三种方法用于不同直径甲状腺微小结节的诊断价值

Diagnostic value of three methods for thyroid micronodules with different diameters

目的 探讨二维高频彩超、声触诊组织定量(VTQ)和实时超声弹性成像(RTE)三种方法用于不同直径甲状腺微小结节(TMN)的诊断价值。方法 TMN患者180例分为A组(结节直径3 mm~,90例)和B组(结节直径6~10 mm, 90例),行二维高频彩超、VTQ和RTE检查。分析两组TMN患者二维高频彩超征象、剪切波速度(SWV)及RTE特征。以病理诊断为金标准,分析三种方法单独和联合检查对两组结节的诊断效能。结果 病理结果示,A组和B组中良性结节分别为55例和49例,恶性结节分别为35例和41例。两组良、恶性结节不同边界、内回声、生长方式、钙化灶和血流信号患者比例均有统计学差异(P<0.05)。B组SWV高于A组[(3.78±2.19) m/s vs.(2.23±0.76) m/s](P<0.01)。A、B两组三种方法联合检查的诊断效能均最高。A组二维高频彩超AUC大于VTQ和RTE(P<0.05),联合检查AUC大于VTQ和RTE(P<0.05);B组二维高频彩超、VTQ、联合检查AUC均大于RTE(P<0.05)。结论 TMN特征分析首选二维高频彩超,联合应用三种方法有助于提高TMN诊断准确性,尤其适用于结节直径6~10 mm的TMN患者。

Objective To investigate the diagnostic value of the three methods of twodimensional high-frequency color Doppler ultrasound(HFCDU),virtual touch tissue quantification(VTQ)and real-time ultrasound elastography(RTE)for thyroid micronodules(TMN)with different nodule diameters.Methods A total of 180TMN patients divided into groups of A(3mm≤nodule diameter<6mm,90cases)and B(nodule diameter 6-10 mm,90cases),who were examined by HFCDU,VTQ and RTE.The characteristics of HFCDU,shear wave velocity(SWV)and RTE in two groups were analyzed.Taking pathological diagnosis as the gold standard,the diagnostic efficacy of the three methods alone and combined use of them were analyzed.Results Pathological results showed that there were 55cases and 49cases of benign nodules in groups of A and B,and there were 35cases and 41cases of malignant nodules in groups of A and B,respectively.There were significant differences in boundary,internal echo,growth pattern,calcification foci and blood flow signal between the benign and malignant nodules in groups of A and B(P<0.05).SWV of group B was higher than that of group A[(3.78±2.19)m/s vs.(2.23±0.76)m/s](P<0.01).The diagnostic efficacy of combined use of the three methods was the highest in two groups.The AUC of HFCDU was greater than that of VTQ and RTE(P<0.05),which of combined use of the three methods was greater than that of VTQ and RTE in group A(P<0.05).The AUC of HFCDU,VTQ and combined use of the three methods was greater than that of RTE in group B(P<0.05).Conclusion HFCDU is preferred for TMN feature analysis.The combined use of the three methods is helpful to improve the diagnostic accuracy of TMN,especially for TMN patients with nodule diameter 6-10mm.