超声造影对甲状腺单发实性结节良恶性的诊断价值

Diagnostic value of contrast-enhanced ultrasonography in benign and malignant solitary thyroid nodule

目的探讨超声造影对甲状腺单发实性结节良恶性的诊断价值。方法 75例经病理证实为甲状腺单发实性结节,先行常规超声检查,后超声造影观察其增强特征和时间-强度曲线定量参数:峰值强度(Peak)、达峰时间(Tp)、曲线下面积(AUC)及造影剂平均通过时间(MTT),判断结节的良恶性。结果甲状腺良性结节造影后形态多规则,边界清晰,明显增强,分布均匀且无灌注缺损;恶性结节表现为形态不规则,边界不清,无明显增强,分布不均匀,可见灌注缺损;两者差异有统计学意义(P<0.05)。与常规超声比较,超声造影测量甲状腺良性结节大小差异无统计学意义,测量恶性结节直径较大(P<0.05)。与良性结节比较,恶性结节AUC和Peak降低,Tp延迟(P<0.05);两组MTT差异无统计学意义。以病理结果为金标准,超声造影诊断甲状腺良恶性结节的符合率为89.3%。结论甲状腺良恶性结节造影增强特征明显不同,定量参数Peak、AUC及Tp可作为甲状腺良恶性结节鉴别诊断中的参考指标。

Objective To explore diagnostic value of contrast-enhanced uhrasonography（CEUS） in benign and malignant solitary thyroid nodule. Methods Seventy-five patients with solitary solid thyroid nodules proved by pathology were examined using conventional uhrasonography. Enhanced characteristics of thyroid nodules, peak intensity（Peak）, time to peak（Tp）, area under the curve（AUC） and contrast agent mean transit time（MTT） were detected using CEUS to determine benign and malignant nodules. Results After CEUS, benign thyroid nodules showed regular shape, clear boundary, significant enhancement, homogeneous distribution and no perfusion defect. Malignant nodules showed irregular shape, obscure boundary, no obvious enhancement, uneven distribution and visible perfusion defect. There were significant differences between the two. There was no significant difference in measuring benign thyroid nodules between conventional ultrasonography and CEUS. Compared with conventional ultrasonography, measurement size of malignant nodules increased using CEUS （P〈0.05）. Compared with benign nodules, AUC and Peak of malignant nodules decreased, Tp of malignant nodules delayed （P〈0.05）. There was no significant difference in Mq＂F between the two groups. Pathological findings used as gold standard, coincidence rate of CEUS diagnosing benign and malignant thyroid nodules was 89.3%. Conclusion Contrast-enhanced characteristics are significantly different between benign and malignant thyroid nodules. In all quantitative parameters, Peak, AUC and Tp can be regarded as reference indexes in the differentiation of benign and malignant thyroid nodules.