超声血流参数及造影参数预测甲状腺乳头状癌患者颈部淋巴结转移的价值研究

Values of ultrasound blood flow parameters and contrast-enhanced parameters in predicting cervical lymph node metastasis of patients with papillary thyroid carcinoma

目的:探讨Aixplorer超声图像诊断仪的血流参数及造影参数对甲状腺乳头状癌(PTC)患者颈部淋巴结转移(LNM)的预测价值。方法:选取医院收治的131例PTC患者,依据病理检查结果将其分为转移组(53例)和未转移组(78例)。所有患者均行超声检查,比较两组患者淋巴结的收缩期加速时间(AT)、收缩期峰值血流速度(PSV)、搏动指数(PI)及阻力指数(RI)等血流参数,以及峰值强度(Peak)、达峰时间(TTP)、平均渡越时间(MTT)等造影参数,采用受试者工作特征(ROC)曲线下面积(AUC)评估其预测PTC患者LNM的价值。结果:两组患者不同淋巴结长径与短径比值(L/S)、淋巴门、囊性变、钙化、增强程度等超声影像表现比较,差异具有统计学意义(x^(2)=22.241,x^(2)=9.463,x^(2)=8.551,x^(2)=11.098,x^(2)=17.372;P<0.05)。转移组患者PSV、PI及RI明显高于未转移组,差异有统计学意义(t=12.485,t=9.812,t=8.821;P<0.05);ROC曲线分析显示,PSV、PI及RI预测PTC患者颈部LNM的AUC分别为0.944、0.857和0.857,诊断灵敏度分别为88.7%、92.5%和69.8%,特异度分别为100%、64.1%和93.6%。转移组患者Peak、AUC明显高于未转移组,差异有统计学意义(t=6.558,t=6.799;P<0.05);Peak、AUC预测PTC患者颈部LNM的AUC分别为0.759、0.780,灵敏度分别为50.9%、49.1%,特异度均为100%。结论:PTC患者LNM不仅超声影像表征与非LNM不同,且血流参数及造影参数与非LNM也有差异,超声图像诊断仪的血流参数及造影参数预测PTC患者LNM具有较高的准确性。

Objective:To investigate the predictive value of blood flow parameters and contrast-enhanced parameters of the Aixplorer ultrasound image diagnostic instrument for cervical lymph node metastasis(LNM)in patients with papillary thyroid carcinoma(PTC).Methods:A total of 131 PTC patients admitted to hospital were selected and they were divided into metastasis group(53 cases)and non-metastasis group(78 cases)based on pathological examination results.All patients underwent ultrasound examination,and the parameters of blood flow included systolic acceleration time(AT),the peak systolic velocity(PSV),pulsatile index(PI)and resistance index(RI)of lymph nodes between the two groups were compared,as well as the contrast-enhanced parameters such as peak intensity(Peak),time to peak(TTP)and mean transit time(MTT).The area under characteristics(AUC)of receiver operating characteristic(ROC)was adopted to assess the value of that in predicting LNM of PTC patients.Results:The differences of the ultrasound imaging manifestations such as long/short diameter(L/S),lymphatic hilum,cystic change,calcification and enhancement degree between the two groups were statistically significant(x^(2)=22.241,x^(2)=9.463,x^(2)=8.551,x^(2)=11.098,x^(2)=17.372,P<0.05),respectively.The PSV,PI and RI in the metastasis group were significantly higher than those in the non-metastasis group(t=12.485,t=9.812,t=8.821,P<0.05),respectively.The ROC analysis showed that the AUC values of PSV,PI and RI were respectively 0.944,0.857 and 0.857 in predicting cervical LNM of PTC patients.The diagnostic sensitivities of the PSV,PI and RI were respectively 88.7%,92.5%and 69.8%,and the specificities of them were respectively 100%,64.1%and 93.6%.The Peak and AUC value of the metastasis group were significantly higher than those of non-metastasis group(t=6.558,t=6.799,P<0.05),respectively.The AUC values of Peak and AUC were respectively 0.759 and 0.780 in predicting the cervical LNM of PTC patients,and the sensitivities of them were respectively 50.9%and 49.1%,and the specificities both of them were 100%.Conclusion:Not only the ultrasound imaging characteristics of cervical LNM of PTC patients is different to that of cervical non-LNM of PTC patients,but also the blood flow parameters and the contrast-enhanced parameters of them are different to those of cervical non-LNM of PTC patients.In addition,the blood flow parameters and the contrast-enhanced parameters of the ultrasound image diagnostic instrument have higher accuracy in predicting LNM of PTC patients.