超声造影定量分析联合ACR TI-RADS分类在甲状腺实性结节鉴别诊断中的价值

Value of contrast-enhanced ultrasound quantitative analysis combined with ACR TI-RADS classification in the differential diagnosis of thyroid solid nodules

目的探讨VueBox?超声造影定量分析联合ACR TI-RADS分类在诊断甲状腺实性结节良恶性中的应用价值。方法回顾性分析2020年10月至2022年2月广西壮族自治区人民医院具有术后/穿刺活检病理结果的201例甲状腺实性结节患者(共201个结节)的术前常规超声及超声造影图像。根据病理结果将其分为恶性组和良性组,分析两组结节超声造影定量参数的差异,包括峰值强度(peak enhancement,PE)、流入相和流出相曲线下面积(wash-in and wash-out area under the curve,WiWoAUC)、流入相灌注指数(wash-in perfusion index,WiPI)。以周围正常腺体为基准,计算周围正常腺体与结节的参数差值获得ΔPE、ΔWiWoAUC、ΔWiPI。通过ROC曲线分析不同定量参数在甲状腺实性结节良恶性鉴别诊断中的价值。选取超声造影定量参数中评估甲状腺结节效能最优者,与ACR TI-RADS分类系统进行联合诊断,比较单一诊断与联合诊断方法间诊断效能的差异。结果定量参数PE、WiWoAUC、WiPI、ΔPE、ΔWiWoAUC、ΔWiPI在良恶性组间差异有统计学意义(均P<0.001);ΔPE在所有定量参数中的诊断价值最高(ROC曲线下面积为0.802),截断值为0.21;ΔPE与ACR TI-RADS分类联合诊断甲状腺实性结节良恶性的曲线下面积为0.898,敏感性、特异性、阳性预测值及阴性预测值分别为73.39%、93.48%、93.02%、74.78%,诊断效能较单一诊断方法更优。结论VueBox?超声造影定量参数对于评估甲状腺结节良恶性具有一定价值,与ACR TI-RADS分类联合可提高甲状腺结节诊断的准确性。

Objective To evaluate the value of VueBox®contrast-enhanced ultrasound(CEUS)quantitative analysis combined with ACR TI-RADS classification in the diagnosis of benign and malignant solid thyroid nodules.Methods A total of 201 patients with thyroid solid nodules(201 nodules)who underwent surgery or puncture biopsy in the People′s Hospital of Guangxi Zhuang Autonomous Region were enrolled from October 2020 to February 2022.The preoperative conventional ultrasound and contrast-enhanced ultrasound images were retrospectively analyzed.According to the pathological results,they were divided into the malignant group and benign group.The differences of the quantitative parameters of CEUS between the two groups were analyzed,including peak enhancement(PE),wash-in and wash-out area under the curve(WiWoAUC),wash-in perfusion index(WiPI).ΔPE,ΔWiWoAUC,ΔWiPI were obtained by calculating the parameter difference between the surrounding normal glands and nodules.ROC curve was used to analyze the value of different quantitative parameters in the differential diagnosis of benign and malignant solid thyroid nodules.The CEUS quantitative parameters with best diagnostic performance was selected and combined with ACR TI-RADS classification system to evaluate the diagnostic efficiency of the single diagnostic approaches and the combined approach.Results The quantitative parameters of PE,WiWoAUC,WiPI,ΔPE,ΔWiWoAUC,ΔWiPI were significantly different between benign group and malignant group(all P<0.001).ΔPE had the highest diagnostic value among all the quantitative parameters(the area under the ROC curve was 0.802),and the cut-off value was 0.21.ΔPE combined with ACR TI-RADS classification showed the best efficiency in diagnosis of benign and malignant thyroid nodules,with an area under the curve of 0.898,and the sensitivity,specificity,positive predictive value and negative predictive value of 73.39%,93.48%,93.02%and 74.78%,respectively.Conclusions Quantitative parameters of CEUS by using VueBox®software is valuable for the differential diagnosis of benign and malignant solid thyroid nodules,and its combination with ACR TI-RADS classification can improve the diagnosis accuracy.