超声弹性成像联合超声造影对甲状腺TI-RADS4级肿块的良恶性鉴别的诊断价值

目的探讨超声弹性成像联合超声造影对根据甲状腺影像报告和数据系统超声（TI-RADS-US）标准诊断为4级的甲状腺结节的诊断价值.方法选取2014年1月至2015年10月在我院行甲状腺超声检查并分级为 TI-RADS4级的肿块185个,依据超声弹性成像改良5分法和超声造影相关指标,分别对肿物进行良恶性诊断,并对术后病理结果进行跟踪对比.结果 185个甲状腺病灶,病理学诊断良性145个,恶性40个.良恶性肿块的弹性成像的弹性评分、造影模式的差异均具有统计学意义（P ﹤0.05）;超声弹性评分显示145个良性肿块中有122个≤3分,评价为良性,40个恶性肿块中有31个≥4分,评价为恶性.超声造影结果显示145个良性肿块中造影评价为良性的有118个,40个恶性肿块中造影评价为恶性的有32个.弹性成像、超声造影及二者联合运用诊断肿块的敏感性分别为77.5%、80.0%、92.5%,特异性分别为84.1%、81.4%、89.7%,准确性分别为83.6%、81.1%、90.3%,结果表明二者间单独应用比较无统计学意义（P 〉0.05）,二者联合应用的敏感性、特异性及准确性均高于二者单独应用,具有统计学意义（P〈0.05）.结论超声弹性成像联合超声造影技术更有助于甲状腺TI-RADS4级肿块良恶性的鉴别.

Objective：TO investigate the diagnostic value of ultrasonic elastography （UE） combined with contrast-enhanced ultrasonography （CEUS） in the differential diagnosis of TIRADS 4 thyroid lesions （TI-RADS-US）.Method： Select 185 thyroid lesions of TI-RADS Level 4 in our hospital from January, 2014 to October, 2015, the analysis has been carried out according to ultrasonic elastography and contrast-enhanced ultrasonography respectively for identifying the benign and malignant lesions.Pathological outcomings were as standard criterion. Result ： 145 benign lesions and 40 malignant lesions were confirmed by pathology. The differences of their ultrasonic elasticity scores and morphological feature have statistical significance （P ﹤ 0.05）. The ultrasonic elastography shows that among 145 benign cases, 122 are no more than 3 scores, and evaluated as benign; among 40 malignant cases, 31 are no less than 4 scores and evaluated as malignant. Contrast-enhanced ultrasound showed that among 145 benign cases, 118 cases were evaluated as benign ,and among 40 malignant cases, 32 cases were evaluated as malignant. The sensitivity of ultrasonic elastography, ultrasound contrast and their combination to identify the benign or malignant TI-RADS Level 4 lesions is separately 77.5%, 80.0% and 92.5%, respectively, and the specificity was 84.1%, 81.4% and 89.7% respectively, and the accuracy was 83.6%, 81.1% and 90.3% respectively.The differences between the two separately have no statistical meaning. The sensibility, specialty and accuracy of the two combined is all higher than that when they are applied separately （P ﹤ 0.05）. Conclusion： The combination of ultrasonic elastography and ultrasound contrast is more helpful in the diagnosis of TI-RADS Level 4 lesions.