超声造影联合弹性成像在甲状腺结节性病变良恶性诊断中的临床应用

Clinical application of contrast-enhanced ultrasound combined with ultrasound elastography in diagnosis of malignant and benign nodules of thyroid

目的探讨超声造影(CEUS)联合超声弹性成像(UE)在甲状腺结节性病变良恶性鉴别诊断中的临床应用价值。方法回顾性分析86例患者98个甲状腺良恶性结节的CEUS和UE的图像信息并进行对比分析,以病理结果为金标准,评估CEUS、UE及联合应用CEUS和UE诊断甲状腺结节良恶性的准确率。结果98个甲状腺结节中,经病理确诊恶性结节40个,良性结节58个。恶性结节增强后以不均匀低增强为主,早于正常甲状腺组织消退。良性结节则以均匀等增强或高增强为主,晚于正常甲状腺组织消退。CEUS联合UE的灵敏度、特异度、阴性预测值及诊断符合率比单用UE高,差异有统计学意义(P<0.05)。结论超声造影和弹性成像对甲状腺良恶性结节有较高的鉴别诊断价值,两者联合应用可使甲状腺良结节诊断的准确率显著提高。

【Objective】To evaluate contrast-enhanced ultrasound（CEUS） combined with ultrasound elastography（UE） in diagnosis of malignant and benign nodules of thyroid.【Methods】Eighty-six patients with benign and malignant thyroid nodules who were confirmed by operations and pathology were enrolled in the study, their CEUS and UE findings were compared and analyzed retrospectively. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic rate were evaluated. 【Results】In 98 nodules, there were 40 malignant thyroid nodules, and 58 benign thyroid nodules. After the injection of contrast media the enhancement in benign nodules was earlier than peripheral gland and wash-out was earlier than peripheral gland, most nodules showed peripheral ring enhancement. Malignant nodules showed hypo-enhancement, uneven enhanced echo, and wash-out of contrast agents was later than the peripheral thyroid tissue. The sensitivity, specific degree, negative predictive value and diagnostic coincidence rate of CEUS combined with UE were higher than those of UE（P〈0.05）.【Conclusion】Both CEUS and UE have high value in differential diagnosis of benign and malignant thyroid nodules, the combination of the two methods can improve the diagnostic rate greatly.