高分辨率超声和超声弹性成像在甲状腺结节良恶性病变鉴别诊断中的对比研究

A comparative study of high resolution ultrasound and ultrasound elastography in the defferential ;diagnosis of benign and malignant tumors in thyroid nodules

目的：探讨高分辨率超声检测指标对甲状腺良、恶性结节鉴别诊断的诊断效能，对比分析高分辨率超声和超声弹性成像在甲状腺结节良恶性病变鉴别诊断中的应用价值。方法选取2012年6月至2015年8月克拉玛依市人民医院超声科收治的甲状腺结节患者123例，共148枚甲状腺结节的高分辨率超声及超声弹性检查资料进行分析，以手术病理结果为金标准，运用Logistic回归分析的方法，筛选出高分辨率超声中有价值的检测指标，比较上述指标和超声弹性成像法诊断甲状腺结节良恶性的灵敏度、特异度、准确度和Kappa系数。结果高分辨率超声检测指标多因素Logistic回归分析结果显示结节性质、结节形态、有无微钙化是恶性结节是否发生的独立危险因素，高分辨率超声符合任意4个检测指标为最佳诊断临界点，其诊断特异性、敏感性、阳性预测值、阴性预测值分别为78.1%、70.7%、85.5%和59.3%，其准确率和Kappa系数分别为73.3%和0.454。超声弹性成像评分≥3分的诊断特异性、敏感性、阳性预测值、阴性预测值分别为90.0%、70.6%、80.0%和84.4%，其准确率和Kappa系数分别为83.0%和0.622。结论结节性质、形态及有无微钙化对甲状腺结节良恶性具有独立预测作用，超声弹性成像对甲状腺良恶性结节的鉴别诊断具有较高的准确度和特异度，可协助高分辨率超声提高甲状腺良恶性病变鉴别诊断的准确率。

Objective To detect the efficiency of high resolution ultrasound in the differential diagnosis of benign and malignant thyroid nodules, to compare the vaule of high resolution ultrasound and ultrasound elastography in the differential diagnosis of benign and malignant tumors in thyroid nodules. Methods A total of 148 thyroid nodules from 123 patients were reviewed and analyzed by high resolution ultrasound and ultrasound elastography. With pathological findings as the golden diagnosis standard , using Logistic regression model, valuable indicators from the examination were screenrd.The sensitivity,specifi city,accuracy and Kappa of high resolution ultrasound were compared with ultrasound elastography in the defferential diagnosis of benign and malignant tumors in thyroid nodules. Results Logistic regression model showed echostruction,shape and calcification were independent risk factors of the differential diagnosis of benign and malignant under high resolution ultrasound Examination of thyroid nodules.The best diagnosis criteria of high resolution ultrasound met any four of eight indicators ,with sensitivity,specificity,accuracy and Kappa of 70.7%,78.1%,73.3%and 0.454 respectively. The diagnosis criteria of ultrasound elastography was the elasticity score ≥ 3, with sensitivity,specificity,accuracy and Kappa of 70.6%,90.0%,83.0%and 0.622 respectively. Conclusions Echostruction,shape and calcification were independent determinants of the differential diagnosis of benign and malignant under high resolution ultrasound Examination of thyroid nodules.＆nbsp;The specificity and accuracy of ultrasound elastography are higher in the differential diagnosis of benign and malignant thyroid nodules,ultrasound elastography are more helpful to raising accuracy in defferential diagnosis of benign and malignant thyroid nodules combinated application of high resolution ultrasound Examination.