声触诊组织成像联合常规超声鉴别诊断甲状腺结节良恶性的临床价值

Clinical value of virtual touch tissue imaging combined with coventional ultrasound in the differential diagnosis of benign and malignant thyroid nodules

目的探讨声触诊组织成像(VTI)技术联合常规超声鉴别诊断甲状腺结节良恶性的临床价值。方法选取于我院行常规超声和VTI检查的134例甲状腺结节患者(共144个结节),总结良、恶性结节的超声特征。以细针穿刺活检及手术病理结果为金标准,绘制受试者工作特征(ROC)曲线评估常规超声和VTI对甲状腺结节良恶性的诊断效能。结果甲状腺良、恶性结节在大小、位置、回声、边缘、血流方面比较差异均无统计学意义,在纵横比和有无钙化方面比较差异均有统计学意义(均P<0.05)。恶性结节VTI分级多表现为Ⅳ~Ⅵ级(83.9%),良性结节分级多表现为Ⅰ~Ⅲ级(90.2%),差异有统计学意义(P<0.05);62个恶性结节的VTI与常规超声测量的面积比为1.45±0.45,82个良性结节的面积比为1.09±0.15,差异有统计学意义(P<0.05)。ROC曲线分析表明,VTI分级的截断值为Ⅳ级,其诊断敏感性、特异性、准确率、阳性预测值、阴性预测值和约登指数分别为83.5%、90.2%、87.5%、86.7%、88.1%和0.741;面积比的截断值为1.22,其诊断敏感性、特异性、准确率、阳性预测值、阴性预测值和约登指数分别为79.0%、80.5%、79.9%、75.3%、83.5%和0.495;二者联合诊断的敏感性、特异性、准确率、阳性预测值、阴性预测值、约登指数分别为82.3%、92.7%、88.2%、89.5%、87.4%和0.749。结论VTI和常规超声均可应用于甲状腺结节良恶性的诊断,二者联合应用可进一步提高诊断特异性和准确率。

Objective To explore the clinical value of virtual touch tissue imaging(VTI)combined with coventional ultrasound in the differential diagnosis of benign and malignant thyroid nodules.Methods A total of 134 patients with 144 thyroid nodules who underwent conventional ultrasound and VTI from our hospital were enrolled,the ultrasound characteristics of benign and malignant nodules was summarized.Taking fine needle aspiration biopsy and surgical pathology findings as the gold standard,the receiver operating characteristic(ROC)curve was drawn to assess the diagnostic value of conventional ultrasound and VTI for benign and malignant thyroid nodules.Results There were no statistically significant differences between benign and malignant thyroid nodules in terms of size,location,echogenicity,margin and blood flow,but the differences were statistically significant in aspect ratio and calcification(both P<0.05).The VTI grading of most malignant nodules were gradeⅣ~Ⅵ(83.9%),and most benign nodules were gradeⅠ~Ⅲ(90.2%).There was significant difference of VTI grading between benign and malignant nodules(P<0.05).The area ratio value of 62 malignant nodules was 1.45±0.45,and that of 82 benign nodules was 1.09±0.15,which indicated a significant difference(P<0.05).ROC analysis showed that,the cutoff value of VTI grading was gradeⅣ,and the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Youden index were 83.5%,90.2%,87.5%,86.7%,88.1%and 0.741,respectively.The cutoff value of area ratio was 1.22,and the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Youden index were 79.0%,80.5%,79.9%,75.3%,83.5%and 0.495,respectively.The specificity,accuracy,positive predictive value and Youden index of two combined were 82.3%,92.7%,88.2%,89.5%,87.4%and 0.749,respectively.Conclusion VTI and conventional ultrasound can be used in the diagnosis of benign and malignant thyroid nodules.The combined application of the two further improves the diagnostic specificity and accuracy.