常规超声联合超声造影诊断甲状腺炎并发乳头状癌研究

Study of conventional ultrasound combined with contrast-enhanced ultrasound in papillary thyroid carcinoma with Hashimoto’s thyroiditis

目的 探讨甲状腺乳头状癌(PTC)合并桥本氏甲状腺炎(HT)行常规超声联合超声造影的超声特征及其诊断价值。方法 选取某院2019年1月至2021年3月收治的59例甲状腺结节合并HT患者,共75个结节。其中PTC40例,良性结节35例。比较两组的超声特征,采用多因素分析筛选出影响PTC合并HT诊断的超声特征相关危险因素,并运用受试者工作曲线(receiver operating characteristic curve, ROC)分析不同诊断方法的临床价值。结果 两组患者甲状腺结节大小、结节性质、回声情况、晕轮征比较,差异无统计学意义(P>0.05)。但是,PTC组纵横比≥1、边界不清楚、微小钙化、周围血流信号、低增强、可获取峰值强度(PI)指数<1、曲线下面积(AUC)指数<1的占比高于良性结节组,差异有统计学意义(P<0.05)。多因素分析显示,边界不清楚、微钙化、PI指数<1是诊断PTC合并HT的独立危险因素(P<0.05)。甲状腺影像报告和数据系统(TI-RADS)诊断PTC合并HT的最佳截断值为4b/4c,敏感性为85.50%,特异性为66.70%,AUC为0.822(95%CI:0.703~0.942)。TI-RADS联合CEUS诊断PTC合并HT的最佳截断值为4a/4b,敏感性为86.70%,特异性为98.05%,AUC为0.949(95%CI:0.886~1.000)。两种诊断方法的AUC比较,差异有统计学意义(P=0.043)。结论 CEUS联合TI-RADS有助于提高PTC合并HT的诊断价值,值得临床进一步推广。

Objetive To investigate the ultrasonic characteristics and diagnostic value of conventional ultrasound combined with contrast-enhanced ultrasound(CEUS) in papillary thyroid carcinoma(PTC) with Hashimoto’s thyroiditis(HT).Methods Fifty-nine cases of thyroid nodules with HT in one hospital from Jan.2019 to Mar.2021 were selected, including 75 nodules.Among them, PTC was diagnosed in 40 cases and benign nodules in 35 cases.The ultrasonic characteristics between the two groups were compared.The risk factors of ultrasonic characteristics influencing the diagnosis of PTC combined with HT were screened by multivariate analysis.The clinical value of different diagnostic methods was analyzed by receiver operating characteristic curve(ROC).Results There was no significant difference in thyroid nodule size, nodule component, echo and halo sign between the two groups(P>0.05).However, the proportions in PTC group with taller-than-wider shapes, ill-defined margins, microcalcification, peripheral vascularity, hypo-enhancement, peak intensity(PI) index<1,area under the curve(AUC) index <1 was higher than those in the benign nodule group(P<0.05).The best cutoff value of TI-RADS in the diagnosis of PTC with HT was 4 b/4 c, with sensitivity of 85.50%,specificity of 66.70% and AUC of 0.822(95% CI:0.703-0.942).The best cutoff value of TI-RADS combined with CEUS in the diagnosis of PTC with HT was 4 a/4 b, with sensitivity of 86.70%,specificity of 98.05% and AUC of 0.949(95% CI:0.886-1.000).There was significant difference in AUC between the two diagnostic methods(P=0.043).Conclusions CEUS combined with TI-RADS can improve the diagnostic value of PTC combined with HT,which is worthy of further clinical promotion.