甲状腺木乃伊结节的常规超声、声触诊组织量化成像及超声造影表现

Sonographic characteristics of mummified thyroid nodules:conventional ultrasound,virtual touch imaging and quantification,and contrast-enhanced ultrasound

目的探讨常规超声、声触诊组织量化成像(VTIQ)及超声造影(CEUS)在鉴别甲状腺木乃伊结节中的临床价值。方法选取23例甲状腺木乃伊良性结节患者(木乃伊结节组)和17例甲状腺乳头状癌患者(PTCs组),应用常规超声、VTIQ及CEUS获取结节的大小、形态、边界、回声、钙化、声影、黑白双层晕环征、血流、剪切波速度(SWV)及CEUS各参数,并进行比较分析,绘制受试者工作特征(ROC)曲线获得SWV的截断值,计算曲线下面积。采用Logistic回归分析获得木乃伊结节的独立影响因素。结果木乃伊结节组与PTCs组血流信号、SWV值、增强模式、峰值强度比<1、曲线下面积比<1比较差异均有统计学意义(均P<0.05),其余特征比较差异均无统计学意义。ROC曲线分析显示以SWV值3.69 m/s为截断值,其诊断甲状腺木乃伊结节的敏感性82.4%,特异性52.2%,曲线下面积0.673。Logistic回归分析显示黑白双层晕环征和峰值强度比<1是甲状腺木乃伊结节的独立影响因素(OR=27.589、40.877,P=0.012、0.007)。结论熟悉和掌握木乃伊结节的超声特征,并结合既往超声检查的结果,有助于鉴别甲状腺木乃伊结节。常规超声、VTIQ及CEUS对甲状腺木乃伊结节的鉴别诊断均具有重要价值。

ObjectiveTo explore the clinical value of conventional ultrasound(US),virtual touch imaging and quantification(VTIQ) and contrast-enhanced ultrasound(CEUS) in differential diagnosis of mummified thyroid nodules.MethodsTwenty-three patients with mummified thyroid nodules and 17 patients with papillary thyroid carcinomas(PTCs)were enrolled in this study.The size,shape,margin,echogenicity,calcification,posterior shadowing,black and white double halo,vascularity,shear wave velocity(SWV) and CEUS parameters for each nodule were obtained. The receiver operating characteristics(ROC)curves were plotted to get the SWV cutoff value,and the area under the curve was calculated. Logistic regression analysis was used to obtain the independent influence factor of mummified thyroid nodules.ResultsThere were significant differences in blood flow signals,SWV,enhancement mode,peak intensity ratio <1,and area ratio under the curve <1 in the mummified nodule group and PTCs group(all P<0.05),and there were no significant differences in other characteristics.ROC curve showed that the cutoff value of SWV was 3.69 m/s,the diagnostic sensitivity was 82.4%,the specificity was 52.2%,and the area under the curve was 0.673. Logistic regression analysis showed that the black and white double halo sign and peak intensity ratio <1 were independent influence factors of thyroid mummy nodules(OR=27.589,40.877,P=0.012,0.007).ConclusionMastering the ultrasound findings of mummified thyroid nodules and combining previous ultrasound findings are critical for detecting benign nodules from malignant nodules.US,VTIQ and CEUS all have important value in differential diagnosis of mummified thyroid nodules.