二维超声联合超声造影鉴别甲状腺良恶性结节

Two Dimensional Ultrasonograhy(2D-US) Combined with Contrast Enhanced Ultrasonogrphy(CEUS) in Differentiation of Thyroid Malignant and Benign Masses

目的评估二维灰阶超声(2D-US)联合超声造影(CEUS)鉴别甲状腺良、恶性结节的价值。方法分析2011年11月～2012年11月期间,经手术病理证实的42例甲状腺癌患者47个恶性结节及45例甲状腺良性肿块患者53个良性结节的二维超声诊断结果及超声造影结果,评估二维灰阶超声、超声造影及二者联合诊断甲状腺癌的价值。结果恶性结节CEUS增强模式:早期低增强7个,全程低增强36个,等增强3个,高增强1个;良性结节增强模式:早期低增强4个,全程低增强11个,等增强28个,高增强10个。2D-US甲状腺恶性结节诊断结果:恶性26个,性质待定20个,良性1个;良性结节诊断结果:恶性1个,性质待定8个,良性44个。超声造影以早期低增强及全程低增强诊断甲状腺癌敏感度、特异性及准确性分别为91.5%、71.7%、81.0%;2D-US诊断甲状腺癌敏感度、特异性及准确性分别为55.3%、83.0%、70%;二者联合诊断甲状腺癌的敏感度、特异性及准确性分别为89.4%、90.1%、90.0%。结论超声造影诊断甲状腺癌具有较高的敏感度,而二维灰阶超声则具有较高的特异性,二者联合可进一步提高超声鉴别甲状腺良、恶性肿块的能力。

Objective To evaluate the diagnostic value of 2D - US combined with CEUS in differentiating between thyroid malignant masses and benign masses. Methods Forty two patients with 47 thyroid malignant masses and 45 patients with 53 benign nodules were enrolled into this retrospective study from November 2011 to November 2012. 2D -US diagnostic results and CEUS enhancement patterns of nodules were analyzed. The diagnostic yield of 2D - US and CEUS, and combination of them were assessed for differentiating between the malignant and benign thyroid masses. Results In CEUS enhancement patterns of 47 malignant nodules,7 were with early hypoen- hancement, 36 with whole - phase hypoenhaneement, 3 with isoenhancement, 1 with hyperenhancement. In CEUS Enhancement patterns of 53 benign nodules, 4 with early hypoenhancement, 11 with whole- phase hypoenhancement, 28 with isoenhancement, 10 with hyper- enhancement. There was a significant difference between malignant and benign enhancement patterns of thyroid nodules （χ^2= 40. 886 ,P = 0. 000）. 2D - US diagnostic results of 47 malignant nodules, 26 were malignant nodules, 20 unidentified nodules, 1 benign nodule. In 2D -US diagnostic results of 53 malignant nodules, 1 was malignant nodules, 8 were unidentified nodules, 44 benign nodules. Early hy- poenhancement and whole -phase hypoenhancement pattern predicted thyroid malignant nodules with sensitivity of 91.5% （43/47） , spe- cificity of 71.7 % （ 38/53 ） , and accuracy of 81.0 % （ 81/100 ）. 2D - US diagnosed malignant nodules with sensitivity of 55.3 % （26/47） , specificity of 83.0% （44/53） , and accuracy of 70% （70/100）. The combination of 2D -US and CEUS diagnosed thyroid malignant nod- ules with sensitivity of 89.4% （42/47）, specificity of 90.1% （48/53）, and accuracy of 90.0% （90/100）. Conclusion CEUS had high- er sensitivity for the diagnosis of thyroid carcinoma, and 2D - US had higher specificity, and the combination of 2D - US and CEUS could improve the capability of differentiation of thyroid malignant and benign nodules.