To investigate the differential diagnostic value for thyroid rich blood supply lesions by contrast-enhanced ultrasound (CEUS).

From February 2016 to January 2015, patients who suffered with thyroid nodules underwent conventional ultrasound and CEUS before biopsy. Sixty-two lesions with high-enhancement features were included in the final data. The enhancement patterns within and around lesions of CEUS were analyzed, and the high-enhancement ranges were compared with lesions sizes displayed on conventional ultrasound imaging. When pathology was regarded as the golden standard, 39 nodules of 62 were benign, and 23 were malignant. The difference of CEUS characteristics between benign and malignant lesion was compared using χ² test.

The homogeneity or not had significant difference between benign and malignant lesions with high-enhancement features (χ²=9.78, P=0.002). The features of high-enhancement with cystic area and uneven distribution of high-enhancement area had significant difference between benign and malignant lesions (χ²=10.77, P=0.001), and the former were frequently seen in benign lesions. Peripheral regular and irregular rings had significant difference between the benign and malignant lesions (χ²=24.33, P<0.001). All lesions showed large high-enhancement area were malignant (χ²=6.52, P=0.01). The diagnostic sensitivity, specificity and accuracy of CEUS were 95.83%, 78.95% and 85.48% for thyroid rich blood supply lesions, which were better than those of conventional ultrasound (87.5%, 68.42%, 75.81%).

There are different features in CEUS between the benign and malignant thyroid lesions with rich blood supply. Heterogeneous high-enhancement, peripheral irregular rings and extensive high-enhancement area were malignant features.