Study On The Value Of Multimodal Ultrasound Imaging Of Thyroid Nodules

ObjectiveThe purpose of this study was to analyze the ultrasound features of conventional ultrasound,strain elastography(SE)and contrast enhanced ultrasound(CEUS)of benign and malignant thyroid nodules.Then,an ultrasonographic multimodality diagnostic model was established and its efficacy was verified.MethodsA retrospective analysis was performed on 604 thyroid nodules in 502 patients who underwent thyroidectomy at Peking Union Medical Hospital(PUMCH)from November 2011 to January 2019.All patients were received conventional ultrasound,CEUS and SE examinations before surgery.We evaluated the ultrasound features of thyroid nodules.Binary logistic regression analysis was performed by step forward method and independent predictors of malignant thyroid nodules were selected.An ultrasonographic multimodality diagnostic model was established and the diagnostic value of this model was assessed and compared with the diagnostic value of conventional ultrasounds CEUS and SE.ResultsAmong the 604 nodules,213 were benign and 391 were malignant.The conventional ultrasound features including echogenicity,composition,shape,border,margin,calcification,halo,blood flow distribution and extrathyroidal extension had difference between benign and malignant groups(p<0.001).The sensitivity,specificity,PPV5 NPV,accuracy and AUC value of diagnosis of conventional ultrasound were 98.0%,63.4%,83.1%94.4%,85.8%and 0.807(0.765-0.848,95%CI),respectively.Among CEUS features,there was difference in the relative arrival time of microbubble,peak intensity,microbubble distribution and enhancement pattern between benign and malignant groups(p<0.001).The accuracy of the diagnosis of heterogenous enhancement was higher than other CEUS features.The sensitivity,specificity,PPV,NPV,accuracy and AUC value of the diagnosis of CEUS were 87.2%,77.9%,87.9%,76.9%,83.9%and 0.826(0.788-0.863,95%Cl),respectively.The sensitivity,specificity,PPV,NPV,accuracy and AUC value of the diagnosis of elastic score ? 3 were 87.5%?60.6%?80.3%?72.5%?78.0%and 0.771(0.730-0.812,95%Cl),respectively.According to the results of binary logistic regression analysis,five independent predictors of malignant thyroid nodules were selected:hypoechoic or very hypoechoic,irregular or lobultate margin,microcalcification,irregular blood flow distribution and heterogenous enhancement.Ultrasonographic multimodality diagnostic model was established:P=1/1+e-z,z=-3.684+1.702×heterogenous enhancement+1.686×hypoechoic or very hypoechoic+1.221×microcalcification+1.107×irregular or lobulated margin+0.994×irregular blood flow distribution?When P>0.60 diagnosed as malignant,this model has high diagnostic value,the sensitivity,specificity,PPV,NPV,accuracy and AUC value were 89.7%?81.8%?90.0%?81.4%?86.9%and 0.920(0.896-0.945,95%Cl),respectively.The specificity,PPV,accuracy and AUC value were higher than any other single mode(p<0.05).Ultrasonographic multimodality diagnostic model was verified by using 72 thyroid nodules and the results indicated that this model has high diagnostic value for benign and malignant thyroid nodules.ConclusionUltrasonographic multimodality diagnostic model has high diagnostic value for benign and malignant thyroid nodules,and can improve the diagnostic accuracy of thyroid cancer compared with any single mode.ObjectiveThe purpose of this study was to investigate the value of contrast enhanced ultrasound in thyroid nodules that were classified to intermediate and low malignant risk by 2015 ATA GuidelinesMethodsA retrospective analysis was performed on 553 patients who underwent thyroidectomy at PUMCH from November 2011 to January 2019.All patients were received conventional ultrasound and contrast enhanced ultrasound examinations before surgery.The thyroid nodules were classified according to the stratification of ATA guidelines.Finally,147 intermediate and low risk thyroid nodules were selected among 134 patients and we investigated the value of contrast enhanced ultrasound to diagnose these nodules.ResultsAmong the 147 intermediate and low risk thyroid nodules,CEUS indicators including the relative arrival time of microbubble and enhancement pattern had significant difference between benign and malignant groups.Heterogeneous enhancement pattern(OR=7.339,p<0.001)and the relative delayed arrival time of microbubble(OR=3.209,p=0.042)were independent risk factors in the diagnosis of intermediate and low risk thyroid nodules.And the sensitivity,specificity,PPV,NPV,accuracy,and AUC values of heterogeneous were 58.3%,87.8%,48.3,91.5%,83.0%,and 0.731(0.606-0.855,95%Cl),respectively.Among 58 intermediate risk thyroid nodules,there had difference in the relative arrival time of microbubble,peak intensity and enhancement pattern between benign and malignalt groups(p<0.05).The sensitivity,specificity,PPV,NPV,accuracy,and AUC values of heterogeneous were 61.9%,83.8%,68.4%,79.5%,75.9%,0.740(0.596-0.883),respectively.Among 89 low risk thyroid nodules,there were no significant difference in the relative arrival of microbubble,peak intensity and enhancement pattern between benign and malignant groups.Ring enhancement pattern combined with 2015 ATA guidelines help to reduce the fine-needle Aspiration(FNA)rate of low risk thyroid nodules,and 86.8%FNA would be avoided for low risk nodules.ConclusionContrast enhmiced ultrasound plays an important role in diagnosing benign and malignant thyroid nodules that classified into intermediate and lowrisk.Ring enhancement could reduce the rate of fine needle biopsy in low risk thyroid nodules.