超声造影评估TI-RADS 3类和4类甲状腺微小结节的价值研究

Value of contrast-enhanced ultrasound in diagnosis of thyroid micronodules in TI-RADS 3 and 4

目的探讨常规超声联合超声造影对TI-RADS 3类和4类甲状腺微小结节的诊断价值。方法选取经病理和临床证实的TI-RADS 3类和4类甲状腺孤立性微小结节患者88例,按病理结果分为恶性组40例和良性组48例,回顾性分析并比较两组常规超声和超声造影表现。以常规超声和超声造影表现中差异有统计学意义的参数为变量,建立Logistic回归方程,计算单独常规超声、超声造影及两者联合应用判断甲状腺微小结节良恶性的准确率、敏感性和特异性;绘制单独常规超声、超声造影及两者联合应用诊断甲状腺微小结节的受试者工作特征(ROC)曲线,计算其曲线下面积。检验两者联合诊断结果与病理结果的一致性。结果多因素分析表明,常规超声表现中微钙化和颈部异常淋巴结诊断甲状腺微小结节的恶性相关性最高,其诊断准确率、敏感性、特异性分别为85.2%、80.0%、89.6%;超声造影表现中结节增强时间和环状增强诊断甲状腺微小结节的恶性相关性最高,其诊断准确率、敏感性、特异性分别为87.5%、87.5%、87.5%;两种方法联合的特征性指标有微钙化、颈部异常淋巴结、结节增强时间和环状增强,其诊断甲状腺微小结节的准确率、敏感性、特异性分别为97.7%、97.5%、97.9%。常规超声、超声造影及两者联合诊断甲状腺微小结节的ROC曲线下面积分别为0.900、0.907、0.990。两者联合诊断结果与病理诊断结果的一致性较高(Kappa=0.813,P=0.000)。结论常规超声联合超声造影在诊断甲状腺微小结节的良恶性时具有更高的准确率和敏感性,具有一定的临床价值,值得推广应用。

Objective To investigate the diagnostic value of thyroid micronodules in TI-RADS 3 and 4 by conventionaland contrast-enhanced ultrasound （CEUS） .Methods According to the pathological results, 88 patients with isolated thyroidmicronodules in TI-RADS3 and 4 were divided into malignant group （n=40）and benign group （n=48） .The characteristics ofconventional ultrasound and CEUS were retrospectively analyzed and compared between the two groups.The Logistic regressionequation was established to calculate the accuracy, sensitivity and specificity of the judgment of thyroid micronodules byconventional and contrast-enhanced ultrasound alone and in combination with the two variables, respectively.ROC curves wasplotted for the diagnosis of thyroid micronodules by conventional ultrasound, CEUS alone and combined application of both,and the area under the curve was calculated.The consistency of the combined diagnosis and pathological results was tested.Results Logistic regression analysis of conventional ultrasound showed that microcalcification and suspicious lymph glands wererisk factors for malignant thyroid micronodules.The accuracy, sensitivity and specificity were 82.5%, 80.0 % and 89.6% of thediagnosis by conventional ultrasound, respectively.Logistic regression analysis of CEUS showed that slow enhancement time andabsence of rim-like enhancement were risk factors for malignant thyroid micronodules.The accuracy, sensitivity and specificity ofthe diagnosis by CEUS were 87.5%, 87.5% and 87.5%, respectively.Logistic regression analysis of conventional ultrasoundcombined with CEUS demonstrated that microcalcification, suspicious lymph gland, slow enhancement time and absence with rim-like enhancement were risk factors.The accuracy, sensitivity and specificity of the diagnosis by combined application were 97.7%,97.5% and 97.9% , respectively.The area under ROC curve for conventional ultrasound, CEUS, and conventional ultrasoundcombined with CEUS were 0.900, 0.907, 0.990, respectively.The consistency between the diagnosis of thyroid micronodules bycombined application and pathological diagnosis was higher（Kappa=0.813, P=0.000） .Conclusion Conventional ultrasoundcombined with CEUS has higher accuracy and sensitivity in the diagnosis of benign and malignant thyroid micronodules.It hascertain clinical value and can be further popularized.