二维影像特征与CDFI血流特点在甲状腺结节性质诊断中的价值及与侵袭性的关系

The Value of Two-Dimensional Imaging Features and CDFI Blood Flow Characteristics in the Diagnosis of the Nature of Thyroid Nodules and the Relationship with Invasiveness

目的:探究二维超声特征与彩色多普勒血流显像(CDFI)血流特点诊断甲状腺结节(TNS)性质的价值及与侵袭性的相关性。方法:选取2021年2月至2022年2月我院146例TNS患者,均行二维超声和CDFI检查,以病理检查结果为“金标准”,比较恶性与良性TNS患者一般资料、二维超声特征、CDFI血流丰富程度、血流参数[阻力指数(RI)、收缩期峰值流速(PSV)],分析二维超声和CDFI鉴别诊断TNS良恶性的价值,并比较有颈部淋巴结转移与无颈部淋巴结转移恶性TNS患者CDFI血流参数、病灶组织中侵袭基因[金属蛋白酶解离素9(ADAM9)、趋化因子受体4(CXCR4)]表达量,分析CDFI血流参数与恶性TNS病灶组织中侵袭基因表达量的关系及诊断颈部淋巴结转移的价值。结果:本研究146例TNS患者中52例经病理检查证实为恶性TNS,94例为良性TNS;恶性TNS患者二维超声特征微钙化灶、低回声、周边无声晕比例、CDFI血流丰富程度、RI、PSV均高于良性TNS患者(P<0.05);二维超声和CDFI鉴别诊断TNS良恶性的敏感度、特异度及准确度分别为73.08%、78.72%、76.71%;恶性TNS患者中有颈部淋巴结转移者RI、PSV及病灶组织中ADAM9、CXCR4基因表达量均高于无颈部淋巴结转移者(P<0.05);恶性TNS患者RI、PSV与病灶组织中ADAM9、CXCR4基因表达量呈正相关(P<0.05);RI、PSV联合诊断恶性TNS患者颈部淋巴结转移的曲线下面积(AUC)为0.906,诊断敏感度、特异度分别为94.74%、93.94%。结论:二维超声和CDFI在TNS良恶性鉴别诊断方面具有良好价值,且CDFI血流参数与恶性TNS的侵袭性密切相关,可为临床诊断恶性TNS患者颈部淋巴结转移提供可靠参考。

Objective:To explore the value of two-dimensional ultrasonography and color Doppler flow imaging(CDFI)flow characteristics in diagnosing the nature of thyroid nodules(TNS)and their correlation with invasiveness.Methods:From February 2021 to February 2022,146 patients with TNS in our hospital were selected and examined by 2D ultrasound and CDFI,and the pathological findings were used as the"gold standard"to compare the general data,2D ultrasound characteristics,CDFI flow abundance,flow parameters[resistance index(RI),peak systolic flow velocity(PSV)]between malignant and benign TNS patients.The study compared CDFI flow parameters and expression of invasive genes[metalloproteinase dissociin 9(ADAM9)and chemokine receptor 4(CXCR4)]in patients with malignant TNS with those without cervical lymph node metastasis,and analyzed the relationship between CDFI flow parameters and malignant TNS lesions.The relationship between the expression of invasion genes in tissues and the value of diagnosing cervical lymph node metastasis.Results:Among the 146 TNS patients in this study,52 were confirmed to be malignant TNS by pathological examination,and 94 were benign TNS;the 2D ultrasonic features of microcalcified foci,hypoechogenicity,proportion of peripheral anechoic halo,CDFI flow abundance,RI,and PSV were higher in patients with malignant TNS than in patients with benign TNS(P<0.05);the sensitivity,specificity and accuracy of 2D ultrasonography and CDFI in the differential diagnosis of benign and malignant TNS were 73.08%,78.72%,and 76.71%,respectively;the expression of RI,PSV and ADAM9 and CXCR4 genes in focal tissues was higher in patients with malignant TNS with cervical lymph node metastasis than in those without cervical lymph node metastasis(P<0.05);there was a positive correlation between RI,PSV and ADAM9 and CXCR4 gene expression in focal tissues in patients with malignant TNS(P<0.05);The area under the curve(AUC)of combined RI and PSV for the diagnosis of cervical lymph node metastasis in patients with malignant TNS was 0.906,with diagnostic sensitivity and specificity of 94.74% and 93.94%,respectively.Conclusion:2D ultrasonography and CDFI have good value in the differential diagnosis of benign and malignant TNS,and CDFI blood flow parameters are closely related to the invasiveness of malignant TNS,which can provide a reliable reference for clinical diagnosis of cervical lymph node metastasis in patients with malignant TNS.