高帧频超声造影在评价C-TIRADS 4-5类甲状腺结节成像特征中的应用

Application of high-frame-rate contrast-enhanced ultrasound in evaluation of imaging features of C-TIRADS 4-5 thyroid nodules

目的探索中国甲状腺超声报告与数据系统(C-TIRADS)4-5类甲状腺结节高帧频超声造影(H-CEUS)成像特征。方法前瞻性纳入2022年9月至2023年5月空军军医大学第一附属医院甲状腺C-TIRADS 4-5类结节患者102例(共109个结节),进行H-CEUS及常规超声造影(C-CEUS)检查。分析造影特征:结节内有无迂曲血管、增强方向、增强均匀性、增强强度以及边界是否清晰。分析造影时间-强度曲线(TIC)参数[到达时间(AT)、达峰时间(TTP)、峰值强度(PI)、上升斜率(AS)、下降斜率(DS)]。以细针抽吸或手术病理结果为最终诊断结果,将结节分为良性结节组与恶性结节组。采用χ^(2)检验或Fisher确切概率检验比较2组内H-CEUS与C-CEUS特征的差异,采用非参数Mann-Whitney检验比较良、恶性结节组内C-CEUS与H-CEUS TIC参数的差异。结果纳入的109个结节中,恶性结节61个,良性结节48个。在恶性结节中,H-CEUS显示78.7%(48/61)的结节增强后内部存在迂曲血管,高于C-CEUS的31.1%(19/61),在良性结节中,H-CEUS显示91.7%(44/48)的结节增强后边界清晰,高于C-CEUS的31.3%(15/48),差异均具有统计学意义(χ^(2)=27.843、36.984,P均<0.001)。H-CEUS与C-CEUS在显示造影增强方向、增强均匀性以及增强强度方面比较,差异均无统计学意义(P均>0.05)。良、恶性结节H-CEUS TIC参数PI分别为24.18(19.09,31.20)和18.20(16.66,23.91),低于C-CEUS的35.42(25.83,39.77)和27.79(25.88,29.98),差异具有统计学意义(Z=-3.467、-3.922,P=0.001、<0.001)。恶性结节H-CEUS TIC参数DS[-0.11(-0.15,-0.09)]高于C-CEUS[-0.15(-0.18,-0.12)],差异具有统计学意义(Z=-2.578,P=0.010)。2组内,H-CEUS TIC参数AT、TTP、AS与C-CEUS比较,差异均无统计学意义(P均>0.05)。结论H-CEUS能够反映C-TIRADS 4-5类甲状腺结节增强特征,并在显示迂曲血管及边界清晰度方面具有一定的优势。

Objective To explore the characteristics of high-frame-rate contrast-enhanced ultrasound(H-CEUS)in Chinese thyroid imaging reporting and data system(C-TIRADS)4-5 thyroid nodules.Methods One hundred and two patients with C-TIRADS 4-5 thyroid nodules(n=109)diagnosed at the First Affiliated Hospital of the Air Force Military Medical University from September 2022 to May 2023 were prospectively collected.H-CEUS and conventional contrast-enhanced ultrasound(C-CEUS)were performed.The characteristics of H-CEUS imaging were analyzed with regard to whether there was tortuous blood vessels in the nodules,enhancement direction,enhancement uniformity,enhancement intensity,whether the boundary was clear,and the time-intensity curve(TIC)parameters[arrival time(AT),time to peak(TTP),peak intensity(PI),maximum slope of rise curve(AS),and maximum slope of decline curve(DS)].These features were then compared with the C-CEUS imaging features.Based on fine-needle aspiration or surgical pathology,the nodules were divided into either a benign group or a malignant group.Theχ^(2)test or Fisher exact probability method was used to compare the differences in imaging features between H-CEUS and C-CEUS in the two groups.Nonparametric Mann-Whitney test was used to compare the differences between C-CEUS and H-CEUS TIC parameters in the two groups.Results Of the 109 nodules included,there were 48 benign nodules and 61 malignant nodules.In malignant nodules,H-CEUS showed that 78.7%(48/61)of the nodules had tortuous blood vessels after enhancement(C-CEUS showed 31.1%,χ^(2)=27.843,P<0.001).In benign nodules,H-CEUS showed that 91.7%(44/48)of the nodules had a clear boundary after enhancement(C-CEUS showed 38.9%,χ^(2)=36.984,P<0.001).H-CEUS and C-CEUS showed that there was no significant difference in enhancement direction,enhancement uniformity,or enhancement intensity between thyroid benign and malignant nodules after enhancement(P>0.05).In H-CEUS,the PI of benign nodules and malignant nodules was 24.18(19.09,31.20)and 18.20(16.66,23.91),respectively,significantly lower than that of C-CEUS[35.42(25.83,39.77)and 27.79(25.88,29.98),respectively;Z=-3.467 and-3.922;P=0.001 and<0.001,respectively].In H-CEUS,DS[-0.11(-0.15,-0.09)]was signifciantly higher than that of C-CEUS[-0.15(-0.18,-0.12);Z=-2.578,P=0.010].There was no significant difference in AT,TTP,or AS between H-CEUS and C-CEUS in both benign and malignant nodules(P>0.05).Conclusion H-CEUS can reflect the different enhancement characteristics of C-TIRADS 4-5 thyroid nodules,and has appreciated advantages in showing tortuous blood vessels and nodule boundary.