超声造影联合弹性成像在TI-RADS 4类甲状腺结节良恶性鉴别诊断中的应用价值研究

A research of application value for contrast-enhanced ultrasound combined with acoustic elastography on the differential diagnosis benign or malignant thyroid nodules of TI-RADS 4 lesions

目的:探讨超声造影(CEUS)联合超声弹性成像(AE)在甲状腺超声影像报告和数据系统(TI-RADS)分类标准TI-RADS 4类甲状腺结节良恶性鉴别中的应用价值。方法:回顾性分析132例TI-RADS 4类甲状腺结节患者,根据甲状腺结节的良恶性将其分为良性组(50例)和恶性组(82例)。分析两组患者CEUS、AE以及二者联合检查的资料,以病理检查结果为金标准,比较3种检查方式的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)以及准确率。结果:CEUS在良性、恶性组间的均匀增强、环状增强、不均匀增强、无增强以及时间-强度曲线五项参数均表现出显著的组间差异;AE的4级评分组间比较差异显著(Z=46.73,P<0.01)。CEUS联合AE检查的灵敏度为92.68%、特异度为94.55%、PPV为96.20%、NPV为89.66%、准确率为93.43%,均高于单一使用CEUS和AE。结论:CEUS及AE对TI-RADS 4类甲状腺结节良恶性诊断具有积极意义,二者联合应用有助于提高诊断的准确性。

Objective： To investigate the value of contrast-enhanced ultrasound（CEUS） combined with acoustic elastography（AE） in differential diagnosis benign or malignant thyroid nodules of TI-RADS 4 lesions. Methods： A retrospective analysis for 132 patients with nodules of TI-RADS 4 lesions was adopted to finish this work. The 132 patients were divided into benign group（50 cases） and malignant group（82 cases）. Both of groups were analyzed by CEUS, AE and combination of the two methods, respectively. The pathological findings were set as gold standard. To compare the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV） and accuracy between the three methods. Results： Uniform enhancement, ring enhancement, inhomogeneous enhancement, no enhancement and time intensity curve of CEUS in benign group were significantly different with those in nodules group（P0.05）. Grade 4 scores of AE were significantly different between benign group and nodules group（Z=46.73, P0.05）. The sensitivity, specificity, PPV, NPV, and accuracy were 92.68%, 94.55%, 96.20%, 89.66%, 93.43%, respectively, for CEUS combined with AE. The combination of two methods had the highest diagnostic efficacy. Conclusions： CEUS and AE have positive significance for the diagnosis of benign and malignant thyroid nodules in TI-RADS 4. CEUS combined with AE can be further improved in diagnosis accuracy.