彩色多普勒超声在甲状腺结节性质的鉴别价值及超声表现分析

The Value of Color Doppler Ultrasonography in the Identificationof Thyroid Nodule Properties and Analysis of UltrasonicManifestations

目的 分析彩色多普勒超声在甲状腺结节性质的鉴别价值及超声表现。方法 纳入2019年2月至2022年2月鹤壁市人民医院收治的60例甲状腺结节患者,病理诊断前均实施彩色多普勒超声检查,通过彩色多普勒血流显像(CDFI)观察良恶性结节内部血流分布情况与血流参数。绘制ROC曲线,分析血流参数相关指标鉴别甲状腺结节性质的预测价值。结果 术后病理结果显示,60例患者共78个结节病灶,其中37例为良性甲状腺结节,共48个(61.54%)结节,甲状腺腺瘤26个(54.17%),结节性甲状腺肿22个(45.83%);恶性甲状腺结节有23例,共30个(38.46%)结节,乳头状癌16个(53.33%),滤泡癌10个(33.33%),髓样癌4个(13.33%)。以术后病理诊断为金标准,彩色多普勒超声诊断的敏感度、特异度、准确度分别为93.33%、93.75%、93.59%。恶性结节组的内部低回声、边界不整、淋巴结转移、微钙化灶均高于良性结节组,而周围无回声低于良性结节组,差异有统计学意义(P <0.05)。良性结节组EDV均高于恶性结节组,而PSV及RI均低于恶性结节组,差异有统计学意义(P <0.05)。彩色多普勒超声与金标准的一致性为0.865。ROC曲线显示,PSV、EDV、RI及联合甲状腺结节性质的预测诊断的AUC分别为0.680(95%CI:0.514~0.820)、0.721(95%CI:0.584~0.857)、0.739(95%CI:0.610~0.867)、0.800(95%CI:0.678~0.922)。结论 彩色多普勒超声可通过内部低回声、边界不整、淋巴结转移、周围无回声及微钙化灶影像图特点提高甲状腺结节性质的鉴别准确率,且PSV、EDV及RI的联合诊断可提高预测价值。

Objective To analyze the value of color Doppler ultrasound in the identification of the nature of thyroid nodules and ultrasound manifestations.Methods A total of 60 patients with thyroid nodules admitted to Hebi People's Hospital from February 2019 to February 2022 were included.Color Doppler ultrasonography was performed before pathological diagnosis.The blood flow distribution and blood flow parameters of benign and malignant nodules were observed by color Doppler flow imaging(CDFI).ROC curve was drawn to analyze the predictive value of blood flow parameters in identifying thyroid nodule properties.Results Postoperative pathological results showed that there were 78 nodules in 60 patients,among which 37 cases were benign thyroid nodules[48(61.54%)],26 thyroid adenomas(54.17%),and 22 nodular goiters(45.83%).There were 23 cases of malignant thyroid nodules,including 30 nodules(38.46%),16 cases of papillary carcinoma(53.33%),10 cases of follicular carcinoma(33.33%)and 4 cases of medullary carcinoma(13.33%).Taking postoperative pathological diagnosis as the gold standard,the sensitivity,specificity,and accuracy of color Doppler ultrasound diagnosis were 93.33%,93.75%,and 93.59%,respectively.The internal hypoechoic,irregular boundary,lymph node metastasis,and microcalcification in the malignant nodule group were higher than those in the benign nodule group,while the peripheral anechoic was lower than that in the benign nodule group,and the difference was statistically significant(P<0.05).EDV in the benign nodule group was higher than that in the malignant nodule group,while PSV and RI were lower than those in the malignant nodule group,the difference was statistically significant(P<0.05).The consistency between the color Doppler ultrasound and the gold standard was 0.865.ROC curve showed that the AUC of PSV,EDV,RI,and combined thyroid nodule nature were 0.680(95%CI:0.514~0.820),0.721(95%CI:0.584~0.857)and 0.739(95%CI:0.610~0.867),0.800(95%CI:0.678~0.922).Conclusion Color Doppler ultrasonography can improve the accuracy of the identification of thyroid nodule properties through the features of internal hypoechoic,borderline irregular,lymph node metastasis,peripheral echo,and microcalcification foci,and the combined diagnosis of PSV,EDV,and RI can improve the prediction value.