Value of contrast enhanced ultrasound combined with elastography in differential diagnosis of thyroid imaging reporting and data system 4 thyroid nodules

doi:10.3877/cma.j.jssn.2095-5820.2016.12.008

Abstract

Abstract:

Objective

To assess the diagnostic value of contrast enhanced ultrasound (CEUS), elastography and their combined use in diagnosing thyroid nodules of thyroid imaging reporting and data system (TI-RADS) 4.

Methods

From November 2011 to August 2016, 159 TI-RADS 4 nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CEUS and elastography before surgery. Multivariate logistic regression models were established for CEUS and CEUS combined with elastography to diagnose thyroid malignancy. The diagnostic performances of CEUS, elastography and their combined use were evaluated with the receiver operating characteristic (ROC) curve. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and omission diagnostic rate of CEUS, elastography and their combined use were compared by Chi-square test.

Results

The CEUS features significantly predicting malignancy were heterogeneous enhancement, hypoenhancement, without or incomplete ring-enhancement and later time to peak than the surrounding parenchyma (χ²=24.378, 69.194, 29.434 and 7.375, all P<0.01). Furthermore, the multivariate logistic regression for CEUS combined with elastography showed that heterogeneous enhancement, ring enhancement and elasticity score were the independent predictors of thyroid malignancy. The area under the ROC curve of CEUS combined with elastography was (0.921±0.023) which was higher than that of CEUS and elatography (0.88±0.029 and 0.80±0.038, respectively; both P<0.05). Moreover, the sensitivity, accuracy and negative predictive value of CEUS combined with elastography were 92.1%, 86.2% and 84.6%, respectively. The omission diagnostic rate of CEUS combined with elastography (7.9%) was reduced. And the diagnostic accuracy of CEUS combined with elastography was significantly higher than that of CEUS and elastography (P<0.05). While the diagnostic accuracy of CEUS was close to the elastography, the difference was not statistically significant (P>0.05).

Conclusion

The diagnostic value of CEUS combined with elastography was remarkably significant in the differential diagnosis of TI-RADS 4 nodules.

Key words: Ultrasonography, Elasticity imaging techniques, Thyroid nodule

Huijuan Ma, Jingchun Yang, Zhenpeng Leng, Jia Ma, Hua Kang, Lianghong Teng. Value of contrast enhanced ultrasound combined with elastography in differential diagnosis of thyroid imaging reporting and data system 4 thyroid nodules[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(12): 911-917.

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Figures/Tables 7

References 16

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造影特征		良性（58个）	恶性（101个）	χ²值	P值
增强强度		?	?	24.378	<0.01
?	高增强或等增强	36	23	?	?
?	低增强	22	78	?	?
增强均匀度		?	?	69.194	<0.01
?	均匀	51	20	?	?
?	不均匀	7	81	?	?
环状增强		?	?	29.434	<0.01
?	完全	17	1	?	?
?	不完全或无	41	100	?	?
始增时间		?	?	3.074	>0.05
?	早于或等于	49	73	?	?
?	晚于	9	28	?	?
达峰时间		?	?	7.375	<0.01
?	早于或等于	41	49	?	?
?	晚于	17	52	?	?
弹性评分		?	?	50.887	<0.01
?	1~3分	42	16	?	?
?	4~5分	16	85	?	?

造影特征		良性（58个）	恶性（101个）	χ²值	P值
增强强度		?	?	24.378	<0.01
?	高增强或等增强	36	23	?	?
?	低增强	22	78	?	?
增强均匀度		?	?	69.194	<0.01
?	均匀	51	20	?	?
?	不均匀	7	81	?	?
环状增强		?	?	29.434	<0.01
?	完全	17	1	?	?
?	不完全或无	41	100	?	?
始增时间		?	?	3.074	>0.05
?	早于或等于	49	73	?	?
?	晚于	9	28	?	?
达峰时间		?	?	7.375	<0.01
?	早于或等于	41	49	?	?
?	晚于	17	52	?	?
弹性评分		?	?	50.887	<0.01
?	1~3分	42	16	?	?
?	4~5分	16	85	?	?

超声指标	变量名	赋值说明
增强强度	X₁	高增强或等增强=0，低增强=1
增强均匀度	X₂	均匀=0，不均匀=1
环状增强	X₃	完全=0，不完全或无=1
始增时间	X₄	早于或等于周边组织=0，晚于周边组织=1
达峰时间	X₅	早于或等于周边组织=0，晚于周边组织=1
弹性评分（分）	X₆	1~3 =0，4~5 =1
甲状腺结节病理结果	Y	良性=0，恶性=1

超声指标	变量名	赋值说明
增强强度	X₁	高增强或等增强=0，低增强=1
增强均匀度	X₂	均匀=0，不均匀=1
环状增强	X₃	完全=0，不完全或无=1
始增时间	X₄	早于或等于周边组织=0，晚于周边组织=1
达峰时间	X₅	早于或等于周边组织=0，晚于周边组织=1
弹性评分（分）	X₆	1~3 =0，4~5 =1
甲状腺结节病理结果	Y	良性=0，恶性=1

变量		β	S_E	Wald	df	P	Exp（β）	95.0% CI for Exp（β）
联合诊断		?	?	?	?	?	?	?
?	X₂	2.897	0.560	26.734	1	0.000	18.122	6.043~54.350
?	X₃	3.401	1.209	7.916	1	0.005	29.988	2.806~320.478
?	X₆	1.785	0.509	12.323	1	0.000	5.960	2.200~16.148
常量		-4.809	1.245	14.921	1	0.000	0.008	-
超声造影		?	?	?	?	?	?	?
?	X₂	3.414	0.535	40.708	1	0.000	30.389	10.647~86.736
?	X₃	3.794	1.192	10.131	1	0.001	44.444	4.297~459.707
常量		-4.396	1.208	13.249	1	0.000	0.012	-

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