多普勒血流动力学指标诊断甲状腺乳头状癌颈部淋巴结转移的价值

Value of CDFI hemodynamic parameters in diagnosing cervical lymph node metastasis of papillary thyroid carcinoma

目的探讨利用CDFI血流动力学指标诊断甲状腺乳头状癌(PTC)颈部淋巴结转移的价值。方法收集47例经手术病理证实的单侧PTC患者,根据有无颈部淋巴结转移分为转移组(n=30)和无转移组(n=17)。回顾性分析术前CDFI检查资料,观察病灶血流分布情况,进行Adler血流分级,测算肿瘤血管收缩期峰值血流速度(PSV)、收缩期加速时间(AT)、阻力指数(RI)及搏动指数(PI),分析上述血流动力学指标与PTC颈部淋巴结转移的相关性,并绘制ROC曲线,分析利用RI和PI诊断PTC颈部淋巴结转移的最佳界值。结果①转移组与无转移组Adler血流分级均以2、3级为主。两组间CDFI血流检出率及2、3级血流信号检出率的差异均无统计学意义(P均>0.05)。②转移组PSV、RI及PI均明显高于无转移组(P均<0.01),而两组间AT差异无统计学意义(P>0.05)。PSV、RI及PI均与颈部淋巴结转移个数呈正相关(r=0.58、0.64、0.60,P均<0.01),AT与颈部淋巴结转移个数无相关性(r=0.38,P>0.05)。③对PTC颈部淋巴结转移的最佳诊断界值:RI为0.74,PI为1.09。结论 CDFI检查可用于术前评估PTC患者伴发颈部淋巴结转移的可能性,为制定手术方案提供依据。

Objective To explore the value of hemodynamic parameters obtained with CDFI in diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma（PTC）.Methods A total of 47 PTC patients confirmed with operation and pathology were enrolled and divided into metastasis group（n=30） and non-metastasis group（n=17） according to whether there was cervical lymph node metastasis.Preoperative Doppler image data were retrospectively analyzed.The blood flow distribution of the lesions was observed and the classification with Adler grades of blood flow was done.Secondly,the parameters,including peak systolic velocity（PSV）,systolic acceleration time（AT）,resistance index（RI） and pulsative index（PI） were measured and calculated.Correlation analysis between the parameters and metastasis was performed.Furthermore,the optimum critical values of RI and PI in assessing PTC cervical lymph node metastasis were analyzed by ROC curve.Results ①There were rich blood flows in both metastasis and non-metastasis groups with the major Adler grades as 2 and 3.No statistical difference was found in the detection rate of blood flow,nor in displaying rate of 2 and 3 Adler grades flow signals between the two groups（both P0.05）.②PSV,RI and PI in metastasis group were higher than those in non-metastasis group（all P0.01）,while there was no statistical difference of AT（P0.05）.In addition,PSV,RI and PI positively correlated with the number of metastasized lymph nodes（r=0.58,0.64 and 0.60,all P0.01）,but no statistical correlation of AT was found（r=0.38,P0.05）.③The optimum critical values of RI and PI was 0.74 and 1.09,respectively.Conclusion CDFI can be used to evaluate the possibility of cervical lymph node metastasis in PTC patients and provide evidence for formulating operation plans.