TI-RADS诊断标准结合超声弹性成像技术对甲状腺结节良恶性鉴别诊断的价值

Combination of TI-RADS and Ultrasonic Elastography in Differentiation of Thyroid Nodules

目的探讨甲状腺影像学报告及数据系统(TI-RADS)诊断标准与超声弹性成像(UE)技术对甲状腺结节良恶性诊断的价值。方法选取125例甲状腺结节患者共190个病灶(良性133个,恶性57个),以结节直径为10 mm为界分为两组,行常规超声检查以及UE检查。所有病灶按照TI-RADS评分标准进行评分,并经手术病理证实,以病理检查结果为金标准,构建受试者工作特征曲线(ROC曲线),比较TI-RADS与UE对甲状腺结节良恶性的鉴别诊断价值。结果 UE的灵敏度、特异度及准确度分别为88%、92%和91%,TI-RADS的敏感度、特异度及准确度分别为72%、84%和81%,弹性成像对甲状腺结节诊断的灵敏度、准确度要高于TI-RADS,差异有统计学意义(P<0.05);两种方法结合后,其敏感度、特异度及准确度均高于单一检查方法。UE评分法与TI-RADS诊断标准的曲线下面积分别为0.926和0.869,差异有统计学意义(P<0.01);两种方法结合后曲线下面积为0.973,诊断价值高于单一方法 (P<0.01)。在结节直径≤10 mm组中,UE的诊断准确度高于TI-RADS(P<0.05),而在结节直径>10mm组中,TI-RADS诊断准确度高于UE(P<0.05)。结论 UE对甲状腺结节良恶性的诊断准确率高于TI-RADS标准,对于不同大小的结节,两种方法可以起到相互补充的作用,两者结合能够提高甲状腺结节良恶性的诊断。

Objective To investigate the value of combination of TI -RADS and ultrasonic elastography （UE） in the differentiation of thyroid nodules. Methods 125 patients with 190 nodules （133 benign, 57 malignant） in the study were di- vided into two groups according to whether the diameter of nodules were larger than 10 mm or not. The nodules were examined by ultrasound and UE. The nodules were graded by TI - RADS and proved by pathologic findings. Receiver operating characteristic curve （ROC） was established by taking pathologic findings as golden standard to compare the value of TI - RADS and UE in dif- ferentiation of thyroid nodules. Results The sensitivity, specificity and accuracy of UE were 88%, 92%, and 91% respec- tively, significantly higher than those of TI - RADS, which were 72%, 84%, and 81% （P 〈0. 05）. The combination of the two methods could bring higher sensitivity, specificity and accuracy than single method. The areas under the curve （AUC） were 0. 926 and 0. 869 respectively for UE and TI - RADS, and the difference was statistically significant （P 〈 0. 01 ）. The AUC for the combination of the two methods was 0. 973, with significantly higher diagnosis accuracy than single method （P 〈 0. 01 ）. In the nodule diameters ~〈 10 mm group, diagnostic accuracy of UE was significantly higher than T[ - RADS （P 〈0.05）, while in the nodule diameters 〉 l0 mm group, diagnostic accuracy of TI - RADS was significantly higher than UE （P 〈 0.05）. Conclu- sion Diagnostic value of UE was better than TI - RADS. The two methods can mutually complement each other in diagnosing thy- roid nodules with different diameters. The combination of TI - RADS and UE could improve the differentiation of thyroid nodules.