超声造影对TI-RADS 4类甲状腺微小结节定性诊断的临床价值

Value of contrast-enhanced ultrasound in qualitative diagnosis of thyroid micronodules in TI-RADS 4

目的:探讨超声造影(CEUS)对甲状腺影像报告与数据系统(TI-RADS)4类甲状腺微小结节定性诊断的临床价值。方法:选取2019年1月至2020年8月就诊于新疆医科大学第四附属医院的139个病人的139个常规超声(US)诊断为TI-RADS 4类甲状腺微小结节,均行US及CEUS检查,所有结节均有术后病理结果,其中恶性结节98个,良性结节41个。以US、CEUS表现中差异有统计学意义的参数为自变量,病理结果为因变量,构建二元Logistic回归方程,计算单独使用US、CEUS赋值评分及两者联合诊断甲状腺微小恶性结节的最佳截断值,绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC),评价其诊断效能。结果:甲状腺良、恶性微小结节在边界、形态、纵横比、钙化、结节与被膜关系等5项US检查比较,差异均有统计学意义(P<0.05),在CEUS的增强水平、方式、周边有无环状增强、增强后均匀性、增强后边界、大小等方面差异均有统计意义(P<0.05)。常规超声评分诊断AUC敏感性、特异性及准确率分别为86.7%(85/98)、73.2%(30/41)、82.7%(115/139)。超声造影AUC的敏感性、特异性及准确率分别为93.9%(92/98)、82.9%(34/41)、90.6%(126/139)。两者联合的AUC为0.942,敏感性、特异性和准确率分别为93.9%、87.8%、92.1%。结论:超声造影可以有效提高TI-RADS 4类甲状腺微小结节良恶性诊断准确性。

Objective: To explore the clinical value of contrast-enhanced ultrasound(CEUS) in qualitative diagnosis of Thyroid Imaging-Reporting and Data System 4(TI-RADS 4)thyroid micronodules.Methods: A total of 139 patients with TI-RADS 4 diagnosed by routine ultrasound(US) were selected from The Fourth Affiliated Hospital of Xinjiang Medical University from January 2019 to August2020. US and CEUS were performed on all the nodules. Postoperative pathological results were obtained for all the nodules, including 98 malignant nodules and 41 benign nodules. Binary logistic regression equation was established to calculate the cut-off value of US and CEUS. The receiver operating characteristic(ROC) curves was drawn for the diagnosis of thyroid micronodules by US, CEUS alone, and combined application of both, respectively, and the diagnostic efficiency was evaluated.Results: There were statistically significant differences in the boundary, morphology, aspect ratio,calcification and the relationship between nodules and capsule between benign and malignant thyroid micronodules(P<0. 05). There were statistically significant differences in CEUS enhancement level,enhancement mode, peripheral enhancement, post-enhancement uniformity, post-enhancement boundary, size, and other aspects(P<0. 05). The sensitivity, specificity, and accuracy of area under the ROC curve(AUC) were 86. 7%(85/98), 73. 2%(30/41), and 82. 7%(115/139) in US, respectively. The sensitivity, specificity and accuracy of AUC were 93. 9%(92/98), 82. 9%(34/41), and90. 6%(126/139) in CEUS, respectively. The combined AUC was 0. 942, and its sensitivity, specificity, and accuracy were 93. 9%, 87. 8%, and 92. 1%, respectively. Conclusion: Contrast-enhanced ultrasound has a higher accuracy rate in the diagnosis of thyroid micronodules in TI-RADS 4.