高分辨率超声、超声弹性成像及超声造影在甲状腺结节良恶性病变诊断中的比较研究

A comparative study of high resolution ultrasound, ultrasound elasticity imaging, and contrast-enhanced ultrasound in the differential diagnosis of benign and malignant lesions in thyroid nodules

目的 确定高分辨率超声、超声弹性成像和超声造影鉴别甲状腺结节良恶性病变的诊断指标,评估其临床应用价值.方法 选取行手术治疗的甲状腺结节患者63例,术前予高分辨率超声、弹性成像和造影检查.根据术后病理结果区分良恶性病变,筛选有价值的检测指标,构建受试者工作特征曲线确定诊断标准.结果 (1)高分辨率超声中有意义的指标为结节低回声、结节回声不均、边界不清、形态不规则、纵横比≥1以及结节内细小点状钙化(均P＜0.05).(2)超声弹性成像分级评分在良恶性病变之间差异有显著统计学意义(P＜0.05).(3)超声造影有意义的指标为强化边界不清和强化形态不规则(均P＜0.05).(4)高分辨率超声的诊断标准为符合6个指标中的任意3个,敏感性80.0％,特异性77.6％,准确性78.6％.弹性成像诊断标准为弹性评分≥3分,敏感性48.6％,特异性83.7％,准确性69.0％.超声造影的诊断标准为符合2个指标中任意1个,敏感性68.6％,特异性82.5％,准确性为76.0％.结论 在甲状腺结节良恶性病变的鉴别诊断中,高分辨率超声具有较高的敏感性和准确性,超声弹性成像和超声造影的特异性较高.

Objective To determine the diagnostic criteria of high resolution ultrasound,ultrasound elasticity imaging,and contrast-enhanced ultrasound in the differential diagnosis of benign and malignant lesions in thyroid nodules and assess their clinical efficacy.Method Sixty-three patients with thyroid nodules underwent high resolution ultrasound,elasticity imaging,and contrast-enhanced ultrasound examinations before surgery.Distinguishing benign from malignant lesions was based on pathological results.Valuable indicators from the examinations were screened and patients' occupational characteristic curves were made.Results (1) The significant indicators of high resolution ultrasound in differential diagnosis of thyroid nodules were hypoechoic nodules,uneven echo,ill-defined,irregular shape,aspect ratio ≥ 1 and punctate calcification within the nodule (P＜0.05).(2) The elastosonography grading score had significant differences between benign and malignant lesions (P＜0.05).(3) The meaningful indicators of contrast-enhanced ultrasound were the unclear enhanced border and the irregular enhanced shape (P＜0.05).(4) The diagnostic criteria of high-resolution ultrasound met any three of six indicators,with the sensitivity,specificity,and accuracy of 80.0％,77.6％,and 78.6％ respectively.The diagnostic criterion of elastography was the elasticity score ≥ 3 points,with the sensitivity,specificity,and accuracy were 48.6％,83.7％,and 69.0％ respectively.The diagnostic criteria of contrast-enhanced ultrasound were complying with any one of two indicators,with the sensitivity,specificity,and accuracy of 68.6％,82.5％,and 76.0％ respectively.Conclusions The high-resolution ultrasound may yield higher sensitivity and accuracy in the differential diagnosis of benign and malignant lesions in thyroid nodules,while ultrasound elasticity imaging and contrast-enhanced ultrasound may offer a higher specificity.