实时超声弹性成像诊断甲状腺单发实性小结节

Diagnosis of small single solid thyroid nodule with real-time ultrasound elastography

目的探讨实时超声弹性成像对常规超声可疑恶性甲状腺结节的鉴别诊断价值。方法对51例甲状腺单发实性小结节患者首先行灰阶超声检查,观察结节大小、形态、边界、内部回声、有无钙化、晕环等;再采用彩色能量多普勒超声观察结节内有无彩色血流及其分布;然后在纵切面进行实时弹性成像,将弹性图分为Ⅰ～Ⅴ级。将超声诊断结果与病理结果进行对照。结果超声弹性成像结果:Ⅰ、Ⅱ级共6例患者,均为良性;Ⅲ级9例(6例良性,3例恶性);Ⅳ、Ⅴ级共36例(34例恶性,2例良性)。以弹性分级Ⅳ～Ⅴ级为高度恶性预测指标,其灵敏度为91.89%,特异度85.71%,准确率90.20%,阳性预测值94.44%,阴性预测值80.00%,明显高于灰阶和彩色能量多普勒超声(χ2=16.252,P<0.001)。结论实时超声弹性成像对常规超声发现可疑恶性的甲状腺单发实性小结节的鉴别诊断有很大的帮助。

Objective To assess the diagnostic value of ultrasonographic elastography for identifying suspected malignant thyroid nodules.Methods Fifty-one patients with small single solid thyroid nodule underwent two-dimensional and color power Doppler ultrasonography.The size,shape,boundary,internal echo and halo,calcification of thyroid nodule were observed with two-dimensional ultrasound.Then color Doppler ultrasonography was used to detect blood signal and distribution in the nodules.Longitudinal scanning of elastography was performed,and the findings on elastography were classified into Ⅰ-Ⅴ grades.The ultrasonographic results were compared with pathologic findings.Results Six patients were found with grade Ⅰ and Ⅱ benign lesions;9 with grade Ⅲ（6 benign and 3 malignant）,36 with Ⅳ and Ⅴ（2 benign and 34 malignant）lesions on ultrasonographic elastography.Taking the elasticity grade Ⅳ or Ⅴ as malignant standard,the diagnostic sensitivity was 91.89%,specificity was 85.71%,accuracy was 90.20%,while the positive and negative predictive value was 94.44% and 80.00%,respectively.Conclusion Real-time ultrasound elastography is a promising imaging technique that can assist in the differential diagnosis of malignant thyroid small single solid nodule.