超声弹性成像在甲状腺结节定性中的应用

VALUE OF ULTRASOUND ELASTOGRAPHY IN THE QUALITATIVE DIAGNOSIS OF THYROID NODULES

目的比较甲状腺影像报告及数据系统(TI-RADS)和加入弹性评分的改良系统在甲状腺结节定性诊断中的差别,探讨甲状腺弹性成像的意义。方法对有术前超声检查弹性成像及术后病理检查的1 398个甲状腺结节进行回顾性分析,按照甲状腺影像报告及数据系统的标准对甲状腺结节进行评分。之后将超声弹性成像分级加入该评估系统,对甲状腺结节重新记分,构建受试者工作曲线(ROC曲线),计算出阈值。参照手术后的病理诊断计算两个评估系统的敏感度特异度。结果按照甲状腺影像报告及数据系统的标准分值≥4分诊断为恶性,≤3分诊断为良性,甲状腺影像报告及数据系统的敏感性75.94%,特异度79.02%。加入弹性成像分级的系统标准。将弹性分级<2级记本评估体系0分,≥3级记2分,介于两者之间记1分。将该分数加上原甲状腺影像报告及数据系统的分值构成新的分值。构建受试者工作曲线(ROC曲线),计算出阈值。临界值定于5分,≥5诊断为恶性,≤4分诊断为良性。加入弹性评分的评估系统在敏感性84.49%特异度83.98%,两者间的差异有统计学意义(P<0.05)。结论改良版的甲状腺影像评估标准是对甲状腺结节定性的良好评估系统。

Objective To compare the difference between thyroid imaging reporting and data system and improved system ones, and to explore the value of ultrasound elastography in the qualitative diagnosis of thyroid nodules. Methods A total of 1398 thyroid nodules, underwent preoperative ultrasonography, ultrasound elastography and postoperative＇pathological examination, were retrospectively analyzed. According to the standard of thyroid imaging reporting and data system, the scores of nodules were added. And the ultrasound elasticity imaging grading was added to the evaluation system to gain the new ones. Then the receiver operating curve was constructed and gained cutoff value. The sensitivity and specificity of the two evaluation systems were also calculated. Results According to the standard of thyroid imaging reporting and data system. Score more than 4 points predicts malignant nodule, less than 3 points means benign one. The sensitivity and specificity of TI- RADS were 75.94% and 79.02%, The elasticity grades 0% I equals 0, grades Ⅱ equals 1, grades Ⅲ - Ⅳ equals 2. The ultrasound elasticity imaging scords adding the scord of TI- RADS makes the score of the new system. The score more than 5 points could predict malignant nodule, less than 4 points means benign one, whose sensitivity and specificity were 84.49% and 83.98%. the difference compared to former was statistically significant（P〈0.05）. Conclusion Ultrasound elastography has high value in differential diagnosis of malignant and benign nodules of thyroid.