灰阶超声联合弹性成像在甲状腺结节良恶性鉴别诊断中的应用研究

Application of gray-scale ultrasound combined with elastography in differential diagnosis of benign and malignant thyroid nodules

目的探讨灰阶超声(GSUS)联合弹性成像(UE)在甲状腺良、恶性结节中的鉴别诊断价值。方法回顾性分析703例甲状腺结节临床和超声资料,比较结节外形、内部回声、内部成份、边界、钙化及UE评分在良、恶性病变中的差别,以病理为金标准,比较GSUS、UE以及GSUS联合UE诊断敏感性、特异性、阴性预测值、阳性预测值及正确率。结果甲状腺恶性结节纵横比>1344个(344/486,70.8%),低回声379个(379/486,78.0%)或极低回声92个(92/486,18.9%),实性结节40个(401/486,82.5%),边界不清42个(421/486,86.6%),伴微钙化176个(176/486,36.2%),UE评分为4分或5分410个(410/486,84.4%);而甲状腺良性结节纵横比<1173个(173/217,79.7%),低回声117(117/217,53.9%)或等回声89个(89/217,41.1%),实性结节126个(126/217,58.1%),边界清晰155个(155/217,71.4%),伴粗钙化31个(31/217,14.3%),UE评分为1分,2分或3分201个(201/217,92.6%)(P<0.001);GSUS联合UE诊断敏感性(93.8%)、阴性预测值(97.4%)及准确率(96.2%)均高于GSUS和UE(P<0.01)。结论GSUS联合UE能有效提高甲状腺结节良、恶性鉴别诊断效能。

Objective To investigate the differential diagnosis value of gray-scale ultrasound(GSUS) combined with elastography(UE) in benign and malignant thyroid nodules. Methods 703 cases of thyroid nodules clinical and ultrasound data were retrospectively analyzed. The differences in nodular shape, internal echo, internal components, borders, calcification and UE scores between benign and malignant lesions were compared. With pathology as the gold standard, the diagnostic sensitivity, specificity, negative predictive value, positive predictive value and correct rate of GSUS, UE And GSUS combined UE was compared. Results There were 344 thyroid malignant nodules of which the aspect ratio was >1(344/486,70.8%).There were 379 hypoechoic nodules (379/486, 78.0%) or 92 nodules with extremely low echo (92/486, 18.9%), 40 solid nodules (401/486, 82.5%), 42 nodules with unclear borders (421/486, 86.6%), and 176 nodules combined with micro-calcifications (176/486, 36.2%). And among them, there were 410 cases of UE score 4 points or 5 points (410/486, 84.4%). There were 173 thyroid benign nodules of which the aspect ratio was <1 (173/217, 79.7%). There were 117 hypoechoic nodules(117/217,53.9%)or 89 iso-echo nodules (89/217,41.1%), 126 solid nodules(126/217,58.1%), 155 nodules with clear borders(155/217,71.4%), and 31 nodules combined with coarse calcifications (31/217,14.3%). There were 201 cases of UE score1 point, 2 points or 3 points (201/217,92.6%)(P<0.001). The diagnostic sensitivity (93.8%), negative predictive value (97.4%) and accuracy (96.2%) of GSUS combined with UE were higher than those of GSUS and UE(P<0.01). Conclusion GSUS combined with UE can effectively improve the differential diagnosis effect of benign and malignant thyroid nodules.