超声造影对不同大小TI-RADS 4类甲状腺结节的定性诊断价值

Qualitative diagnostic value of contrast-enhanced ultrasound in TI-RADS 4 thyroid nodules of different sizes

目的探讨超声造影(CEUS)在鉴别诊断不同大小甲状腺影像报告与数据系统(TI-RADS)4类结节良恶性中的应用价值。方法回顾性分析261例患者经常规超声(US)诊断为TI-RADS 4类甲状腺单发结节261个病灶,按结节的最大径分为小结节组(≤10 mm,142例)和大结节组(>10 mm,119例),所有结节均行CEUS检查,并以术后病理结果为金标准进行对比。采用χ^(2)检验比较两组甲状腺结节良、恶性CEUS特征差异,根据CEUS特征对病灶赋值评分,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),评价超声造影对不同大小的TI-RADS 4类甲状腺结节良恶性的诊断价值。结果小结节组中超声造影特征差异均有统计学意义(P<0.05),大结节组中,除增强后结节大小外,其余超声造影特征差异均有统计意义(P<0.05)。CEUS评估甲状腺小结节良恶性的AUC、敏感性、特异性及准确率分别为0.856、86.5%、71.1%、82.4%,CEUS评估甲状腺大结节良恶性的AUC、敏感性、特异性及准确率分别为0.896、94.0%、82.9%、90.8%。结论超声造影对于鉴别诊断TI-RADS 4类甲状腺大结节的良恶性效能高于小结节。

Objective To explore the application value of contrast-enhanced ultrasound(CEUS)in differential diagnosis of benign and malignant Thyroid Imaging-Reporting and Data System(TI-RADS)4 nodules of different sizes.Methods A total of 261 patients with TI-RADS class 4 single thyroid nodules diagnosed by conventional ultrasound(US)were retrospectively analyzed.According to the maximum diameter of nodules,the patients were divided into small nodules group(≤10 mm,142 cases)and large nodules group(>10 mm,119 cases).All nodules were examined by CEUS,and the postoperative pathological results were used as the gold standard for comparison.Theχ^(2) test was used to compare with the differences of characteristics of benign and malignant thyroid nodules by CEUS between the two groups.According to the CEUS characteristics,the lesions were scored.Drawing receiver operating characteristic(ROC)curve and calculating area under the curve(AUC)to evaluate the diagnostic value of contrast-enhanced ultrasound of benign and malignant thyroid nodules with different sizes in TI-RADS 4.Results In small nodule group,there were statistically significant differences in all aspects of CEUS characteristics(P<0.05).In large nodule group,except for the size of the nodule after the enhancement,the rest of contrast-enhanced ultrasound features were significantly different(P<0.05).TheAUC,sensitivity,specificity and accuracy of CEUS in evaluating benign and malignant small thyroid nodules were 0.856,86.5%,71.1%and 82.4%,respectively.The AUC,sensitivity,specificity,and accuracy of CEUS in evaluating benign and malignant large thyroid nodules were0.896,94.0%,82.9%and 90.8%,respectively.Conclusion The efficacy of contrast-enhanced ultrasound in differential diagnosis of large thyroid nodules of TI-RADS 4 is higher than that of the small nodules.