超声造影成像对甲状腺乳头状癌被膜侵袭的诊断价值

Diagnostic value of contrast-enhanced ultrasound in the capsule invasion of papillary thyroid microcarcinoma

目的探讨超声造影成像(CEUS)对甲状腺乳头状癌(PTC)被膜侵袭的诊断价值。方法本研究为回顾性研究,选取2019年1月至2021年12月北部战区总医院收治的经病理证实为PTC的198例患者(227个结节),男94例,女104例,年龄(47.06±15.33)岁,年龄范围为22~69岁。术前分别行常规超声和CEUS检查,比较常规超声和CEUS诊断PTC被膜侵袭的效果。结果227个癌灶中,150个为侵袭性,77个为非侵袭性。常规超声检查时,非侵袭组(非侵袭性癌灶)和侵袭组(侵袭性癌灶)的病灶大小、边界及造影前病灶附近被膜是否连续比较,差异有统计学意义(P<0.05)。CEUS检查时,非侵袭组和侵袭组的病灶动脉期灌注模式、造影后病灶附近被膜是否连续比较,差异有统计学意义(P<0.05)。logistic多因素回归分析显示,造影后病灶动脉期向心性灌注、病灶附近被膜不连续与被膜侵袭相关。CEUS诊断灵敏度均高于常规超声诊断,CEUS的ROC曲线下面积大于常规超声。结论CEUS对PTC被膜侵袭的检查较常规超声具有更高的评估价值,可为临床提供一定的指导作用。

Objective To explore the diagnostic value of contrast-enhanced ultrasound(CEUS)in the capsule invasion of papillary thyroid carcinoma(PTC).Methods This study was a retrospective study,a total of 198 patients with PTC,94 males and 104 females,aged(47.06±15.33)years old,ranging from 22 to 69 years old,admitted to the department of ultrasound diagnosis in the General Hospital of Northern Theater Command from January 2019 to December 2021.All patients underwent routine ultrasound examination and CEUS before surgery.The effect of routine ultrasound and CEUS in the capsule invasion of PTC was compared.Results In the 227 foci,150 were invasive and 77 were non-invasive.During the ultrasound,the difference of lesion size,boundary and capsule continuity continuous near the lesion before contrast in the non-invasive group and invasive group were statistically significant(P<0.05).During the CEUS,the difference of focal arterial perfusion mode and capsule continuity continuous near the lesion after contrast were statistically significant(P<0.05).Logistic multivariate regression analysis showed that cardiac perfusion at the arterial stage and discontinuity of the surrounding capsule were associated with capsule invasion.The sensitivity,specificity and accuracy of CEUS diagnosis were higher than those of ultrasoud,and the ROC curve of CEUS was larger than that of ultrasoud.Conclusions CEUS examination of capsule invasion has a higher evaluation value.