超声造影校对TI-RADS 4类甲状腺结节价值评估

Value of contrast enhanced ultrasound in revision of thyroid nodule classified TI-RADS 4

目的探讨超声造影对甲状腺影像分析与数据报告4类(TI-RADS 4类)结节的校对价值。方法选择经病理诊断证实甲状腺结节患者49例(50个病灶),其中男性19例;女性30例;年龄17~73岁,平均年龄48岁。应用超声造影方法对以上50个甲状腺影像分析与数据报告(TI-RADS)分类为4类结节进行再次评估,并重新分类;以术后病理诊断为"金标准",分析并对比超声诊断甲状腺结节良恶性价值。结果经病理诊断,甲状腺良性42个,恶性8个。通过建立Logistic回归方程和运用受试者工作特性(ROC)曲线证实,应用超声造影重新校对TI-RADS分类后,其诊断试验正确区分该疾病为良性和恶性的概率为0.823。同时,由曲线趋势及面积可见,相比于灰阶超声TI-RADS分类及超声造影两种方法联合诊断具有更高的准确度。采用灰阶超声和超声造影联合诊断法,纳入Logistic回归模型的变量,最终模型纳入了增强模式和纵横比两个变量,这两个变量可以预测良性或者恶性,模型公式:Logit(P)=-0.685+1.361×纵横比+(-2.271)×增强模式(等增强、无增强)+1.002×增强模式(高增强)。结论应用超声造影方法校对甲状腺TI-RADS 4类结节,并将两者结合,联合诊断具有较高灵敏度的同时又具有较好的特异度,该诊断方法可以进一步有效地预测良恶性分类。

Objective To explore revised value of contrast-enhanced ultrasound(CEUS) in patients with thyroid nodules by thyroid imaging reporting and data system classification 4 types(TI-RADS 4). Methods A total of 49 patients(50 lesions) with thyroid nodules confirmed by pathological diagnosis were enrolled, which included 19 males and 30 females, aged 17 ~ 73 years old with mean age of 48 years old. The 50 nodules of TI-RADS 4 were re-evaluated and re-classified by CEUS, and postoperative pathological diagnosis was used as "gold standard" to analyze diagnosis value of CEUS in benign and malignant thyroid nodules. Results There were 42 cases of benign thyroid and 8 cases of malignant in pathological results. The Logistic regression equation and receiver operating characteristic(ROC) curves confirmed that the probability of correctly distinguishing benign from malignant by CEUS was 0.823 after re-TI-RADS classification. Meantime, from the curve trend and area, TI-RADS classification and CEUS combined diagnosis showed higher accuracy than gray-scale ultrasound. Conclusion It is demonstrated that CEUS revised thyroid TI-RADS 4 nodules, and combined diagnosis showed high sensitivity and specificity,which could further effectively predict the classification of benign and malignant.