甲状腺影像学报告及数据系统分级联合超声造影对甲状腺良、恶性结节的鉴别诊断价值

Value of thyroid imaging reporting and data system combined with contrast enhanced ultrasound in differential diagnosis of benign and malignant thyroid nodules

目的探讨甲状腺影像学报告及数据系统(TI-RADS)分级联合超声造影(CEUS)鉴别甲状腺良、恶性结节的价值。方法选取91例甲状腺结节患者(共127个结节),分别行常规超声及CEUS检查,所有病灶依据二维超声特征进行TI-RADS分级,并经手术病理证实,以病理检查结果为金标准,评估TI-RADS分级、CEUS及二者联合诊断甲状腺癌的价值。结果甲状腺恶性结节的CEUS增强模式主要表现为早期低增强、不均匀增强、周边无环状增强,以此为甲状腺恶性结节的诊断标准,其灵敏度、特异度及符合率分别为73.08%(19/26)、80.20%(81/101)、78.74%(100/127);73.08%(19/26)、75.25%(76/101)、74.80%(95/127);96.15%(25/26)、32.67%(33/101)、45.67%(58/127)。以TI-RADS分级5级判定为恶性,其灵敏度、特异度及符合率分别为46.15%(12/26)、99.00%(100/101)、88.19%(112/127);TI-RADS分级联合CEUS诊断甲状腺恶性结节的灵敏度、特异度及符合率分别为80.76%(21/26)、96.04%(97/101)、92.91%(118/127)。TI-RADS分级联合CEUS诊断对甲状腺恶性结节的准确性明显高于TI-RADS分级或CEUS单独诊断(P<0.05)。结论 TI-RADS分级可对甲状腺病灶进行初步规范化恶性风险判断,利用CEUS可进一步提高结节的良恶性鉴别诊断能力,二者联合可提高甲状腺结节的术前诊断能力。

Objective To investigate the diagnostic value of thyroid imaging reporting and data system（ TI-RADS） combined with contrast enhanced ultrasound（ CEUS） in differentiating benign and malignant thyroid nodules.Methods Ninety-one patients with thyroid nodule involving 127 nodules were examined by conventional ultrasound and CEUS respectively.All of the nodules were graded by TI-RADS based on their two-dimensional ultrasound features, and then were confirmed by their pathologic findings after operation.The pathologic findings were taken as golden standard to assess the values of TI-RADS,CEUS and their combination in the diagnosis of thyroid cancer.Results Most of the images of CEUS enhancement pattern for malignant thyroid nodules showed early hypoenhancement,heterogeneous enhancement and no surrounding ring enhancement.Based on these features as the diagnostic standard of malignant thyroid nodules, the sensitivity,specificity and coincidence rate for the diagnosis of early hypoenhancement were 73.08%（19/26）,80.20%（81/101） and 78.74%（100/127）,respectively,of heterogeneous enhancement were 73.08%（19/26）,75.25%（76/101） and 74.80%（95/127）,respectively,and of no surrounding ring enhancement were 96.15%（25/26）,32.67%（33/101） and 45.67%（58/127）,respectively.Based on TI-RADS Grade 5 as malignants,the sensitivity,specificity and coincidence rate of TI-RADS for the diagnosis of malignant thyroid nodules were 46.15%（12/26）, 99.00%（100/101） and 88.19%（112/127）,respectively;of TI-RADS combined with CEUS were 80.76%（21/26）,96.04%（97/101） and 92.91%（118/127）,respectively.TI-RADS combined with CEUS had a significantly higher accuracy in the diagnosis of malignant thyroid nodules compared with TI-RADS or CEUS alone（P〈0.05）.Conclusion TI-RADS might give a preliminary and standard risk judgment on malignant thyroid lesions,the use of CEUS might further improve the efficiency in the differential diagnosis of benign and malignant nodules,and the combination of TI-RADS and CEUS might improve the efficiency in the preoperative diagnosis of thyroid nodules.