TI-RADS分类、实时弹性成像及超声造影联合应用对伴微钙化甲状腺结节的诊断价值

Diagnosis value of the combined application of TI-RADS,real-time elastography,contrast-enhanced ultrasound for microcalcification in thyroid nodule

目的探讨联合应用甲状腺影像报告和数据系统(TI-RADS)分类、实时弹性成像(RTE)及超声造影(CEUS)在鉴别诊断伴微钙化甲状腺结节良恶性中的价值。方法选取2018年5月至2020年2月在西安市中心医院经病理证实的伴微钙化甲状腺结节患者92例,共计112个结节(良性67个,恶性45个),分别行TI-RADS分类及RTE、CEUS检查,并判断结节的良恶性,评估三种方法单独及联合诊断的敏感度、特异度和准确度。绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评价三种方法单独及联用对伴微钙化甲状腺结节的诊断价值。结果在鉴别诊断伴微钙化结节的良恶性上,TI-RADS分类、RTE、CEUS及三者联合诊断的敏感度分别为71.11%、80.00%、82.22%、91.11%,特异度分别为53.73%、82.09%、86.57%、97.01%,准确度分别为60.71%、81.25%、84.82%、94.64%,AUC分别为0.624、0.810、0.844、0.941;三者联合应用的诊断效能明显高于单一方法的诊断效能,且差异具有统计学意义(P<0.05)。结论联合应用TI-RADS分类、RTE及CEUS能为诊断提供更全面的信息,对伴微钙化的甲状腺结的良恶性具有较高的诊断价值。

Objective To explore the value of combining thyroid imaging reporting and data system(TI-RADS)classification,real-time elastography(RTE),contrast-enhanced ultrasound(CEUS)in the differential diagnosis of benign and malignant microcalcification in thyroid nodules.Methods A total of 112 cases of microcalcification in thyroid nodules(67,benign;45,malignant)in 92 patients confirmed by pathology were selected in Xi'an Central Hospital Affiliated to Xi'an Jiaotong University from May 2018 to February 2020.The patients were examined by TI-RADS classification,RTE and CEUS.The benign and malignant nodules were differentiated with three methods.The sensitivity,specificity,accuracy of the three methods alone and combined diagnosis were evaluated.The receiver operating characteristic(ROC)curves of the three methods alone or combined diagnosis were drawn and the area under curve(AUC)was calculated.The diagnostic value of three methods alone and combined diagnosis for microcalcification in thyroid nodules were evaluated.Results In the differential diagnosis of benign and malignant microcalcification in thyroid nodules,the sensitivity of TI-RADS classification,RTE,CEUS and the combined diagnosis of the three methods were 71.11%,80.00%,82.22%,and 91.11%,respectively.The specificity was 53.73%,82.09%,86.57%,and 97.01%,respectively.The accuracy was 60.71%,81.25%,84.82%,and 94.64%,respectively.The areas under the received operating characteristic curve(AUC)was 0.624,0.810,0.844 and 0.941 respectively.The diagnostic efficiency of combined application of the three methods was significantly higher than that of single method(all P<0.05).Conclusion Combined application of TI-RADS classification,RTE and CEUS can provides more comprehensive information for the diagnosis,which has higher value in the differential diagnosis of benign and malignant microcalcification in thyroid nodules.