高频超声、弹性成像及超声造影对甲状腺实性结节的诊断价值

Values of high-frequency ultrasound,elastography and ultrasound contrast in diagnosis of thyroid solid nodules

目的:探讨高频超声、超声弹性成像及超声造影对甲状腺实性结节的诊断价值。方法:选择87例甲状腺实性结节患者,术前均进行高频超声、超声弹性成像及超声造影检查,术后根据结节病理性质区分良、恶性质,并分别对比3种检查的良、恶性结节图像特征。同时,将87例入选者随机分为对照组(40例)、观察组(47例),对照组选择高频超声联合超声弹性成像分级数据进行综合诊断,观察组采取3种方式联合数据进行检诊,以病理检查结果为金标准,比较2组诊断敏感性。结果:高频超声中的等回声、极低回声、不规则周边声晕,结节的边界清晰、纵横比>1、微钙化均表现出了良、恶性结节间的显著差异(χ~2=4.603、17.394、5.833、14.832、10.107、27.392,P均<0.05)。良性结节85%是超声弹性成像的Ⅰ~Ⅱ级,恶性结节的81.82%是Ⅲ~Ⅳ级,良、恶比较差异显著(χ~2=53.42,P=0.00);在超声造影中良性结节多为环形增强(χ~2=39.16,P<0.01),恶性结节多表现出不均匀增强(χ~2=40.28,P<0.01),且造影后结节范围显著增大(t=2.19,P<0.05)。观察组敏感性82.86%,显著高于对照组的59.38%(χ~2=4.537,P=0.033)。结论:甲状腺实性结节的高频超声、弹性成像、超声造影图像均表现出了良、恶性结节的特征差别,三者联合应用可提高对结节性质的判断。

Objective To investigate the diagnostic criteria of thyroid solid nodules by high-frequency ultrasound,elastography and ultrasound contrast. Methods Totally 87 patients with thyroid solid nodules underwent high-frequency ultrasound, elastography and ultrasound contrast before surgery, distinguishing benign from malignant lesions was executed based on pathological results, and according to the pathological character the image features by the three measures were compared. There were 40 patients divided into a control group going through the examination by high-frequency ultrasound,and 47 ones into an observation group with the examinations by the three measures. Pathological results were used as gold standard, and the two groups were compared on diagnostic sensitivity. Results High-frequency ultrasound showed significant differences of benign and malignant nodules in equal echo, very low echo, irregular peripheral halo, rates of clear nodule boundary and aspect ratio higher than as well as microcalcification（ χ~2=4.603, 17.394, 5.833, 14.832, 10.107 and 27.392,and all P values were less than 0.05）. There were 85% benign nodules gained grade Ⅰ and Ⅱ elastography images, 81.82%malignant nodules had grade Ⅲ and Ⅳ elastography images, and there were significant differences between benign and malignant nodules（ χ~2=53.42, P=0.00）. Ultrasound contrast found annular enhancement in most of benign nodules（ χ~2=39.16,P0.01） while uneven enhancement in most of malignant nodules（ χ~2=40.28, P 0.01）, and the nodule ranges increased significantly after contrast（t=2.19, P0.05）. The observation group had the sensitivity being 82.86%, which was statistically higher than 59.38% in the control group（ χ~2=4.537, P =0.033）. Conclusion High-frequency ultrasound, elastography and ultrasound contrast all show the manifestations of thyroid solid nodules, and the comprehensive application of the above three measures contributes to determining the nature of the nodules.