甲状腺良恶性结节多模态超声显像参数差异分析

Multimodal ultrasonography parameter difference between benign and malignant thyroid nodule

目的探讨甲状腺癌与甲状腺良性结节多模态超声显像参数差异及恶性结节的独立危险因素。方法回顾性选取2020年1月至2022年12月保定市第二中心医院行手术治疗并经术后病理证实的甲状腺癌患者60例为恶性组,同期选取甲状腺良性结节患者60例为结节组。比较两组常规超声征象、超声造影(CEUS)征象、剪切波弹性成像(SWE)征象,多因素logistic回归分析甲状腺恶性结节独立危险因素。结果两组常规超声结节形态、回声、构成、纵横比、边界、钙化、颈部淋巴结特征、血流情况比较,差异有统计学意义(P<0.05);两组CEUS增强形态、增强后边界、增强水平、增强均匀性、增强模式、退出模式比较,差异有统计学意义(P<0.05);恶性组SWE杨氏模量纵断面及横断面的最大值、平均值高于结节组(P<0.05);两组SWE图像分型差异有统计学意义(P<0.05)。Logistic回归分析显示,常规超声微钙化(OR=6.435,95%CI:4.115~10.063)、CEUS向心性增强(OR=5.257,95%CI:2.857~9.674)、SWE杨氏模量纵断面最大值较高(OR=5.120,95%CI:3.026~8.663)为恶性结节独立危险因素(P<0.05)。结论常规超声微钙化、CEUS向心性增强、SWE杨氏模量纵断面最大值较高为甲状腺恶性结节超声独立危险因素,超声多模态联合应用有望进一步提高甲状腺结节定性诊断准确率。

Objective To investigate the difference of multimodal ultrasound parameters between thyroid carcinoma and benign thyroid nodules in imaging and the independent risk factors of malignant nodules.Methods Sixty patients with thyroid carcinoma who underwent surgical treatment and confirmed by postoperative pathology in Baoding No.2 Central Hospital from January 2020 to December 2022 were retrospectively selected as the malignant group,and sixty patients with benign thyroid nodules during the same period were selected as the nodule group.Conventional ultrasound signs,contrast-enhanced ultrasound(CEUS)signs,and shear wave elastography(SWE)signs were compared between the two groups,and a multivariate logistic regression analysis was performed to identify independent risk factors for thyroid malignant nodules.Results There were significant differences in nodule morphology,echo,composition,aspect ratio,boundary,calcification,cervical lymph node characteristics and blood flow of conventional ultrasound signs between the two groups(P<0.05).There were significant differences in enhancement pattern,enhancement boundary,enhancement level,enhancement uniformity,enhancement mode and exit mode of CEUS between two groups(P<0.05).The maximum and average values of SWE Young's modulus in the longitudinal and transverse sections of the malignant group were higher than those of the nodule group(P<0.05).There was statistical difference in SWE image classification between the two groups(P<0.05).Logistic regression analysis showed that conventiona ultrasound signs micro-calcification(OR=6.435,95%CI:4.115-10.063),CEUS centripetal enhancement(OR=5.257,95%CI:2.857-9.674),and higher SWE Young's modulus longitudinal maximum value(OR=5.120,95%CI:3.026-8.663)were independent risk factors for malignant nodules(P<0.05).Conclusion Conventional ultrasound signs micro-calcification,CEVS enhanced centrality and high maximum profile of SWE Young's modulus are independent ultrasonic risk factors of thyroid nodules.The combined application of ultrasonic multimode is expected to further improve the accuracy of qualitative diagnosis of thyroid nodules.