超声造影联合二维超声在TI-RADS 4类甲状腺结节良恶性鉴别诊断中的应用价值

Application value of contrast-enhanced ultrasound combined with two-dimensional ultrasound in differential diagnosis of TI-RADS 4 thyroid benign and malignant nodules

目的探讨超声造影(contrast-enhanced ultrasound,CEUS)联合二维超声在TI-RADS 4类甲状腺结节良恶性鉴别诊断中的应用价值。方法回顾性分析经手术病理证实的211例(共251个结节)TI-RADS 4类甲状腺结节患者的超声造影资料,通过超声造影图像特征调整甲状腺结节TI-RADS分类,比较二维超声、CEUS联合二维超声对TI-RADS 4类甲状腺良恶性结节的诊断价值以及CEUS联合二维超声对不同大小TI-RADS 4类甲状腺结节良恶性的诊断价值。结果 CEUS联合二维超声诊断TI-RADS 4类甲状腺结节的灵敏度(Se)、特异度(Sp)、准确率(Ac)、曲线下面积(AUC)分别为90.9%、82.5%、87.6%、0.895,均高于二维超声的82.5%、70.1%、77.7%、0.752;CEUS联合二维超声诊断>1 cm的TI-RADS 4类甲状腺结节的Se、Sp、Ac、AUC分别为93.2%、86.4%、90.4%、0.912,均高于诊断≤1cm的88.8%、78.3%、84.9%、0.867。结论对于TI-RADS 4类甲状腺结节在二维超声基础上进行超声造影检查可进一步鉴别甲状腺结节的良恶性,CEUS联合二维超声对不同大小TI-RADS 4类甲状腺良恶性结节均有较高诊断价值,但对>1 cm的甲状腺结节诊断效果更佳。

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)combined with two-dimension ultrasound in differential diagnosis of TI-RADS 4 thyroid benign and malignant nodules. Methods The CEUS imaging data of 211 patients(251 nodules)with TI-RADS 4 thyroid nodules confirmed by operation and pathology were retrospectively analyzed. The classification of thyroid nodules was adjusted by the characteristics of CEUS. The diagnostic value of two-dimensional ultrasound,CEUS combined with two-dimensional ultrasound in TI-RADS 4 thyroid nodules and CEUS combined with two-dimensional ultrasound in different sizes of TI-RADS 4 thyroid nodules were compared. Results The sensitivity,specificity and accuracy and area under curve of CEUS combined with two-dimensional ultrasound in thyroid TI-RADS 4 nodules diagnosis were 90.9%,82.5%,87.6% and 0.895 respectively,which were higher than 82.5%,70.1%,77.7% and 0.752 of two dimensional ultrasound. The sensitivity,specificity and accuracy and area under curve of CEUS combined with two-dimensional ultrasound of > 1 cm in TI-RADS 4 thyroid nodules diagnosis were 93.2%,86.4%,90.4% and 0.912 respectively,which were higher than the 88.8%,78.3%,84.9%,0.867 of CEUS combined with two-dimensional ultrasound of ≤1 cm. Conclusion CEUS can further differentiate TI-RADS 4 thyroid benign and malignant nodules based on two dimensional ultrasound. CEUS combined with two-dimensional ultrasound has high value in the diagnosis of TI-RADS 4 thyroid benign and malignant nodules of different sizes,but it is more effective in the diagnosis of thyroid nodules > 1 cm.