常规超声和超声造影鉴别诊断甲状腺皱缩结节与乳头状癌

Differential diagnosis of mummified thyroid nodule and papillary thyroid carcinoma with conventional and contrast-enhanced ultrasound

目的评价常规超声和超声造影(CEUS)鉴别诊断甲状腺影像报告和数据系统(TI-RADS)4类及以上甲状腺皱缩结节(MTN)与甲状腺乳头状癌(PTC)的价值。方法纳入52例MTN、53个结节(MTN组)和47例PTC、48个结节(PTC组),比较组间常规超声和CEUS特征差异,评价MTN特异性超声征象诊断MTN的效能。结果组间TI-RADS分类差异具有统计学意义(P<0.05)。常规超声显示组间结节位置、纵横比、钙化形态、钙化位置、血流分布、囊壁塌陷征、同心圆征及声晕差异均有统计学意义(P均<0.05);结节最大径及回声特点差异均无统计学意义(P均>0.05);组间结节CEUS增强模式和壁增强模式差异均有统计学意义(P均<0.05)。根据常规超声囊壁塌陷征、同心圆征、黑白双晕及CEUS结节无增强、壁增强诊断MTN的特异度及阳性预测值均为100%;无增强模式诊断MTN的敏感度、准确率与阴性预测值均显著高于常规超声指标及壁增强(P均<0.05)。结论CEUS诊断MTN的效能显著优于常规超声,鉴别MTN与PTC具有较高临床价值。

Objective To observe the value of conventional and contrast-enhanced ultrasound(CEUS)in differential diagnosis of mummified thyroid nodules(MTN)and papillary thyroid carcinoma(PTC)among thyroid imaging report and data system(TI-RADS)category 4 and above thyroid nodules.Methods Totally 52 MTN patients with 53 nodules(MTN group)and 47 PTC patients with 48 nodules(PTC group)were enrolled.The findings of conventional ultrasound and CEUS were compared between groups,and the efficiency of the specific sonographic signs of MTN for diagnosis of MTN were observed.Results TI-RADS classifications of thyroid nodules of MTN and PTC were statistically different(P<0.05).There were statistically significant differences of conventional ultrasonic findings,including nodular location,aspect ratio,calcification morphology,calcification location,blood flow distribution,cystic wall shrinkage sign,concentric configuration and the halo sign between groups(all P<0.05),but not of the maximum diameter and echo characteristics of the nodules between groups(both P>0.05).During CEUS,there were significant differences of enhancement patterns and wall enhancements between groups(both P<0.05).The specificity and positive predictive value of conventional ultrasound features,including cystic wall shrinkage sign,concentric configuration,black-and-white halo,as well as no enhancement pattern and wall enhancement of CEUS for diagnosing MTN were all 100%,while the sensitivity,accuracy and negative predictive values of CEUS no enhancement pattern for diagnosing MTN were all significantly higher than those of conventional ultrasonic indicators and CEUS wall enhancement(all P<0.05).Conclusion The efficiency of CEUS for diagnosing MTN was significantly higher than that of conventional ultrasound,which was valuable for distinguishing MTN and PTC.