ABSTRACT Objective To investigate the value of 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules (C-TIRADS) combined with angio plus planwave ultrasensitive imaging (AP) technology in the differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas. Methods A total of 234 patients who received treatment in the Xiangzhou District People's Hospital and the Fifth Affiliated Hospital of Sun Yat-sen University from May 2020 to November 2022 were prospectively included. There were 234 thyroid nodules, which were divided into MTN group (112 cases) and PTC group (122 cases) according to ultrasonic follow-up and pathological results, and the two-dimensional ultrasound features and AP blood flow grading were analyzed. All the nodules were classified based on C-TIRADS with or without AP technology, and the ROC curve was constructed to analyze the diagnostic efficacy of C-TIRADS combined with AP technology for MTN and PTC. Results There were statistically significant differences in markedly hypoechoic, vertical orientation and comet-tail artifacts between the MTN and PTC groups (P＜0.05) . The blood flow of MTN was mainly grade 0 to I, while that of PTC was mainly grade II to III, and the difference was statistically significant (P＜0.05). After correction with AP technology, C-TIRADS could better distinguish MTN and PTC (2 =155.564，P＜0.05). The area under curve (0.928), sensitivity (85.25%), specificity (95.54%), accuracy (90.17%), positive predictive value (95.41%) and negative predictive value (85.60%) of C-TIRADS combined with AP technology were higher than those of C-TIRADS (P＜0.05). Conclusion AP technology can clearly show the blood flow characteristics in thyroid nodules, which combined with C-TIRADS can significantly improve the differential diagnostic ability of MTN and PTC, and is helpful to reduce misdiagnosis.