Abstract: Objective To investigate the correlation between elasticity score, strain ratio( SR) of real-time ultrasound elastrography ( RTE ) and microvessel density ( MVD ) in papillary thyroid carcinoma (PTC). Methods A retrospective study was performed on 54 cases(58 nodules)of patients with PTC who were admitted from January 2016 to December 2017. All patients underwent standard RTE examination pre-operatively, CD 34 immunohistochemical staining and MVD count were performed postoperatively. The nod-ules were divided into ≤10 mm,10 ~20 mm and >20 mm groups. The difference of elasticity score,SR and MVD in the three groups was compared,and the correlation between elasticity score,SR and MVD in PTC nodules was analyzed. Results Among the 58 PTC nodules,54 had elastic scores greater than or e-qual to 3 points(93. 1%),and the average SR value was(3. 6 ± 1. 3). There was no statistically significant difference between the maximum diameter ≤10 mm group,10 ~ 20 mm group and >20 mm group( P>0. 05). Among the 58 PTC nodules, the expression rate of CD 34 was 100%. Nodules of MVD in the 3 groups were(47. 7 ± 8. 8)/HP,(51. 1 ± 8. 5)/HP and(56. 1 ± 5. 8)/HP,respectively,with statistically significant differences(P<0. 05). In elastic score 2 points,3 points and 4 points PTC groups,mean MVD were (55. 6 ±9. 5)/HP,(53. 3 ± 7. 7)/HP and(43. 9 ± 6. 7)/HP,respectively. There were statistically significant difference in MVD among different score PTC groups(F =11. 642,P =0. 000). MVD in the 2 points group and 3 points group were all significantly higher than that in the 4 points group(P<0. 05), while there was no statistically significant difference in MVD between 2 points group and 3 points group (P>0. 05). PTC elastic score was negatively correlated with MVD,and the difference was statistically sig-nificant(r= -0. 567,P=0. 000);SR and MVD of PTC were also negatively correlated,with statistically significant differences(r= -0. 570,P=0. 000). Conclusion Both elasticity score and SR have signifi-cantly negative correlation with MVD in PTC nodules. RTE may have potential clinical value in predicting aggressiveness and prognosis of PTC preoperatively.