Study Of The Relationship Between Contrast-enhanced Ultrasonography And Microvessel Density And Cervical Lymph Node Metastasis In Papillary Thyroid Carcinoma

PART I THY CHARACTERISTICS OF BEGIN AND MALIGNANT THYROID NODULES IN CONVENTIONAL ULTRASOUND AND CONTRAST-ENHANCED ULTRASONOGRAPHYObjective To observe the characteristics of thyroid nodules in two-dimensional ultrasound and contrast-enhanced ultrasound,to find the different perfusion characteristics and different quantitative parameters of benign and malignant nodules in the contrast-enhanced ultrasound,and to explore the diagnostic value of contrast-enhanced ultrasound in benign and malignant thyroid nodules.Method Retrospective analysis from August 2016 to October 2018 in the thyroid gland surgery of the 96 th Hospital of the People’s Liberation Army,followed by surgical treatment or fine needle aspiration biopsy confirmed 96 cases,a total of 112 nodules.Routine ultrasound and contrast-enhanced ultrasonography were performed before all thyroid nodules,and compared with pathological results,the characteristics of the recorded nodules in the twodimensional ultrasound sonogram were observed,as well as the enhanced phase,enhanced mode,and enhancement during the contrast-enhanced ultrasound.Intensity and quantitative parameters,etc.,statistical methods for data processing,looking for different manifestations of benign and malignant nodules in two-dimensional ultrasound and ultrasound contrast images.Result:Of the 112 thyroid nodules,74(66.1%)were malignant nodules: papillary thyroid carcinoma(69/74),follicular carcinoma(4/71),and undifferentiated carcinoma(1/71);There were 38 benign nodules: nodular goiter(25/38),thyroid adenoma(9/38),and Hashimoto’s thyroiditis(4/38).In the two-dimensional ultrasound image feature statistics,the morphology,boundary and echo type of the nodule were low echo,containing microcalcification,aspect ratio >1,and the difference of peripheral halos was statistically significant(P<0.05);the location of the nodule,There was no statistically significant difference in the margin and echo homogeneity(P>0.05).Benign nodules are characterized by high or equal echo,internal echo homogeny,regular morphology,clear boundary,aspect ratio<1,coarse calcification,complete sonic;malignant nodules often manifest as hypoechoic,internal echo heterogeneity,morphology Irregular,blurred boundaries,aspect ratio≥1,internal microcalcification,incomplete acoustics.In the CDFI,the difference between benign and malignant nodules was statistically significant(P<0.05).The blood flow of malignant nodules was mainly due to lack of blood supply.The blood flow classification of benign nodules was more common in grade II and III..In the contrast-enhanced ultrasound model of thyroid nodules,the enhancement intensity,enhanced posterior border,enhanced size,perfusion pattern,and contrast agent distribution were statistically significant(P<0.05).In terms of strength enhancement,benign nodules showed multiple enhancements(15/38),high enhancement(13/38),and malignant nodules showed low enhancement(54/74).In terms of perfusion,benign nodules were mostly centripetal(22/38),diffuse(14/38),and malignant nodules were more eccentric(59/74).Quantitative analysis parameters of thyroid TIC curve: relative peak intensity(RPI)and relative mean transit time(RMTT)were significantly different between the benign and malignant nodules(P<0.05),relative peak time(RTTP)and relative area under the curve(RAUC)was not statistically significant between the benign and malignant nodules(P>0.05).In conclusion: In two-dimensional ultrasound,we can make a preliminary judgment on the nodule by the morphology,boundary,echo type,presence or absence of microcalcification,aspect ratio≥1,completeness of peripheral vocalization,and CDFI blood flow.Contrast-enhanced ultrasonography can further judge the nodules that are difficult to diagnose with twodimensional ultrasound.After contrast injection,the nodules are low-enhanced,eccentric,inhomogeneous,wide-ranging,and boundary blurring contributes to the diagnosis of mali-gnant nodules.The relative peak intensity(RPI)and relative mean transit time(RMTT)of the parameters were statistically significant(P<0.05),which may contribute to the judgment of nodule properties.PART II THE RALATIONSHIP BETWEEN CONTRAST-ENHANCED ULTRASONOGRAPHY AND CERVICAL LYMPH NODE METASTASIS IN PAPILLARY THYROID CARCINOMAPurpose: To analyze the contrast parameters and characteristics of thyroid papillary carcinoma with cervical lymph node metastasis and cervical lymph node metastasis,and to evaluate the value of contrast-enhanced ultrasound in predicting cervical lymph node metastasis of papillary thyroid carcinoma.Method: From August 2016 to November 2018,he was admitted to the thyroid gland surgery of the 96 th Hospital of the People’s Liberation Army of Shandong Province.All patients underwent contrast-enhanced ultrasonography.56 cases of thyroid papillary carcinoma were confirmed by pathology.According to the pathological results,22 patients with