超声弹性成像技术对桥本甲状腺炎合并良、恶性结节的鉴别诊断价值

Differential diagnosis value of ultrasound elastography in Hashimoto's thyroiditis with benign and malignant nodules

目的探讨超声弹性成像技术在桥本甲状腺炎合并良恶性结节鉴别诊断中的价值。方法选择2013年1月至2015年12月江山市中医院收治的桥本甲状腺炎合并恶性结节21例(25个结节)和良性结节52例(76个结节)为研究对象。所有结节均进行彩色多普勒超声检查和超声弹性成像检查。结果恶性组患者结节中边界清楚、形态规则、非低回声、无钙化或粗钙化、阻力指数(RI)值<0.70、血流信号0~Ⅰ级所占比例(32.0%、24.0%、12.0%、40.0%、32.0%、24.0%)均低于良性组(80.3%、51.3%、47.4%、97.4%、60.5%、51.3%)(χ^2=20.245、5.682、9.928、44.228、6.153、5.682,P=0.000、0.017、0.002、0.000、0.013、0.017)。二维彩色多普勒超声诊断桥本甲状腺炎合并良恶性结节的敏感性为68.0%,特异性为75%,诊断准确性为73.2%。以超声弹性图分级≥Ⅲ级为恶性结节预测指标,超声弹性成像诊断桥本甲状腺炎合并良恶性结节的敏感性为88.0%,特异性为69.7%,诊断准确性为74.3%。以超声弹性成像应变率比值=5.13为截断点,超声弹性成像应变率比值诊断桥本甲状腺炎合并良恶性结节的敏感性为76.0%,特异性为92.1%,诊断准确性为88.1%。结论超声弹性图分级和超声弹性成像应变率在桥本甲状腺炎合并良恶性结节的鉴别诊断中具有一定价值。

Objective To investigate the differential diagnosis value of ultrasound elastography in Hashimoto's thyroiditis with benign and malignant nodules. Methods From January 2013 to December 2015, 21 patients(25 nodules) with Hashimoto's thyroiditis and malignant nodules and 52 patients(76 nodules) with benign nodules in Jiangshan Hospital of Traditional Chinese Medicine were studied.All nodules were detected by color Doppler ultrasound and ultrasound elastography. Results The proportion of boundaries clear, morphological rules, non-low-echo, no calcification or coarse calcifications, RI value <0.70, blood flow grade 0-Ⅰin patients with malignant nodules(32.0%, 24.0%, 12.0%, 40.0%, 32.0%, 24.0%) were lower than those of the benign group(80.3%, 51.3%, 47.4%, 97.4%, 60.5%, 51.3%)(χ^2=20.245, 5.682, 9.928, 44.228, 6.153, 5.682, P=0.000, 0.017, 0.002, 0.000, 0.013, 0.017). The sensitivity, specificity and diagnostic accuracy of two-dimensional color Doppler ultrasound in diagnosing Hashimoto's thyroiditis with malignant and benign nodules were 68.0%, 75.0% and 73.2%, respectively.The ultrasound elastography ≥Ⅲ grade level was as the predictor of malignant nodules, the sensitivity, specificity and diagnostic accuracy of ultrasound elastography in diagnosing Hashimoto's thyroiditis with benign and malignant nodules were 88.0%, 69.7% and 74.3%, respectively.The ultrasound elastography strain rate ratio=5.13 was the cut-off point, the ultrasound elastography strain rate ratio in diagnosing Hashimoto's thyroiditis with benign and malignant nodules, the sensitivity was 76.0%, the specificity was 92.1%, the diagnostic accuracy was 88.1%. Conclusion Ultrasound elastography grading and ultrasound elastography strain rate have certain value in the differential diagnosis of Hashimoto's thyroiditis with malignant and benign nodule.