超声造影、弹性成像联合多层螺旋CT鉴别诊断甲状腺良恶性结节的价值

Value of contrast-enhanced ultrasound,ultrasonic elastography combined with multi-layer spiral CT in the differential diagnosis of benign and malignant thyroid nodules

目的探讨超声造影(CEUS)、弹性成像(UE)及多层螺旋CT(MSCT)联合应用鉴别诊断甲状腺良恶性结节的价值。方法选取我院收治的甲状腺结节患者85例,共计94个病灶(良性结节70个,恶性结节24个),术前均行CEUS、UE及MSCT检查。以病理或细针穿刺活检结果为金标准,分析CEUS、UE、MSCT单独及联合应用对甲状腺良恶性结节的诊断价值。结果 CEUS检查示良恶性结节边缘、形态、有无微小钙化、纵横比、血流情况、增强方式、消退速度、进入方式、是否均匀强化比较,差异均有统计学意义(均P<0.05)。UE检查显示,甲状腺良性结节弹性评分0~2分者63个,3~4分者7个;恶性结节弹性评分0~2分者3个,3~4分者21个,差异有统计学意义(Z=-6.360,P<0.05)。MSCT检查示甲状腺良恶性结节囊变程度、形态、有无微小钙化、直径、强化方式、边缘情况比较,差异均有统计学意义(均P<0.05)。CEUS、UE及MSCT诊断甲状腺良恶性结节的敏感性、特异性、准确率分别为85.71%、83.33%、85.11%,75.71%、75.00%、75.53%,80.00%、79.17%、78.72%;三者联合应用的诊断敏感性、特异性、准确率分别为95.71%、91.67%、94.68%,均高于各方法单独或两两联合应用,差异均有统计学意义(均P<0.05)。结论 CEUS、UE联合MSCT对甲状腺良恶性结节具有较好的鉴别诊断价值,可为临床诊断提供参考。

Objective To explore the value of contrast-enhanced ultrasound(CEUS),ultrasonic elastography(UE)combined with multi-layer spiral CT(MSCT)in the differential diagnosis of benign and malignant thyroid nodules.Methods Eighty-five patients with 94 thyroid nodules(70 benign nodules and 24 malignant nodules)in our hospital were selected,and all patients were examined by CEUS,UE and MSCT before surgery.The diagnostic value of CEUS,UE and MSCT application alone and their combination for benign and malignant thyroid nodules was analyzed according to the pathological results or fine needle aspiration biopsy results.Results CEUS showed that there were significant differences of boundary,shape,microcalcification or not,aspect ratio,blood flow,enhancement pattern,regression velocity,entry mode,uniform enhancement or not between benign and malignant thyroid nodules(all P<0.05).UE showed that there were 63 benign nodules with 0~2 scores,7 benign nodules with 3~4 scores,while there were 3 malignant nodules with 0~2 scores,21 malignant nodules with 3~4 scores,there was significant difference(Z=-6.360,P<0.05).MSCT showed that there were significant differences of degree of cystic degeneration,shape,microcalcification or not,diameter,enhancement pattern,boundary between benign and malignant thyroid nodules(all P<0.05).The sensitivity,specificity and accuracy of CEUS,UE,MSCT were 85.71%,83.33%,85.11%,75.71%,75.00%,75.53%,80.00%,79.17%,78.72%,respectively.The results of combined were 95.71%,91.67%,94.68%,which were higher than those of application alone and two combined(all P<0.05).Conclusion CEUS,UE combined with MSCT has a higher diagnostic value for benign and malignant thyroid nodules.