二维超声、弹性成像及超声造影诊断桥本氏甲状腺炎伴发良恶性结节的价值

Value of two-dimensional ultrasound,elastography and contrast-enhanced ultrasound in the diagnosis of Hashimoto’s thyroiditis with benign and malignant thyroid nodules

目的探讨单独二维超声、弹性成像、超声造影及其联合检查在桥本氏甲状腺炎合并良恶性结节中的诊断价值。方法对44例桥本氏甲状腺炎患者的54个结节分别行二维超声、弹性成像及超声造影检查,并与病理结果进行对照分析,计算并比较单独二维超声、弹性成像、超声造影及三者联合应用对桥本氏甲状腺炎合并良恶性结节的诊断效能。结果以TI-RADS 4、5类作为二维超声诊断恶性结节的标准,其诊断敏感性、特异性及准确率分别为50.0%、82.5%、74.0%;以结节杨氏模量值≥46.1 kPa作为剪切波弹性成像预测恶性结节的标准,其诊断敏感性、特异性及准确率分别为57.1%、85.0%、77.7%;以不均匀性低增强作为超声造影诊断恶性结节的标准,其诊断敏感性、特异性及准确率分别为64.3%、80.0%、75.9%;三种方法联合检查的诊断敏感性、特异性及准确率分别为85.7%、95.0%、92.5%。联合检查的准确率高于单一检查,差异均有统计学意义(均P<0.05)。结论不同超声技术联合检查较单一检查对桥本氏甲状腺炎合并良恶性结节有更高诊断价值,值得进一步推广应用。

Objective To evaluate the diagnostic value of two-dimensional ultrasound,elastography and contrastenhanced ultrasound and their combinations in Hashimoto’s thyroiditis with benign and malignant nodules.Methods Twodimensional ultrasound,elastography and contrast-enhanced ultrasound were performed on 54 nodules in 44 patients with Hashimoto’s thyroiditis respectively.The ultrasound diagnosis results were compared with the pathological results.The diagnostic efficiencies of two-dimensional ultrasound,elastography and ultrasound and their combinations were calculated in Hashimoto’s thyroiditis with benign and malignant nodules.Results Taken TI-RADS 4 and 5 as the diagnostic criteria for malignant nodules the diagnostic sensitivity,specificity and accuracy of two-dimensional ultrasound were 50.0%,82.5%,and 74.0%,respectively.Taken Young’s modulus value of nodules measured by shear wave elastography≥46.1 kPa as the prediction index for malignant nodules,the diagnostic sensitivity,specificity and accuracy of elastography were 57.1%,85.0%and 77.7%,respectively.Taken low heterogeneity enhancement as the diagnostic criteria for malignant nodules,and the diagnostic sensitivity,specificity,and accuracy of contrast-enhanced ultrasound were 64.3%,80.0%and 75.9%,respectively.The diagnostic sensitivity,specificity,and accuracy of the combination of three methods were 85.7%,95.0%and 92.5%,respectively.The accuracy of combinations was higher than that of the single method,and the differences were statistically significant(all P<0.05).Conclusion The combination of different ultrasound methods(two-dimensional ultrasound,elastography,contrastenhanced ultrasound)is more valuable than single ultrasound method in the diagnosis of Hashimoto’s thyroiditis with benign and malignant nodules,which is worthy of further promotion and application.