超声应变弹性成像对继发性甲状旁腺增生诊断分析及其评估增生程度的价值

Diagnosis Analysis of Secondary Parathyroid Hyperplasia by Ultrasonic Strain Elastography and Its Relationship with Hyperplasia Severity

目的:探究超声应变弹性成像(SE)对继发性甲状旁腺增生(PH)的诊断价值及与其增生程度的关系。方法:回顾性分析2021年5月至2022年2月来我院就诊行手术的PH患者50例(168枚病灶)。患者行常规超声及SE检查,确定其增生甲状旁腺直径、个数、检出部位、弹性应变率比值(SR);分析患者病灶的超声特征;以病理诊断结果为金标准,分析常规超声、常规超声联合SE对PH的诊断价值。根据病理结果将病灶分为3个亚组:结节性增生组(n=130)、增生活跃组(n=30)、纤维化组(n=8),比较3组SR值,分析SE对患者增生程度的诊断价值。结果:超声显示PH病灶边界清晰,形态欠规则,以低回声为主,其中单纯低回声126个,低回声内有强回声钙化40个,2个中强回声。彩色多普勒主要表现为点状、条状血流、部分表现为丰富血流或无血流,钙化灶占比为70.83%,钙化以环状钙化为主,少见点状钙化;实时超声弹性检查大多呈现蓝色,部分病灶出现SR增大;与直径<15 mm者比较,直径≥15 mm病灶多表现为不规则形且易发生囊性变,SR更高,差异有统计学意义(P<0.05)。Pearson相关性分析显示,SR与甲状旁腺直径呈正相关(r=0.563,P<0.05);常规超声联合SE的检出率为90.48%,高于常规超声的77.98%;联合组的误诊率为3.18%,低于常规超声的9.03%(P<0.05);3组不同增生程度患者的SR比较,差异有统计学意义(P<0.05),且随增生程度增加,SR水平逐渐升高;受试者工作特征曲线分析显示,SR诊断患者为纤维化的曲线下面积为0.901(P<0.05)。结论:采用常规超声联合SE对甲状旁腺增生的检出率高于常规超声,误诊率低于常规超声,具有较高诊断价值,且能为判断患者疾病进展情况提供可靠依据。

Purpose:To explore the diagnostic value of ultrasonic strain elastography(SE)in secondary parathyroid hyperplasia(PH)and its relationship with hyperplasia severity.Methods:A total of 50 patients(168lesions)with PH treated in the hospital were retrospectively analyzed between May 2021 and February 2022.All the patients underwent routine ultrasound examination and SE to determine the diameter,number,sites and stain ratio(SR)of parathyroid glands.The ultrasound characteristics of lesions were analyzed.Taking the results of pathological diagnosis as the golden standard,diagnostic value of routine ultrasound and routine ultrasound combined with SE for PH was analyzed.According to pathological results,lesions were divided into nodular hyperplasia group(n=130),active hyperplasia group(n=30)and fibrosis group(n=8).SR values in the three groups were compared to analyze the diagnostic value of SE for hyperplasia severity.Results:Ultrasound showed that there was clear boundary and irregular shape in PH lesions,mainly with low echo.There were 126 lesions with simple low echo,40 with strong echo calcification in low echo and 2 with moderately strong echo.Color Doppler ultrasound showed that there was mainly punctate and strip-like blood flow,some lesions were accompanied with abundant or no blood flow,proportion of calcification lesions was 70.83%,the main calcification type was circular calcification,and the spot calcification was rare.Real-time ultrasonography showed that most of lesions were blue,and there were some lesions with increased SR.Compared with lesions with diameter<15 mm,there was irregular and cystic degeneration in lesions with diameter≥15 mm,with higher SR(P<0.05).Pearson correlation analysis showed that SR was positively correlated with the diameter of parathyroid gland(r=0.563,P<0.05).The detection rate of routine ultrasound combined with SE was higher than that of routine ultrasound(90.48%vs 77.98%),and misdiagnosis rate was lower than that of routine ultrasound(3.18%vs 9.03%,P<0.05).There were significant differences in SR among the three groups(P<0.05).With the aggravation of hyperplasia,SR level was gradually increased.The receiver operating characteristic(ROC)curves analysis showed that the area under the curve(AUC)of SR in the diagnosis of fibrosis group was 0.901(P<0.05).Conclusion:The detection rate of PH by routine ultrasound combined with SE is higher than that by routine ultrasound,and misdiagnosis rate is lower than that by routine ultrasound,which has relatively higher diagnostic value and can provide strong basis to determine disease progression.