The Combination Of Superb Microvascular Imaging And Ultrasound Patterns Of ATA (2015) Guidelines In The Differentiation Of Benign And Malignant Thyroid Nodules

?Background and destination? Thyroid nodules are one of the common endocrine diseases in clinical practice.With the widespread use of high-resolution ultrasound,the detection rate of sporadic thyroid nodules has obviously increased.In clinical work,the effective assessment of the malignant risk of thyroid nodules is essential.Ultrasound is the most sensitive imaging method to evaluate the benign and malignant thyroid nodules.The 2015 ATA guideline ultrasound model is the latest criterion for the assessment of thyroid nodules.The SMI technology is a new superb microvascular imaging technique that is more sensitive to blood flow detection than CDFI,especially low-velocity blood flow signals.Therefore,a more realistic response nodular blood flow distribution and vascular walking characteristics can be reflected.In this study,by comparing the ability of CDFI and SMI to detect thyroid nodule blood flow,the diagnostic value of 2015 ATA guideline ultrasound combined with SMI in differentiating benign and malignant thyroid nodules was discussed.?Method? The study included 197 thyroid nodules confirmed by FNAC or histopathologic examination.All nodules were graded staying with in malignancy Risk stratification of thyroids nodule from the 2015 American Thyroid Association(ATA)management guidelines.Both CDFI and SMI.were used to classify blood flows of thyroid nodules according to Adler's grading criteria.Morphologic and distribution features of blood flow were also observed mSMI.The optimal threshold drawing from ROC curve and diagnostic efficacy of single and combinative modality were calculated.?Results?(1)Clinical features and two-dimensional ultrasound features: benign thyroid nodules in this study showed more than the high echo,malignant nodules mainly for hypoechoic,irregular boundaries,aspect ratio>1,microcalcification,surrounding encroachment,cervical lymph node metastasis.(2)Pathological results: Of the 197 nodules,143 were benign and 54 were malignant nodules.(3)2015ATA guidelines Ultrasound patterns and pathological findings contrast: extremely low suspicious malignancy,low suspicious malignant,moderately suspicious malignant,highly suspicious malignant rates were 5.6%,13.2%,20.0%,90.9%,the differences between the various categories are statistically significant for the benign and malignant thyroid nodules were(p <0.001).(4)CDFI,cSMI and mSMI detection capacity comparison:,the difference between CDFI and cSMI was not statistically significant(P =0.121).The difference between CDFI and mSMI(P<0.001)was statistically significant.(5)Microvascular pattern classification of thyroid nodules in mSMI images: The microvascular pattern in benign thyroid nodules is mostly avascular,linear or dendritic.Microvascular patterns of malignant thyroid nodules are mostly residual root or foot type.The structural differences of microvessels in benign and malignant thyroid nodules were statistically significant(p <0.001).(6)Using the ATA ultrasound model,mSMI,and combined modality in the diagnosis of benign and malignant thyroid glands,the area under the curve was 0.745,0.740 and 0.834,respectively.The sensitivities of ATA ultrasound model,mSMI and combined diagnostic mode had no significant difference(P> 0.05).The specificity and accuracy of the ATA +mSMI combined diagnostic modality were significantly higher than those of other single diagnostic modalities(P <0.05).?Conclusions? SMI improves blood flow detection in thyroid nodules.By observing the features of the distribution of the microvessels in thyroid nodules,it is helpful for the differential diagnosis of benign and malignant thyroid nodules.The combination of mSMI and ATA ultrasound can improve the diagnostic efficiency of thyroid nodules.