超声弹性成像和超声造影在甲状腺良恶性结节中的诊断价值

Diagnostic value of ultrasound elastography and contrast-enhanced ultrasound in benign and malignant thyroid nodules

目的探讨常规超声、超声弹性成像和超声造影在甲状腺良恶性结节中的诊断价值。方法选取2013年10月至2015年6月涿州市医院行手术治疗的甲状腺结节患者98例,术前均分别给予常规超声、超声弹性成像和超声造影检查,术后对结节进行病理检查区分良恶性病变。应用受试工作特征曲线(ROC)评价各诊断方法的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率,并计算ROC曲线下的面积(AUC)。结果甲状腺恶性结节的常规超声检查多表现为低回声、回声不均匀、形状不规则、边界不清晰、纵横比<1、微钙化及周边声晕不规则,与良性结节比较,差异有统计学意义(P<0.05)。恶性结节的超声弹性图像评分多为3分,良性结节弹性评分多为2分;良恶性结节在2、3、4分值之间比较差异均有统计学意义(P<0.05);恶性结节的超声造影多为形态不规则、边界不清、无明显增强、增强不均匀及可见灌注缺损,与良性结节比较,差异均有统计学意义(P<0.05);ROC曲线显示,超声弹性成像和超声造影的灵敏度和特异度均优于常规超声,联合这2种超声检查,曲线下面积最大(AUC=0.914),其灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别是96.4%、93.6%、85.2%、96.9%、92.8%。结论超声弹性成像和超声造影对甲状腺良恶性结节诊断具有较高的价值,两者联合检查可提高其诊断准确性。

Objective To investigate the diagnostic value of conventional ultrasound, ultrasound elastography and contrast-enhanced ultrasound in the diagnosis of benign and malignant thyroid nodules. Methods Ninety-eight patients of thyroid nodules treated from October 2013 to June 2015 in Zhuozhou City Hospital were given conventional ultrasound, ultrasound elastography and contrast-enhanced ultrasound respectively. Postoperative pathological examination was performed to distinguish benign and malignant lesions. Receiver operating characteristic curve(ROC) was applied to assess the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the diagnostic method, and the area under the ROC curve(area under cure, AUC) was calculated. Results Conventional ultrasound examination of malignant thyroid nodules showed more hypoechoic echo, uneven echo, irregular shape, unclear boundary, aspect ratio<1, microcalcification and irregular surrounding acoustic halo, compared with benign nodules,with statistically significant difference(P<0.05). Ultrasound elastography images of malignant thyroid nodules mostly score 3 points, and those of benign nodules mostly score 2 points, with statistically significant differences between benign and malignant nodules in 2, 3 and 4 points(P<0.05). Contrast-enhanced ultrasound in malignant thyroid nodules mostly displayed irregular shape, unclear boundary, no obvious enhancement, uneven enhancement and visible perfusion defects, showing statistically significant difference compared with benign nodules(P<0.05). ROC curves showed that the sensitivity and specificity of ultrasound elastography and contrast-enhanced ultrasound were superior to that of conventional ultrasound. For combined detection of ultrasound elastography and contrast-enhanced ultrasound, the area under the curve was the largest(AUC=0.914), and the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic coincidence rate were 96.4%, 93.6%, 85.2%, 96.9%, 92.8%, respectively. Conclusion Ultrasound elastography and contrast-enhanced ultrasound are both valuable in diagnosis of benign and malignant thyroid nodules,and combined examination can further improve the diagnostic accuracy.