超声造影及定量分析技术鉴别甲状腺实性肿块良恶性的价值

Value of contrast enhanced ultrasonography and quantitative analysis in differentiation of solid thyroid malignant and benign masses

目的评估甲状腺超声造影及定量分析技术鉴别甲状腺实性肿块良恶性的价值。方法对40例甲状腺实性肿块患者，共45个肿块行甲状腺超声造影检查，所有肿块性质均经粗针穿刺活检或手术病理证实。通过分析甲状腺良恶性肿块的超声造影增强表现及定量分析参数判断甲状腺超声造影鉴别良恶性肿块的价值。结果恶性肿块28个，无增强2个，早期低增强6个，低增强14个，等增强5个，高增强1个；良性肿块17个，超声造影表现低增强4个，等增强7个，高增强6个，甲状腺良恶性肿块增强方式有差别（Y2=12．184，P=0．016），以早期低增强及低、无增强判断甲状腺癌的敏感性、特异性分别为78．5％、76．5％。甲状腺定量分析参数鉴别甲状腺良、恶性肿块以病灶区相对峰值强度（IMAX％）价值最大；其ROC曲线下面积0．878，病灶区与参考区平均渡越时间比值（mTT—Ratio）、病灶区与参考区上升时间比值（RT—Ratio）、病灶区与参考区达峰时间比值（TTP—Ratio）诊断价值次之，其ROC曲线下面积分别为0．749、0．744、0．704，而病灶区上升时间（RT）、达峰时间（TTP）、平均渡越时间（mTT）诊断价值不大，其ROC曲线下面积分别为0．619、0．601、0．656。以IMAX％≤900A诊断甲状腺癌的敏感性、特异性分别为80．8％、82．6％。结论早期低增强及低、无增强为甲状腺实性恶性肿块较特异的超声造影表现；定量分析参数IMAX％鉴别甲状腺实性良、恶性肿块价值较大。

[Abstract] Objective To evaluate the diagnostic value of contrast enhanced ultrasonogrphy（CEUS） and quantitative analysis in differentiating between thyroid solid malignant masses and solid benign masses. Methods 40 patients with thyroid solid mass were enrolled into this prospective study between March 2012 and June 2012. A total of 45 thyroid solid masses were evaluated by CEUS,and the final pathology diagnosis was confirmed by core biopsy or thyroidectomy. The diagnostic yield of enhancement patterns and quantitative parameters were assessed for differentiating between the solid malignant and benign masses. Results Enhancement patterns were classified into five types （nonenhancement, early hypo enhancement, hypo enhancement, isoenhancement, hyperenhancement）. Two malignant masses had nonenhancement pattern,and 6 malignant masses had early hypoenhancement pattern,and 14 malignant and 4 benign masses had the hypo enhancement pattern,and 5 malignant and 7 benign masses had the isoenhancement pattern, and 1 malignant and 6 benign masses had the hyperenhancement pattern. There was a significant difference between malignant and benign enhancement patterns of thyroid solid masses （X2= 12. 184, P = 0. 016）. Nonenhancement,early hypoenhaneement and whole phase hypoenhancement pattern predict thyroid solid malignant masses with sensitivity of 78.5 % and specificity of 76.5 %. Among seven quantitative parameters used to predict thyroid malignant mass, the relative maximum intensity （IMAXG） of lesions had highest value in differentiating between the malignant and benign masses with sensitivity of 80.8 % and specificity of 82.6% ,and area under receiver operating curve （AUC） of the IMAX% was 0. 878. RT （rising time） ,TTP （time to peak intensity）, mTT （mean transit time） had almost non differentiation value with AUC of0. 619,0. 601,0. 656 separately. And mTT-Ratio （mTT of lesion/mTT of parametric area）, RT-Ratio （RT of lesion/RT of parametric area）,TTP-Ratio （TTP of lesion/TTP of parametric area） had less differential diagnostic value with AUC of 0. 749,0. 744,0. 704 comparing with IMAX%. Conclusions Nonenhancement and early or whole phase hypoenhancement could be characteristic enhancement pattern of malignant thyroid solid masses, and IMAX% had good diagnostic value in differentiating between malignant and benign masses among the quantitative parameters.