超声造影在伴有钙化的甲状腺实性结节良恶性鉴别方面的辅助价值

Role of Contrast-enhanced Ultrasound in Distinguishing between Benign and Malignant Thyroid Nodules with Calcification

目的探讨超声造影在伴有钙化的甲状腺实性结节良恶性鉴别方面的辅助诊断价值。方法使用常规超声以及常规超声联合超声造影方法评估76例患者的102处伴有钙化的甲状腺实性结节,并对常规超声以及超声造影特征赋分,最终比较单用常规超声与常规超声同超声造影串联联合诊断试验之间的诊断价值优劣。结果良、恶结节在微钙化(P<0.001)、纵横比>1(P=0.039)、边缘模糊(P=0.027)、结节周边环状增强(P=0.000)、结节非钙化部分的增强程度(P=0.000)及增强均匀程度(P=0.001)方面差异有统计学意义;常规超声联合超声造影可以显著提高诊断试验的曲线下面积(0.841比0.701,P<0.001)和特异度(97.06%比44.12%,P=0.007),而灵敏度差异无统计学意义(67.55%比73.53%,P=0.727)。结论常规超声联合超声造影能够提高常规超声在伴有钙化的甲状腺实性结节良恶性的鉴别诊断价值,并且常规超声(实性、低回声、微钙化、纵横比和边缘模糊)和超声造影(结节周边非环状增强、非钙化部分呈低增强和非均匀增强)累及出现5项及以上恶性征象高度提示伴钙化的甲状腺实性结节为恶性结果。

Objective To explore the roles of conventional ultrasound and contrast-enhanced ultrasound in distinguishing between benign and malignant thyroid nodules with calcification.Methods A total of 102 solid thyroid nodules with calcification in 76 patients were evaluated by conventional ultrasound alone and conventional ultrasound combined with contrast-enhanced ultrasound.The features obtained through conventional ultrasound alone and that combined with contrast-enhanced ultrasound were scored,and the diagnostic performance of the two methods was analyzed based on the final pathological results.Results The distribution of microcalcification(P<0.0001),aspect ratio>1(P=0.039),unclear boundary(P=0.027),ring enhancement around nodules(P=0.000),and the degree(P=0.000)and uniformity(P=0.001)of enhancement for the non-calcified part were statistically different between benign and malignant nodules.Compared with conventional ultrasound alone,conventional ultrasound combined with contrast-enhanced ultrasound significantly improved the area under the curve(0.841 vs.0.701,P<0.001)and specificity(97.06%vs.44.12%,P=0.007),without significant change in sensitivity(67.55%vs.73.53%,P=0.727).Conclusions The combination with contrast-enhanced ultrasound can improve the performance of conventional ultrasound in the differential diagnosis of benign and malignant thyroid solid nodules with calcification.Eight malignant signs include solid,hypoechoic,microcalcification,aspect ratio,and blurred edges detected by conventional ultrasound,and non-circular enhancement around nodules,low enhancement and non-uniform enhancement of solid parts detected by contrast-enhanced ultrasound.A solid thyroid nodule with calcification presenting five or more malignant signs highly suggests malignancy.