Abstract: Abstract: Objective To explore the diagnostic value of multimodal ultrasound imaging in evaluating the moderate and highly suspected malignant thyroid nodules. Methods Multimodal ultrasound imaging, including two-dimensional ultrasound (US), superb microvascular imaging (SMI) and shear wave elastography (SWE), were performed in 323 moderate and highly suspected malignant thyroid nodules according to the 2015 American Thyroid Association (ATA) guideline. The diagnostic effects of SMI, SWE, US, and SMI combined with SWE and US were calculated using the ROC curve on the basis of the results of pathological results. Results The vascular distribution pattern of malignant thyroid nodules was mainly perforator vessel, the numbers of benign and malignant nodules determined by surgical pathology were 205 (63.5%) and 118 (36.5%). The vascular distribution pattern of malignant thyroid nodules was mainly perforating vessels, and the SWV values of benign nodules were less than those of malignant nodules (P＜0.05). The sensitivity, specificity, accuracy positive predictive value, negative predictive value and Youden index of SMI combined with SWE and US were 95.7%, 92.7%, 93.8%, 91.9%, 95.0% and 0.884, which were significantly higher than those of the single diagnostic modes, and the necessary FNA rates of multimodal ultrasound imaging were 24.1% and 3.5%. Conclusion Multimodal ultrasound imaging could provide comprehensive information regarding the thyroid nodule, which is helpful to improve the diagnostic value of the moderate and highly suspected malignant thyroid nodules.

Key words: thyroid nodule, thyroid neoplasms, ultrasonography, endoscopic ultrasound-guided fine needle aspiration, superb microvascular imaging, shear wave elastography