超声新技术在甲状腺良恶性结节诊断中的价值

Use of Conventional Ultrasound, Contrast-enhanced Ultrasound, Shear Wave Elastography for the Differential Diagnosis of Benign and Malignant Thyroid Nodules

【目的】探讨常规超声、超声造影、剪切波弹性成像超声在甲状腺结节良恶性鉴别诊断中的应用价值。【方法】对本院内分泌科门诊的45例甲状腺结节患者行常规超声、超声造影及剪切波弹性成像超声检查,以病理结果为诊断良恶性的金标准,绘制受试者工作曲线,分析3种不同超声检查方法单独或联合应用对甲状腺结节良恶性的诊断价值。【结果】常规超声、超声造影及剪切波弹性成像3种超声学检查方法在甲状腺结节良恶性鉴别中均具有应用价值。单独应用时,剪切波弹性成像超声的诊断效能最高,最大曲线下面积(AUC)=0.850、敏感性=90.0%、特异性=80.0%、准确性=82.2%。常规超声次之,AUC=0.721、敏感性=70.0%、特异性=74.3%、准确性=73.3%。超声造影的诊断效能最低,AUC=0.708、敏感性=66.7%、特异性=75.0%、准确性=73.2%。常规超声联合剪切波弹性成像、超声造影联合剪切波弹性成像都可以将敏感性提升至100%,其中以"常规超声联合剪切波弹性成像"诊断的特异性最高,达85.7%。【结论】剪切波弹性成像超声鉴别甲状腺良恶性结节的敏感性和特异性均较高;常规超声与剪切波弹性成像联合应用可能进一步提高诊断价值。

[Objective] To evaluate the efficiency of conventional ultrasound （CUS）, contrast-enhanced ultrasound （CEUS）, shear wave elastography （SWE）, and their different combinations for the differential diagnosis of benign and malignant thyroid nodules. [ Methods ] 45 patients were recruited from the out-patient clinic of the first affiliated hospital of Sun Yat-Sen University. The predictive value of conventional US, CEUS, and SWE were collected and compared with pathology of core needle biopsy or surgery. [Results ] A total of 35 benign and 10 malignant lesions were analyzed. Characteristics of SWE （cutoff, 39.3 kPa） were： sensitivity = 90.0%, and specificity = 80.0%. The AUC was 0.850. Characteristics of the CUS Score were ： sensitivity = 70.0%, and specificity = 74.3%. Characteristics of the CEUS Score were： sensitivity =66.7%, and specificity =75.0%. When used in combination, ＂conventional US or SWE＂ and ＂CEUS or SWE＂ both gained a sensitivity of 100%. The combination of ＂conventional US and SWE＂ improved the specificity to 85.7%. [Conclusion] SWE may be the most efficient sonographic technique for evaluation of thyroid nodules, and the combination of conventional US and SWE in an ＂and＂ / ＂or＂ rule may bring further improvement of specificity and sensitivity in the differential diagnosis of benign and malignant thyroid nodules.