PTC with cervical lymph node metastasis and 22 patients with PTC without cervical lymph node metastasis were used as study group and control group.The characteristics of contrast-enhanced ultrasound in the two groups were observed,and the nodule TIC curve was drawn by using the ACQ analysis software.The peak intensity(PI),mean transit time(MTT),peak time(TTP)and curve were obtained.Area(AUC),analysis and comparison of control group and study group parameter differences.Result: In the two-dimensional ultrasound images of PTC tumors,the tumor diameter,calcification type and the relationship between tumor and capsule were statistically significant in the PTC tumors of the metastatic group and the non-metastasis group(P<0.05);There was no statistically significant difference in morphology,echo type between the two groups.There were no significant differences in contrast agent perfusion intensity,perfusion pattern and perfusion uniformity between the PTC tumors in the metastatic group and the non-metastasis group(P<0.05).There were no significant differences in the parameters of PI,MTT,TTP and AUC between the cervical lymph node metastasis group and the nonmetastasis group.However,there were significant differences in PI and AUC between the cervical lymph node metastasis group and the non-metastasis group(P<0.05).In conclusion Quantitative analysis of thyroid papillary carcinoma by contrast-enhanced ultrasonog-raphy is important for predicting the metastasis of cervical lymph nodes.The intensity of contrast-enhanced ultrasound contrast and the area under the curve may be related to cervical lymph node metastasis.Tumor size,microcalcification,and the relationship between tumor and capsule are also risk factors for lymph node metastasis.PART III THE CORRELATION BETWEEN CONTRAST-ENHANCED ULTRASOUND PARAMETERS AND MICROVESSEL DENSITY IN PAPILLARY THYROID CARCINOMAPurpose: In order to investigate the correlation between the contrast-enhanced parameters of thyroid papillary carcinoma and the microvessel density(MVD),the value of non-invasive assessment of intratumoral microangiogenesis by contrast-enhanced ultrasound is a new reference for preoperative clinical guidance of PTC.Method: From August 2016 to November 2018,he was admitted to the thyroid gland surgery of the 96 th Hospital of the People’s Liberation Army of Shandong Province.All patients underwent contrast-enhanced ultrasonography.44 cases of thyroid papillary carcinoma were confirmed by pathology.Subsequently,CD34 immunohistochemical staining was performed on the lesions and normal thyroid tissue specimens around the lesion,and the MVD was counted.According to the diameter of the nodules,they were divided into three groups: <10mm,10~20mm,and >20mm.The normal thyroid tissue around the lesion was used as the control group.The ACQ analysis software was used to analyze the three groups of nodules and control groups with different diameters.TIC curve depiction,quantitative parameter analysis.Ultrasound contrast parameters and MVD were compared between different PTC groups.The quantitative parameters of TEM curve of thyroid papillary carcinoma were analyzed and correlated with MVD of pathological immunohistochemical staining.Result: The area under the curve(AUC)of papillary thyroid carcinoma and normal thyroid tissue around the tumor were 885.96±56.81 and 1168.43±80.47,respectively.The peak intensity(PI)of papillary thyroid carcinoma and normal thyroid tissue around the tumor were 13.74±4.87,20.53,respectively.±6.11.The ACU and PI of papillary thyroid carcinoma were lower than those of normal thyroid tissue around the tumor,and the difference was statistically significant(P<0.05).There was no significant difference in peak time(TTP)and mean transit time(MTT).(P>0.05).The MVD count of papillary carcinoma was lower than that of the surrounding normal thyroid tissue,and the difference was statis tically significant.(P<0.05).Comparing the diameters of<10mm,10-20 mm,and diameter>20mm,the PI,AUC,and MVD counts increased with the increase of diameter,and the difference was statistically significant(F values were 14.478,16.183,respectively).,20.247,P<0.05).There was no significant difference in MTT and TTP between the three groups(P>0.05).In the correlation analysis between PTC contrast ultrasound parameters and MVD values,PI,AUC and MVD values have a pretty correlation(r = 0.766、0.796,P <0.05);MTT,TTP and MVD values have no correlation(P<0.05).In conclusion: There was a difference between the PTC contrast-enhanced blood perfusion parameters and the surrounding normal thyroid tissue.The internal ultrasound contrast parameters PI,AUC and MVD of the papillary carcinoma were lower than the surrounding tissues.And the size of the nodules is related to the microvessel density,and the PI,AUC,and MVD of the larger nodules are higher than the smaller nodules.There is a significant correlation between PTC contrast-enhanced parameters PI,AUC and MVD,which provides a theoretical basis for the non-invasive assessment of PTC microvascular microsurgery.