C-TIRADS结合超声弹性成像诊断甲状腺囊实性结节良恶性的价值

Value of C-TIRADS combined with elastography in diagnosis of partially cystic thyroid nodule

目的 探讨中国版甲状腺影像报告和数据系统(C-TIRADS)与应变弹性成像技术相结合对甲状腺囊实性结节良恶性的鉴别诊断价值。方法 选择行甲状腺超声检查的80例患者(91个囊实性结节),其中男性27例,女性53例;年龄17~72岁,平均年龄47.8岁;结节最大径线5~61 mm,平均结节最大径线27.9 mm。回顾性分析91个甲状腺囊实性结节的二维灰阶超声图像及弹性声像图,运用C-TIRADS进行分类,比较单独使用C-TIRADS分类方法、应变弹性成像技术及两种方法结合对甲状腺囊实性结节的诊断效能。结果 91个甲状腺囊实性结节中良性结节69个(75.8%),包括结节性甲状腺肿37个(53.6%),滤泡性腺瘤囊性变7个(10.1%),穿刺良性结节25个(36.2%);恶性结节22个(24.2%),均为乳头状癌。单独使用C-TIRADS、应变弹性成像技术诊断甲状腺囊实性结节的灵敏度、特异度、准确度分别为45.5%、95.7%、86.8%及59.1%、97.1%、89.0%,两种方法结合诊断甲状腺囊实性结节的灵敏度、特异度、准确度为81.8%、94.2%、91.2%,联合诊断可提高甲状腺囊实性结节的灵敏度及准确度(P <0.05)。C-TIRADS、应变弹性成像技术及联合检查下受试者工作特性(ROC)曲线下面积分别为0.715、0.784、0.881,三者差异有统计学意义(P <0.05)。结论 C-TIRADS分类方法诊断甲状腺囊实性结节特异度高,但灵敏度低。C-TIRADS与应变弹性成像技术相结合可提高甲状腺囊实性结节诊断的准确度。

Objective To explore the value of Chinese thyroid imaging report and data system(C-TIRADS) combined with strain elastography in the diagnosis of partially cystic thyroid nodules. Methods A total of 80 patients(91 partially cystic nodules) examined by ultrasonography were enrolled, which included 27 males and 53 females, aged 17-72 years old with mean age of 47.8 years old;maximum diameter of nodules ranged was 5-61 mm with mean of 27.9 mm. The two-dimensional gray-scale ultrasound images and elastic sonograms of 91 thyroid cystic-solid nodules were retrospectively analyzed,and C-TIRADS was used for classification. The diagnostic efficacy of C-TIRADS classification method, strain elastography and combination of the 2 methods for thyroid cystic-solid nodules was compared. Results Of 91 partially cystic nodules,69(75.8 %) were benign, which included 37(53.6 %) nodular goiters, 7(10.1 %) follicular adenomas, and 25(36.2 %) punctured benign nodules;22 malignant nodules( 24. 2 %) were papillary carcinomas. The sensitivity, specificity, and accuracy of C-TIRADS classification and elastography were 45.5 %, 95.7 %, 86.8 % and 59.1 %, 97.1 %, 89.0 %, respectively;the sensitivity,specificity and accuracy of combined 2 methods were 81.8 %, 94.2 %, 91.2 %. Compared with other groups, the sensitivity and accuracy in combination of 2 methods group were increased(P<0.05). The area under the receiver operator characteristic(ROC)curve in 3 groups was 0.715, 0.784, 0.881, respectively. There were significant differences in 3 groups( P<0.05). Conclusion It is demonstrated that the C-TIRADS classification method showed high specificity but low sensitivity in the diagnosis of partially cystic thyroid nodules, combined C-TIRADS and strain elastography could improve the accuracy of diagnosis of thyroid cystic solid nodules.