超声造影定量分析在甲状腺良恶性结节鉴别诊断中的应用价值

Quantitative assessment of thyroid nodules in the differential diagnosis by contrast-enhanced ultrasonography

目的分析甲状腺良恶性结节超声造影(CEUS)增强模式及时间-强度曲线(TIC)特点,探讨CEUS定量分析在鉴别甲状腺良恶性结节中的应用价值。方法对青岛大学医学院附属医院拟行甲状腺占位切除手术的44例患者62个结节术前行CEUS,观察结节CEUS增强模式,并应用TIC分析结节血流灌注参数,包括峰值强度(Peak)、达峰时间(Tp)、曲线下面积(AUC)及造影剂平均通过时间(MTT)。采用两独立样本t检验比较甲状腺恶性结节与甲状腺良性结节、甲状腺恶性结节与病灶周围正常甲状腺组织、甲状腺良性结节与病灶周围正常甲状腺组织CEUS定量参数Peak、Tp、AUC及MTT差异。结果手术病理结果证实,62个结节中,结节性甲状腺肿31个,甲状腺腺瘤4个,甲状腺乳头状癌27个。结节性甲状腺肿CEUS多表现为整体均匀性增强(27/31);甲状腺乳头状癌CEUS以非均匀性增强为主(24/27),且均形态不规则,边界不清晰;甲状腺腺瘤CEUS多表现为典型的高增强、快进慢退(3/4)。甲状腺恶性结节Peak、AUC均低于甲状腺良性结节[(12.80±4.81)%vs(23.53±4.87)%,(816.61±336.32)%.svs(1757.49±586.17)%.s],Tp晚于甲状腺良性结节[(40.16±7.07)svs(31.75±16.67)s],且差异均有统计学差异(t=-8.409,P=0.000;t=-7.348,P=0.000;t=2.555,P=0.014),但MTT差异无统计学意义[(59.09±6.37)svs(57.84±16.66)s,t=0.387,P=0.701]。甲状腺恶性结节Peak、AUC均低于病灶周围正常甲状腺组织[(12.80±4.81)%vs(22.16±3.34)%,(816.61±336.32)%.svs(1808.20±306.31)%.s],Tp晚于病灶周围正常甲状腺组织[(40.16±7.07)svs(31.84±5.37)s],且差异均有统计学意义(t值分别为-8.295、4.870、-11.327,P均为0.000),但MTT差异无统计学意义[(59.09±6.37)svs(56.18±5.05)s,t=1.859,P=0.069]。甲状腺良性结节与病灶周围正常甲状腺组织相比,Peak、AUC稍低[(23.55±4.73)%vs(25.53±3.81)%,(1766.46±552.37)%.svs(1899.73±489.89)%.s],Tp稍快[(31.85±15.84)svs(32.86±15.84)s],MTT稍慢[(57.91±15.95)svs(54.90±17.42)s],但差异均无统计学意义(t值分别为-1.783、-0.989、-0.249、0.708,P均>0.05)。结论甲状腺良恶性结节CEUS特征不同,TIC定量参数中AUC及Peak可作为甲状腺良恶性结节鉴别诊断中值得重视的参考指标。

Objective To investigate the application value for quantitative analysis of contrast-enhanced ultrasound(CEUS) in the diagnosis of thyroid nodules.The enhancement patterns and characteristics of time-intensity curve(TIC) were assessed.Methods Forty-four patients who were treated in Qingdao Medical University Affiliated Hospital with 62 thyroid nodules were examined by CEUS.The enhancement patterns and perfusion parameters of TIC were assessed.The results of peak intensity(Peak),time to peak(Tp),the area under the curve(AUC),and mean transit time(MTT) in different groups were compared between two independent samples t-test(benign nodules vs malignant nodules,benign nodules vs surrounding normal tissue,and malignant nodules vs surrounding normal tissue).Results The 62 nodules included 31 nodular goiters,4 adenomas and 27 papillary carcinomas were confirmed by pathological examination.Most nodular goiters(27/31) enhanced completely and homogeneously,24 of the 27 malignant nodules enhanced heterogeneously,with irregular shape and vague boundary,3 of the 4 adenomas showed a fast fill-slow down and high-enhanced pattern.The Peak,AUC and Tp of malignant nodules were lower or slower than those of benign nodules[(12.80±4.81)% vs(23.53±4.87)%,(816.61±336.32)%·s vs(1757.49±586.17)%·s,(40.16±7.07)s vs(31.75±16.67) s],and all with a significant difference(t=-8.409,P=0.000;t=-7.348,P=0.000;t=2.555,P=0.014),but there was no difference in MTT between the two groups[(59.09±6.37) s vs(57.84±16.66) s,t=0.387,P=0.701].The Peak,AUC and Tp of malignant nodules were lower or slower than those of surrounding normal tissue[(12.80±4.81)% vs(22.16±3.34)%,(816.61±336.32)%·s vs(1808.20±306.31)%·s,(40.16±7.07) s vs(31.84±5.37) s],and all with a significant difference(t=-8.295,4.870,-11.327,all P=0.000),but there was no difference in MTT between the two groups[(59.09±6.37) s vs(56.18±5.05) s,t=1.859,P=0.069].There were no significant differences in all the parameters between benign nodules and surrounding normal areas(t=-1.783,-0.989,-0.249,0.708,and all P>0.05),though the Peak,AUC and MTT of the former group were a bit lower or slower than those of the latter group[(23.55±4.73)% vs(25.53±3.81)%,(1766.46±552.37)%·s vs(1899.73±489.89)%·s,(57.91±15.95) s vs(54.90±17.42) s ],the Tp of benign group was a little faster than that of normal group[(31.85±15.84)s vs(32.86±15.84) s].Conclusion Different kinds of thyroid nodules with different CEUS characteristics,in all quantitative parameters of TIC,AUC and Peak can be regarded as a significant reference item in the differentiation of malignant and benign thyroid nodules.