彩色多普勒超声对甲状腺恶性结节的诊断价值

The Diagnostic Value of Color Doppler Ultrasonography for Malignant Thyroid Nodules

目的:评价彩色多普勒超声(CDU)指数对甲状腺结节的临床诊断价值。方法:笔者使用CDU对2006-2013年于本院检查的650例患者的650个结节进行观察,其中510个为甲状腺恶性结节,140个为甲状腺良性结节,其中有436个可以测得阻力指数(RI)。所有结节均经超声引导下穿刺活检或手术病理证实。结果:在所有510个甲状腺恶性结节中,14%未探及明显血流,41%可探及少量血流,45%可探及丰富血流。140个甲状腺良性结节中,75个可探及少量血流(约占54%),65个可探及丰富血流(46%)。甲状腺恶性结节的RI(0.80±0.16)明显高于良性结节(0.60±0.12)(P<0.001)。对所有436个恶性结节的RI进行ROC曲线分析,结果将RI界值RI≥0.70时,曲线下面积最大,此时诊断恶性结节的敏感度为72.6%,特异性为83.6%,准确率为76.1%,阳性预测值为90.3%。将界值设为RI≥0.80时,诊断敏感性为48.6%,特异性为95.7%,准确率为63.8%,阳性预测值为96%。296例可测得RI的恶性结节中,根据结节最大径,将296个结节分为三组:dmax<1.0 cm组,1.0 cm≤dmax<2.0 cm组,dmax≥2.0组。用方差分析对三组进行对比分析,结果dmax≥2.0 cm的甲状腺恶性结节较dmax<2.0 cm的甲状腺恶性结节RI值高。结论:甲状腺恶性结节大多可探及血流,45%可探及丰富血流,但结节内血流不丰富或未探及血流不能排除恶性结节的可能。同时,46%的良性结节血流丰富,因此结节内血流丰富也不能排除良性的可能。甲状腺恶性结节的RI明显较良性结节高。RI≥0.70是鉴别甲状腺良恶性结节的最佳界值。RI≥0.80对诊断甲状腺恶性结节有很高的特异性。因此,当甲状腺结节的RI≥0.80时,都要高度怀疑其恶性的可能性。甲状腺恶性结节中,较大的结节其RI亦较高。

Objective： To assess the clinical diagnostic value of Color Doppler ultrasonography （ CDU ） for malignant thyroid nodules. Method： From January 2006 to March 2013, 650 thyroid nodules in 650 patients were retrospectively evaluated with Color Doppler uhrasonographic. All the nodules were proven by surgical operation or Ultrasound guided needle biopsy. 510 cases were malignant thyroid nodules, 140 cases were benign thyroid nodyles, and 436 cases could be measured RI with Doppler.Result： In all 510 malignant thyroid nodules, 14% were avascular, 41% were hypovascular, 45% were hypervascular. In all 140 benign thyroid nodules, 54% were hypovascular, 46% were hypervascular. The RIs of malignant thyroid nodules was obviously higher than benign. The RIs of the 436 nodules who could be measured RIs was analyzed by ROC curve. The area under the curve was maximum when RI ≥ 0.70, and the sensitivity was 72.6%, specificity was 83.6%, accurity was 76.1%, positive predictive value was 90.3%. The sensitivity was 48.6%, specificity was 95.7%, accurity was 63.8%, positive predictive value was 96.0%, when RI ≥ 0.80. The malignant thyroid nodules were divided into three groups according to the manximun diameters （ dmax ） ： dmax〈1.0 cm, 1.0 cm ≤ dmax〈2.0 cm, din= ≥ 2.0. The RIs of the nodules of dmax ≥ 2.0 cm was higher than that of dmax〈2.0 cm. Conclusion： Most of malignant thyroid nodules can be detected vascularity intranodule, 45% of them are hypervascular, but avascularity can not be used to exclude the possibility of malignant. 46% of benign thyroid nodules are hypervascular, so hypervascularity can not be used to exclude the possibility of benign. The RIs of malignant thyroid nodules are obviously higher than benign. RI ≥ 0.70 is the best cut point to differentiate malignant thyroid nodules from benign. RI≥ 0.80 has high specificity to diagnose malignant thyroid nodules. Therefore, when RI ≥ 0.80, malignancy is highly suspected, the bigger, the RI higher, in malignant thyroid nodules.