C-TIRADS及超微血管成像技术评估桥本甲状腺炎合并甲状腺结节性质的价值

The value of C-TIRADS and superb microvasular imaging in the differential diagnosis of thyroid nodules with Hashimoto's thyroiditis

目的探讨2020甲状腺结节超声恶性危险分层中国指南(C-TIRADS)联合超微血管显像技术(SMI)诊断桥本甲状腺炎(HT)合并甲状腺结节性质的价值。方法选择HT合并甲状腺结节患者272例,术前对结节和甲状腺实质分别行二维超声和SMI检测,分析结节的超声征象及甲状腺实质的血流情况。依据二维超声特征对所有结节进行C-TIRADS分类,评估二维超声及二维超声联合SMI诊断HT合并结节性质的诊断效能。结果113例HT患者合并124个甲状腺良性结节(良性组),159例HT患者合并178个甲状腺恶性结节(恶性组),恶性组女性比例和年龄高于良性组(P<0.05),结节平均直径差异无统计学意义。恶性结节多表现为实性低回声或极低回声,并伴有甲状腺外侵犯和局灶性强回声;良性结节多为无局灶性强回声的高/等回声的结节。恶性组甲状腺实质血供类型以无明显改变或轻度增多为主,良性组甲状腺实质血供以中度增多及无明显改变或轻度增多较为常见。C-TIRADS诊断HT合并甲状腺结节性质分级标准的计算恶性率均在建议恶性率范围内。受试者工作特征(ROC)曲线结果显示,C-TIRADS诊断HT合并甲状腺结节性质的最佳诊断截点为C-TIRADS 4C类,C-TIRADS联合SMI诊断HT合并甲状腺结节性质的诊断截点为C-TIRADS 4C类且甲状腺实质血供无明显改变或轻度增多,C-TIRADS联合SMI的特异度和准确性高于C-TIRADS(P<0.05),敏感度和阴性预测值与C-TIRADS差异无统计学意义(P>0.05)。结论C-TIRADS联合SMI探查甲状腺实质血供有助于提高HT合并结节性质的诊断效能。

Objective To explore the value of C-TIRADS and superb microvasular imaging(SMI)in diagnosing the characteristics of thyroid nodules with Hashimoto's thyroiditis(HT).Methods A total of 272 patients with HT combined with thyroid nodules were included in this study.All nodules and thyroid parenchyma were detected by two-dimensional ultrasonography and SMI respectively before operation.The ultrasound characteristics of nodules and blood flow of thyroid parenchyma were analyzed.All nodules were graded by C-TIRADS.The diagnostic efficacy of two-dimensional ultrasonography and two-dimensional ultrasonography combined with SMI was evaluated.Results There were 124 benign nodules in 113 patients(the benign group)and 178 malignant nodules in 159 patients(the malignant group).The proportion and age of females were higher in the malignant group than those in the benign group(P<0.05).There was no significant difference in the average size of nodules between the two groups.Malignant nodules were mostly solid hypoechoic or very hypoechoic,accompanied by external thyroid invasion and strong focal echo.Benign nodules were mostly hyperechoic and isoechoic nodules without focal hyperechoic.The blood supply type was no obvious change or slightly increased in the malignant group,and the benign group showed mainly moderately increased and no obvious change or slightly increased.The malignant rates calculated by C-TIRADS were all within the recommended range of malignant rates.Results of ROC curve showed that the best diagnostic cut-off point of C-TIRADS was C-TIRADS 4C.The best diagnostic cut-off point C-TIRADS combined with SMI was C-TIRADS 4C,and the blood supply of thyroid parenchyma was not significantly changed or slightly increased.Specificity and accuracy were higher in C-TIRADS combined with SMI than those of C-TIRADS(P<0.05).There was no significant difference in the specificity and accuracy between C-TIRADS combined with SMI and C-TIRADS(P>0.05).Conclusion C-TIRADS combined with SMI can improve the diagnostic efficiency of HT complicated with nodules.