy.