超声结合CT对结节性甲状腺肿良恶性的鉴别诊断价值

The Differential Diagnostic Value of Ultrasound Combined with CT on Assessing Characteristic of Thyroid Nodules with Nodular Goiter

[目的]评价超声和CT检查对结节性甲状腺肿良恶性的鉴别诊断价值。[方法]选取52例患者共137个病灶,术前均行常规超声和CT检查,两种检查时间相隔0~14d,主要对结节性甲状腺肿良恶性病灶和颈部淋巴结转移进行对比分析,所有病灶均经手术病理证实,以病理检查结果为金标准,绘制受试者工作特征曲线（ROC曲线）,计算曲线下面积,比较两种方法的诊断准确性。[结果]超声对甲状腺恶性结节诊断的灵敏度、特异性及准确率分别为74.55%、83.95%和79.56%,CT的灵敏度、特异性及准确率分别为64.29%、76.54%和71.53%,超声对恶性结节的诊断准确率显著高于CT（χ2=4.000,P=0.046）;超声和CT的ROC曲线下面积分别为0.786和0.704,两种方法结合后曲线下面积为0.802;结节合并有粗大钙化时,CT诊断准确率（96.00%）要高于超声（72.00%）,两者之间差异有统计学意义（χ2=4.167,P=0.041）;在颈部中央组（Ⅵ区）淋巴结转移方面,CT检查显示率（68.75%）高于超声检查（43.75%）,两者间无显著性差异（χ2=1.500,P=0.221）。[结论]超声对结节性甲状腺肿恶性结节的诊断准确率高于CT,但对于合并有粗大钙化及颈部中央组（Ⅵ区）转移方面的诊断,CT在一定程度上优于超声,是超声的有力补充,两者结合是有效提高诊断准确性的良好方法,对术前评估具有重要的临床价值。

[Purpose] To investigate the differential diagnostic value of ultrasound（US） combined with CT on assessing the characteristic of thyroid nodules with nodular goiter.[Methods] Fifty-two patients with 137 nodules were enrolled in this study.The US and CT examination were performed for all of the nodules preoperation and the time interval between these two examinations was about 0~14d.The characteristic of the thyroid nodules and the metastatic cervial lymph nodes was analyzed.Surgical resection was performed for all of the nodules and the pathologic diagnosis was ＂gold standard＂.The receiver operating characteristic（ROC） curves of US,CT and US combined with CT were draw to compare the accuracy of these two modalities.[Results] The sensitivity,specificity and accuracy for diagnosing the malignant thyroid nodules was 74.55%,83.95% and 79.56% by US and 64.29%,76.54% and 71.53%by CT respectively.The accuracy of US for diagnosing the malignant thyroid nodules was higher than that of CT significantly（χ2=4.000,P=0.046）.The under curve area of US,CT and these combination was 0.786,0.704 and 0.802 respectively.For the nodules with massive calcifications,the accuracy of CT（96.00%） was higher than that of US（72.00%） significantly（χ2=4.167,P=0.041）.Additionally,the detected rate of metastatic lymph nodes in the lever Ⅵ by CT（68.75%） was higher than that by US（43.75%） significantly（χ2=1.500,P=0.221）.[Conclusion] For diagnosing the thyroid nodules with nodular goiter,US is more accurate than CT.However,CT is superior to US when the nodules with massive calcifications and to detect the metastatic lymph nodes in lever Ⅵ.It is helpful to combine these two modalities for more accurate diagnosis and there is important clinical value for the preoperative evaluation.