超声造影参数联合甲状腺影像报告和数据系统评分鉴别诊断甲状腺乳头状癌价值探讨

Value of contrast-enhanced ultrasound parameters combined with thyroid imaging report and data system score in differential diagnosis of papillary thyroid cancer

目的 探讨超声造影(CEUS)参数联合甲状腺影像报告和数据系统(TI-RADS)评分鉴别诊断甲状腺乳头状癌(PTC)的价值,并分析其与PTC分化程度和临床分期的相关性,为临床预后评价提供参考。方法 选取2019-03-01-2021-10-01上蔡重阳医院收治的129例甲状腺结节患者,以术后病理诊断结果为金标准,对比CEUS参数、TI-RADS评分单独及联合检查鉴别诊断PTC的效能。根据术后病理诊断结果,将129例患者分为PTC组(n=42)和良性结节组(n=87),比较2组CEUS参数和TI-RADS评分,并分析CEUS参数[达峰时间(TTP)、平均渡越时间(MTT)、峰值强度(Peak)]、TI-RADS评分与PTC分化程度、临床分期的相关性,以进一步评估患者预后。结果 CEUS参数+TI-RADS评分检查灵敏度为95.24%,高于CEUS(64.29%)和TI-RADS评分(66.67%)单独检查,χ^(2)=13.434,P=0.001;准确度为92.25%,高于CEUS(82.95%)和TI-RADS评分(82.95%)单独检查,χ^(2)=6.198,P=0.045。PTC组MTT为(65.95±11.41) s,高于良性结节组的(57.02±10.27) s,t=4.460,P<0.001;TTP为(45.98±7.96) s,高于良性结节组的(38.13±7.33) s,t=5.541,P<0.001;TI-RADS评分为(8.17±2.17)分,高于良性结节组的(3.52±1.81)分,t=12.788,P<0.001;Peak为(13.58±3.15)%,低于良性结节组的(19.15±4.13)%,t=-7.715,P<0.001。不同分化程度PTC患者CEUS参数[MTT(F=50.319,P<0.001)、TTP(F=44.868,P<0.001)、Peak(F=49.404,P<0.001)]、TI-RADS评分(F=143.248,P<0.001)比较,差异有统计学意义;不同临床分期PTC患者CEUS参数[MTT(F=50.021,P<0.001)、TTP(F=83.627,P<0.001)、Peak(F=62.024,P<0.001)]、TI-RADS评分(F=189.381,P<0.001)比较,差异有统计学意义。MTT(r=-0.824,P<0.01)、TTP(r=-0.843,P<0.01)、TI-RADS评分(r=-0.939,P<0.01)与PTC分化程度呈负相关,MTT(r=0.868,P<0.01)、TTP(r=0.907,P<0.01)、TI-RADS评分(r=0.951,P<0.01)与PTC临床分期呈正相关;Peak与PTC分化程度呈正相关,r=0.842,P<0.01;与PTC临床分期呈负相关,r=-0.890,P<0.01。结论 CEUS参数+TI-RADS评分应用于PTC鉴别诊断的效能较高,且与PTC分化程度和临床分期联系密切,对PTC临床诊断、治疗及预后评价具有重要价值。

Objective To explore the value of contrast-enhanced ultrasound(CEUS)parameters combined with thyroid im-aging report and data system(TI-RADS)score in differential diagnosis of papillary thyroid carcinoma(PTC),and to ana-lyze its correlation with PTC differentiation and clinical stage,providing reference for clinical prognosis evaluation.Meth-ods A total of 129patients with thyroid nodules admitted to Shangcai Chongyang Hospital from March 1,2019to Octo-ber 1,2021were selected.The efficacy of CEUS parameters,TI-RADS scores alone and jointly examination in the differ-ential diagnosis of PTC was compared based on the postoperative pathological diagnosis results as the gold standard.Ac-cording to the postoperative pathological diagnosis,129patients were divided into PTC group(n=42)and benign nodule group(n=87).CEUS parameters and TI-RADS scores were compared between the two groups,and the correlation be-tween CEUS parameters[time to peak(TTP),mean transit time(MTT),peak intensity(Peak)],TI-RADS scores and PTC differentiation degree,clinical stage was analyzed.Results The sensitivity of CEUS parameter+TI-RADS score ex-amination was 95.24%,which was higher than that of CEUS(64.29%)and TI-RADS score(66.67%)detected sepa-rately,χ^(2)=13.434,P=0.001.The accuracy was 92.25%,which was higher than CEUS(82.95%)and TI-RADS score(82.95%)detected separately,χ^(2)=6.198,P=0.045.The MTT of PTC group was(65.95±11.41)s,which was higher than that of benign nodules group(57.02±10.27)s,t=4.460,P<0.001.The TTP was(45.98±7.96)s,higher than(38.13±7.33)s in the benign nodule group,t=5.541,P<0.001.The TI-RADS score was(8.17±2.17),higher than(3.52±1.81)score of the benign nodule group,t=12.788,P<0.001.Peak was(13.58±3.15)%lower than(19.15±4.13)%in the benign nodule group,t=-7.715,P<0.001.There were statistically significant differ-ences in MTT(F=50.319,P<0.001),TTP(F=44.868,P<0.001),Peak(F=49.404,P<0.001),and TI-RADS scores(F=143.248,P<0.001)among PTC patients with different degrees of differentiation.There were statistically significant differences in MTT(F=50.021,P<0.001),TTP(F=83.627,P<0.001),Peak(F=62.024,P<0.001),and TI-RADS scores(F=189.381,P<0.001)among PTC patients of different clinical stages.MTT(r=-0.824,P<0.01),TTP(r=-0.843,P<0.01),and TI-RADS score(r=-0.939,P<0.01)were negatively corre-lated with the degree of PTC differentiation.MTT(r=0.868,P<0.01),TTP(r=0.907,P<0.01),and TI-RADS score(r=0.951,P<0.01)were positively correlated with the clinical stage of PTC.Peak was positively correlated with the degree of PTC differentiation(r=0.842,P<0.01)and negatively correlated with the clinical staging of PTC(r=-0.890,P<0.01).Conclusion CEUS parameter+TI-RADS score has high efficacy in differential diagnosis of PTC,and is closely related to the degree of differentiation and clinical stage of PTC,which has important value in clinical diag-nosis and treatment of PTC.