多模态超声在甲状腺炎性疾病与结节鉴别诊断中的应用

Application of multimodal ultrasonography in the differential diagnosis of thyroid inflammatory diseases and nodules

目的:探讨多模态超声在甲状腺炎性疾病与结节鉴别诊断中的应用。方法:选取312例可疑甲状腺炎性结节、甲状腺炎伴结节及单纯甲状腺结节患者,所有患者均接受甲状腺常规超声检查、超声造影、剪切波弹性成像及穿刺活检,所有病例均有病理结果,部分病变接受手术治疗,有手术病理资料。结果:(1)根据病理结果,甲状腺炎性疾病97例,良性结节56例,恶性结节159例。(2)以病理诊断结果为金标准,常规超声检出甲状腺良性结节70例,恶性145例;实时剪切波弹性成像检测出甲状腺良性结节63例,恶性152例;超声造影检测出甲状腺良性结节60例,恶性155例;多模态超声检测出甲状腺良性结节57例,恶性158例。(3)常规超声、实时剪切波弹性成像、超声造影、多模态超声的敏感度分别为89.30%、91.82%、95.59%、98.11%,特异度分别为94.64%、89.28%、94.64%、96.42%,Kappa值分别为0.776、0.780、0.882、0.940。多模态超声检查的敏感度、特异度、准确率、Kappa值均大于常规超声、实时剪切波弹性成像、超声造影。(4)病理结果甲状腺炎性疾病97例,常规超声检出78例;实时剪切波弹性成像检测出76例;超声造影检测出80例;多模态超声检测出91例。多模态超声的准确性高于常规超声、实时剪切波弹性成像、超声造影。结论:多模态超声对甲状腺疾病具有较好的诊断效能,值得临床推广。

Objective To investigate the diagnostic value of multimodal ultrasonography in thyroid inflammatory diseases and nodules.Methods A total of 312 patients with suspected thyroid nodules with thyroiditis,thyroid nodules with thyroiditis,and simple thyroid nodules were enrolled and underwent routine ultrasonography,contrast-enhanced ultrasound,shear wave elastography,and needle biopsy.Pathological results were available in all cases.Some lesions have undergone surgical treatment,with surgical and pathological data available.Results(1) Pathological examination reported thyroid nodules with thyroiditis in97 cases,benign nodules in 56 cases,and malignant nodules in 159 cases.(2) With pathological diagnosis as the gold standard,when using routine ultrasonography,real-time shear wave elastography,contrast-enhanced ultrasound,and multimodal ultrasonography,separately,benign nodules were detectable in 70,63,60,and 57 cases,while malignant thyroid nodules were detectable in 145,152,155,and 158 cases.(3) Routine ultrasonography,real-time shear wave elastography,contrast-enhanced ultrasound,and multimodal ultrasonography had diagnostic sensitivities of 89.30%,91.82%,95.59%,98.11%,specificities of94.64%,89.28%,94.64%,96.42%,and Kappa values of 0.776,0.780,0.882,0.940,respectively.Multimodal ultrasonography was superior to routine ultrasonography,real-time shear wave elastography,and contrast-enhanced ultrasound in sensitivity,specificity,accuracy,and Kappa value.(4) Out of 97 cases of pathologically confirmed thyroid nodules with thyroiditis,78,76,80,and 91 cases were diagnosed by routine ultrasonography,real-time shear wave elastography,contrast-enhanced ultrasound,and multimodal ultrasonography,indicating that multimodal ultrasonography had higher accuracy than routine ultrasonography,real-time shear wave elastography,and contrast-enhanced ultrasound.Conclusion Multimodal ultrasonography exhibits high diagnostic efficacy for thyroid diseases and is worthy of clinical popularization.