不同医师对甲状腺结节超声造影定量分析的诊断价值

Diagnostic value of different radiologists for thyroid nodule quantitative diagnosis with contrast-enhanced ultrasound

目的探讨不同医师对甲状腺结节超声造影定量分析的诊断价值。方法选取178例甲状腺结节患者共188个结节,其中良性结节102个,恶性结节86个。比较A医师(5年甲状腺超声工作经验)、B医师(2年甲状腺超声工作经验)、C医师(不足1年甲状腺超声工作经验)判读的超声造影定量分析参数,通过与病理结果比较计算敏感性、特异性后绘制受试者工作特征(ROC)曲线图,确定诊断最佳临界值并计算相应的曲线下面积。采用Kappa检验进行不同医师一致性检验。结果 A医师、B医师与C医师判读的超声造影定量比较差异均有统计学意义(P=0.012、0.017)。A、B医师判读的峰值(Peak)和时间-强度曲线的曲线下面积(AUC)参数,以及A医师和B医师判读的各参数的平均值(以下简称二者均值)对甲状腺良恶性结节的判断,差异均有统计学意义(均P<0.05)。以Peak参数作为诊断标准时,二者均值所得Peak值<30.325是诊断甲状腺良恶性结节的诊断的最佳选择,诊断甲状腺恶性结节的敏感性72.1%,特异性49.0%,ROC曲线下面积0.606;以AUC参数作为诊断标准时,二者均值所得AUC值<3.450是诊断甲状腺良恶性结节的最佳选择,诊断甲状腺恶性结节的敏感性69.8%,特异性58.8%,ROC曲线下面积0.643。A医师与B医师判读Peak、AUC参数均表现为基本一致(Kappa=0.778、0.723)。结论应用超声造影定量分析评估甲状腺结节可行,具有一定经验的医师之间有较高的一致性。

Objective To investigate the diagnostic value of quantitative contrast- enhanced ultrasound（CEUS） in thyroid nodules by different radiologists. Methods One hundred seventy-eight patients with 188 nodules who underwent CEUS were enrolled and restrospectively analyzed by three doctors with different diagnostic experience, including 102 benign lesions and 86 malignant ones. Doctor A was of 5 years of experience for thyroid imaging,doctor B was of 2 years of experience,and doctor C was with 1 year of experience. Results that evaluated by three doctors were compared with the pathologic diagnosis.The sensitivity and specificity were calculated. ROC curve was also depicted and the area under the ROC curve was calculated.Kappa test was used for consistency. Results There were significant differences in quantitative comparison of CEUS among doctor A,B and C（P = 0.012,0.017）. Parameters of the Peak,AUC,and the mean value of thyroid nodules were statistically significant between doctor A and B（P〈0.05）. Peak 〈30.325 was the best cutoff value for diagnosis. Using parameter Peak as diagnostic criteria,the sensitivity,specificity and area under the ROC curve of diagnosing malignant thyroid nodules were 72.1%,49.0% and 0.606,respectively;Parameter AUC was the best choice for differential diagnosis with the sensitivity,specificity and area under the ROC curve were 69.8%,58.8% and 0.643,respectively. Peak values and AUC were similar between doctor A and B（Kappa=0.778,0.723）.Conclusion Thedoctorwithexperiencehasahigherdiagnosticvalueinthyroidnodulesbyquantitative CEUS.