超声造影联合C-TIRADS分类鉴别诊断甲状腺结节良恶性的临床价值

Clinical value of contrast-enhanced ultrasound combined with C-TIRADS classification in the differential diagnosis of benign and malignant thyroid nodules

目的探讨超声造影(CEUS)联合中国超声甲状腺影像报告和数据系统(C-TIRADS)分类对甲状腺结节良恶性的鉴别诊断价值。方法选取于我院行甲状腺常规超声和CEUS检查的116例甲状腺结节患者(共121个结节),均行C-TIRADS分类和CEUS评分。绘制受试者工作特征(ROC)曲线分析C-TIRADS分类、CEUS评分单独及联合应用对甲状腺结节良恶性的诊断效能。结果C-TIRADS分类诊断良性结节64个,恶性结节57个;CEUS评分诊断良性结节71个,恶性结节50个;二者联合应用诊断良性结节52个,恶性结节69个。ROC曲线分析显示,C-TIRADS分类、CEUS评分单独及联合应用诊断甲状腺结节良恶性的曲线下面积(AUC)分别为0.820、0.824、0.886,二者联合应用的AUC均高于C-TIRADS分类和CEUS评分,差异均有统计学意义(Z=3.183,P<0.01;Z=2.070,P=0.038)。结论CEUS联合C-TIRADS分类对甲状腺结节良恶性鉴别有较好的临床价值,CEUS对C-TIRADS 4类结节有校正价值。

Objective To explore the value of contrast-enhanced ultrasound(CEUS)combined with Chinese ultrasonic thyroid imaging and reporting and data system(C-TIRADS)classification in the differential diagnosis of benign and malignant thyroid nodules.Methods A total of 116 patients with 121 thyroid nodules who underwent conventional ultrasound examination and contrast-enhanced ultrasound were selected for C-TIRADS classification and contrast-enhanced ultrasound scoring.Receiver operator characteristic(ROC)curve was drawn to analyze the diagnostic performance of C-TIRADS,CEUS and a combination of both methods in the differential diagnosis of benign and malignant thyroid nodules.Results Sixty-four nodules were diagnosed as benign and 57 nodules were diagnosed as malignant by C-TIRADS.71 nodules were identified as benign and 50 nodules were identified as malignant by CEUS.A combination of both methods resulted in the diagnosis of 52 nodules as benign and 69 nodules as malignant.ROC curve analysis showed that the area under the curve of C-TIRADS,CEUS and the combination of both methods were 0.820,0.824 and 0.886,respectively.The area under the curve of CEUS combined with C-TIRADS classification was higher than those of C-TIRADS classification and CEUS scoring alone(Z=3.183,P<0.01,Z=2.070,P=0.038).Conclusion CEUS has revised value for C-TIRADS 4 nodules,CEUS combined with C-TIRADS classification can significantly improve the diagnostic performance of benign and malignant thyroid nodules.