3D-CPA联合TI-RADS标准在甲状腺结节良恶性诊断中的价值

Value of three-dimensional color power angiography combined with TI-RADS standard in the diagnosis of benign and malignant thyroid nodules

目的探讨3D-CPA联合TI-RADS在甲状腺结节良恶性诊断中的价值。方法收集2013年12月~2015年12月在遵义医学院附属医院行甲状腺手术的患者98例共105个甲状腺结节(良性50个,恶性55个),回顾术前常规二维超声检查及3D-CPA检查,所有甲状腺结节均按照TI-RADS标准进行分类。以病理结果为金标准,比较3DCPA与TI-RADS标准对甲状腺结节的良恶性诊断价值及联合两种方法对甲状腺结节良恶性的诊断价值。结果 3DCPA结果:50个良性病灶血流分布在周边的占36个(72.0%)、内外都有14个(28.0%);血管走行规则43个(86.0%)、血管走行不规则为7个(14.0%);空间分布对称为44个(86.0%),空间分布不对称为6个(14.0%)。55个恶性病灶血流分布在周边的占5个(9.1%)、内外都有50个(90.9%);血管走行规则为6个(10.9%),血管走行不规则为49个(89.1%);空间分布对称为18个(32.7%),空间分布不对称为37个(67.3%)。良性结节和恶性结节在3D-CPA声像图3组指标相比均具有明显差异(P<0.05)。3D-CPA与TI-RADS之间比较:SEN、SPE、PPV、NPV及ACC均有统计学差异(P<0.05);.二种方法结合后灵敏度准确度明显高于单一方法。结论 3D-CPA中血流分布部位、血管走行、空间分布对诊断甲状腺结节良恶性有较好的临床意义,其中血管走行的敏感度、特异和准确度最高;.TI-RADS分类标准可以对甲状腺结节超声描述起到规范化、标准化的作用,对甲状腺结节提供了风险性评估方案;3D-CPA与TI-RADS分类标准联合应用可提高诊断甲状腺结节良恶性的灵敏度及准确率。

Objective To evaluate the value of three-dimensional color power angiography combined with TI-RADS standard in the diagnosis of benign and malignant thyroid nodules. Methods 98 patients with 105 thyroid nodules （benign 50, malignant 55）, from December 2013 to December 2015 in Zunyi Medical College Affiliated Hospital were treated with conventional two-dimensional ultrasound and 3D-CPA examination. The thyroid nodules were classified with TI-RADS score standard. The diagnosis value of 3D-CPA and TI-RADS were compared.Results Of 50 benign lesions with 3D-CPA, there were 36 cases （72.0%） with surrounding blood flow distribution, 14 cases （28.0%） with inside and outside blood flow distribution, 43 cases （86.0%） with regular vessel walking and 7 cases （14.0%） with irregular vessel walking, 44 cases （86.0%） with spatial distribution symmetry and 6 cases （10.9%） with spatial distribution asymmetry. Of 55 malignant nodules with 3D-CPA, there were 5 cases （9.1%） with surrounding blood flow distribution, 50 cases （90.9%） with inside and outside blood flow distribution, 6 cases （10.9%） with regular vessel walking and 49 cases （89.1%） with irregular vessel walking, 18 cases （32.7%） with spatial distribution symmetry and 37 cases （67.3%） with spatial distribution asymmetry. Those indexes of benign lesions and malignant nodules were different （P〈0.05）. There were differences of SEN, SPE, PPV, NPV and ACC between 3D-CPA and TI-RADS （P〈0.05）. The sensitivity and accuracy of combined 3D-CPA and TI-RADS was obviously higher than that of the single method. Conclusion Blood flow distribution in 3D-CPA, vascular contorts, spatial distribution is meaningful for the diagnosis of benign and malignant thyroid nodule. The vascular contorts the sensitivity and specialty degree is high. TI-RADS standard of thyroid nodule plays the role of standardization, and canonical in Ultrasonic description, provides a risk evaluation of thyroid nodule. The combination of 3D-CPA and TI-RADS can improve the sensitivity and accuracy of diagnosis and reduce the misdiagnose.