甲状腺结节超声诊断价值的探讨及最佳量化评分点的探寻

Clinical value and optimal diagnostic point of ultrasound in the diagnosis of thyroid lesions

目的探讨常规灰阶超声和超声造影联合诊断甲状腺良恶性结节的价值,探寻评分法诊断甲状腺结节的最佳量化评分点。方法回顾性分析经手术病理证实的178个甲状腺结节的超声表现,对常规灰阶超声显示的结节形状、生长方向、内部回声、周边暗环和微钙化5项指标和超声造影显示的结节周边及内部开始增强时间、结节周边及内部峰值强度、环状增强和增强均一度6项指标进行评分,每个指标阳性记为1分、阴性记为0分。分别绘制常规灰阶超声、超声造影及两者联合评分的受试者操作特点(ROC)曲线,获得三者诊断甲状腺良恶性结节的最佳量化评分点并评估其诊断价值。结果甲状腺良恶性结节的常规灰阶超声评分、超声造影评分、联合评分间差异均有统计学意义(Z=10.188、9.843、10.705,P均<0.001)。常规灰阶超声、超声造影及两者联合评分的ROC曲线下面积分别为0.936、0.919、0.964。甲状腺结节常规灰阶超声5项指标中3项或以上阳性提示恶性,敏感度和特异度分别为79.6%和91.2%;超声造影6项指标中2项或以上阳性提示恶性,敏感度和特异度分别为91.8%和81.2%;常规灰阶超声和超声造影11项指标中5项或以上阳性提示恶性,敏感度和特异度分别为93.6%和92.3%。结论常规灰阶超声和超声造影有助于甲状腺良恶性结节的鉴别诊断,两者联合使用时诊断价值最高,评分法诊断甲状腺结节的最佳量化评分点为5分。

Objective To discuss the combined value of gray-scale ultrasound(GSUS) and contrast-enhanced ultrasound(CEUS) in the diagnosis of benign and malignant thyroid lesions and to explore the optimal diagnostic point of scoring method.Methods Ultrasound images of 178 thyroid lesions confirmed by pathology were synthetically reviewed by scoring 5 GSUS indicators including shape,orientation,interior echogenicity,halo sign,microcalcification and 6 CEUS indicators including relative arrival time of microbubbles in the periphery and interior,peak periphery and interior echogenicity,peripheral ring-enhancement,and homogeneity of enhancement.One positive indicator scored one point.The optimal diagnostic points and their clinical value were explored according to ROC curves.Results Scores of GSUS,CEUS and the combination of GSUS and CEUS were significantly different(Z =10.188,9.843,10.705,all P <0.001).Areas under ROC curves of GSUS,CEUS and the combination of GSUS and CEUS were 0.936,0.919 and 0.964,respectively.Three or more positive GSUS indicators of five in a thyroid lesion predicted that the thyroid lesion was malignant,with the sensitivity of 79.6% and the specificity of 91.2%.Two or more positive CEUS indicators of six in a thyroid lesion predicted that the thyroid lesion was malignant,with the sensitivity of 91.8% and the specificity of 81.2%.Five or more positive GSUS and CEUS indicators of eleven in a thyroid lesion predicted that the thyroid lesion was malignant,with the sensitivity of 93.6% and the specificity of 92.3%.The areas under the ROC curve of GSUS and CEUS were 0.936 and 0.919.The area under the ROC curve of the combination of GSUS and CEUS was 0.964,larger than the areas under the GSUS ROC curve and the CEUS ROC curve.Conclusion Ultrasound is valuable in the differential diagnosis of benign and malignant thyroid lesions,and the combination of GSUS and CEUS is the most valuable with 5 points as the optimal diagnostic scoring method.