甲状腺超声造影评分与弹性成像评分对TI-RADS分级的修正价值分析

Analysis of the revised value of TI-RADS score in the evaluation of thyroid contrast-enhanced ultrasound and elastography score

目的:探讨甲状腺超声造影评分联合弹性成像评分对甲状腺影像报告与数据系统(TI-RADS分级)的修正价值。方法:回顾性分析了自2014年1月至2016年12月的83例患者,共计131个甲状腺结节,所有结节行二维超声检查评估TI-RADS分级,随后根据超声弹性成像评分、超声造影评分对TI-RADS分级进行修正,以术后病理学诊断为金标准,应用相应的统计学方法,分析并对比修正前后TI-RADS分级对甲状腺结节良恶性诊断的价值。结果:经病理学诊断共有90个恶性结节,41个良性结节,单独应用TI-RADS鉴别甲状腺结节良恶性时灵敏度55.56%、特异度78.05%、正确率62.60%、阳性预测值84.75%、阴性预测值44.44%、正确指数33.60%、AUC值0.729,分别应用超声弹性成像、超声造影评分修正后诊断效能的各项指标均有所提高,AUC值分别为0.884、0.889,而当两者评分联合修正时AUC值为0.916,修正前后AUC值之间的差异具有统计学意义(P均<0.001)。结论:单独应用TI-RADS鉴别甲状腺结节良恶性具有一定价值,不过应用超声造影、弹性成像分别修正TI-RADS可获得较高诊断效能,且两者联合应用修正TI-RADS可使其在鉴别甲状腺结节良恶性方面具有更高的诊断价值。

Objective：To evaluate the revied value of contrast-enhanced ultrasound （CEUS） and ultrasonic elastography in thyroid imaging reporting and data system （TI-RADS）.Methods：We retrospectively analyzed a total of 83 patients with 131 thyroid nodules from January 2014 to December 2016.All nodules were evaluated by two-dimensional ultrasonography for TI-RADS classification.Then，the TI-RADS score was revised by the ultrasonic elastography score or/and the CEUS score.The study used postoperative pathological diagnosis as the golden standard.Finally，we analyzed and compared the diagnostic value of before/after revising TI-RADS classification in differentiating malignant from benign thyroid nodules by the corresponding statistical methods.Results：There were 90 malignant nodules and 41 benign nodules pathologically.When TI-RADS alone was used to differentiate the benign and malignant thyroid nodules，the sensitivity was 55.56%，specificity was 78.05%，the accuracy was 62.60%，the positive predictive value was 84.75%，the negative predictive value was 44.44%，the Youden＇s index was 33.60% and the areas under the ROC curves （AUC） value was 0.729.The these index of diagnostic performance were improved after revising TI-RADS classification by ultrasonic elastography score alone or CEUS score alone，especially the AUC value was 0.884，0.889，respectively.Further，when the combined application of two methods score，the AUC value was 0.916.The difference of AUC value was statistically significant before and after revision （P＜0.001）.Conclusion：The application of TI-RADS alone is helpful in the differential diagnosis for benign and malignant thyroid nodules.Moreover，we could obtain a high diagnostic performance after revising TI-RADS by ultrasonic elastography score alone or CEUS score alone.Above all，when we revised TI-RADS by combined application of two methods score，a higher diagnostic performance obtains in differentiating benign and malignant thyroid nodules.