甲状腺恶性结节的独立超声造影危险征象及其诊断价值研究

Research on the risk signs of independent CEUS of thyroid malignant nodules and its diagnostic value

目的:探讨甲状腺恶性结节的独立超声造影危险征象及其诊断价值。方法:选取在医院治疗的114例甲状腺结节患者,根据病理检查结果将其分为良性结节组(60例)和恶性结节组(54例),使用彩色多普勒超声诊断仪进行常规超声检查,记录甲状腺结节的部位、大小、纵横比、边界、形态、回声、内部构成、钙化、血流、声晕以及是否有颈部淋巴结转移等超声征象;行超声造影检查观察甲状腺结节的增强水平、增强形态、增强均匀性、增强后边界、造影剂进入模式以及造影剂退出模式。比较两组患者常规超声征象和超声造影征象,采用多因素Logistics回归分析法,筛选出甲状腺恶性结节的常规超声和超声造影的独立危险征象,采用受试者工作特征(ROC)曲线分析常规超声和超声造影在鉴别甲状腺结节良恶性中的价值。结果:两组常规超声甲状腺结节的部位、纵横比、边界、形态、回声、内部构成、钙化、血流以及是否有颈部淋巴结转移的征象比较,差异有统计学意义(x^(2)=7.037,x^(2)=24.174,x^(2)=9.882,x^(2)=23.447,x^(2)=16.671,x^(2)=10.641,x^(2)=28.003,x^(2)=15.560,x^(2)=12.179;P<0.05),而甲状腺结节的大小、声晕差异无统计学意义。两组超声造影甲状腺结节的增强水平、增强形态、增强均匀性、增强后边界、造影剂进入模式以及造影剂退出模式的征象比较,差异有统计学意义(x^(2)=26.138,x^(2)=24.311,x^(2)=14.805,x^(2)=15.393,x^(2)=7.915,x^(2)=25.601;P<0.05)。将上述差异有统计学意义的所有征象进行多因素Logistic回归分析后发现,形态不规则、微钙化及纵横比≥1为甲状腺恶性结节的独立常规超声危险征象,向心性增强、不均匀增强及造影剂快退模式为甲状腺恶性结节的独立超声造影危险征象。采用ROC曲线分析常规超声诊断恶性甲状腺结节时,ROC曲线下面积(AUC)为0.758,灵敏度为76.38%,特异度为77.94%,准确率为78.12%;超声造影诊断恶性甲状腺结节时,AUC为0.897,灵敏度为92.46%,特异度为89.64%,准确率为88.67%。结论:相比于常规超声,超声造影对鉴别甲状腺结节良恶性的灵敏度、特异度及准确率较高,在早期诊断和早期治疗方面具有重要意义。

Objective:To analyze the risk signs of independent contrast-enhanced ultrasonography(CEUS)of thyroid malignant nodules and its diagnostic value.Methods:A total of 114 patients with thyroid nodules who were treated in hospital were selected and were divided into benign nodules group(n=60)and malignant nodules group(n=54)according to the pathological examination results.Routine ultrasound examination was performed with color Doppler ultrasound diagnostic instrument,and the location,size,aspect ratio,boundary,shape,echo and internal composition of thyroid nodules were recorded,and the calcification,blood flow,acoustic halo and whether there was cervical lymph nodule metastasis also were recorded.Then the examination of CEUS was performed to observe the enhancement level,enhancement morphology,enhancement uniformity,enhanced boundary,entry and exit mode of contrast agent in thyroid nodule.The signs of conventional ultrasound and CEUS between two groups were compared.The multivariate logistic regression analysis was adopted to screen the independent risk signs of conventional ultrasound and CEUS of thyroid malignant nodules.And the receiver operating characteristic(ROC)curve was adopted to analyze the values of conventional ultrasound and CEUS in differentiating benign and malignant thyroid nodules.Results:There were statistically significant differences in the location,aspect ratio,boundary,shape,echo,internal composition,calcification,blood flow and whether there was the signs of cervical lymph nodule metastasis between the two groups(x^(2)=7.037,x^(2)=24.174,x^(2)=9.882,x^(2)=23.447,x^(2)=16.671,x^(2)=10.641,x^(2)=28.003,x^(2)=15.560,x^(2)=12.179,P<0.05),respectively.While there were no significant differences in size and acoustic halo(P>0.05).There were significant differences in the enhanced level,enhanced shape,enhanced uniformity,enhanced boundary,entry and exit mode of contrast agent of thyroid nodule of CEUS between the two groups(x^(2)=26.138,x^(2)=24.311,x^(2)=14.805,x^(2)=15.393,x^(2)=7.915,x^(2)=25.601,P<0.05).Multivariate logistic regression analysis showed that irregular shape,micro-calcification and“aspect ratio≥1”were independent risk signs of thyroid malignant nodules in conventional ultrasound,and centripetal enhancement,uneven enhancement and fast backward mode of contrast agent were independent risk signs of thyroid malignant nodules in CEUS after above all signs with significances were analyzed by Multivariate logistic regression.The results of ROC curve showed that the area under the curve(AUC)was 0.758,and the sensitivity was 76.38%,and the specificity was 77.94%,and the accuracy rate was 78.12%when conventional ultrasound was used to diagnose malignant thyroid nodule.And they were 0.897,92.46%,89.64%and 88.67%when CEUS was used to diagnose that,respectively.Conclusion:Compared with conventional ultrasound,CEUS has higher sensitivity,specificity and accuracy in differentiating benign and malignant thyroid nodules.It has important significance in early diagnosis and treatment.