超声弹性成像与常规超声对甲状腺结节诊断价值的研究

Value of ultrasound elastography and Ultrasound for diagnosing thyroid nodules

目的:探讨甲状腺影像报告和数据系统(TI-RADS)、超声弹性成像及两者联合应用对甲状腺结节的诊断价值。方法:回顾性分析经手术病理证实的290例患者275个甲状腺结节的超声资料,并总结其常规超声和超声弹性成像特征。275个甲状腺结节中良性143个,恶性132个;以手术结果作为金标准,绘制TI-RADS、超声弹性成像及二者联合应用的受试者操作特性(ROC)曲线,计算ROC曲线下面积,计算TI-RADS、超声弹性成像及两者联合应用诊断甲状腺癌的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果:275个甲状腺结节中,ROC曲线下面积依次为两者联合应用、TI-RADS、超声弹性成像(0.966、0.941、0.892)。在灵敏度和阴性预测值方面,TI-RADS[100.0%(132/132)、100.0%(97/97)]高于弹性评分[93.9%(124/132)、93.4%(114/122)]和二者联合[99.2%(131/132)、99.2%(117/118)]。在特异度、PPV和准确度方面,二者联合[81.8%(117/143)、83.4%(131/157)、90.2%(248/275)]高于弹性评分[79.7%(114/143)、81.0%(124/153)、86.5%(238/275)]和TI-RADS[67.8%(97/143)、74.2%(132/178)、83.3%(229/275)]。结论:常规超声应作为甲状腺癌的首选筛查方法,弹性成像可作为辅助手段,二者联合使用可进一步提高甲状腺结节的鉴别诊断水平。

Objective To investigate the value of ultrasound thyroid imaging reporting and data system(TI-RADS), ultrasound elastography(UE), and combined application of both in the diagnosis of thyroid nodules. Methods The ultrasonic data of 290 patients with 275 thyroid tiny nodules confirmed by surgery and pathology were analyzed prospectively, then their TI-RADS and UE features were summarized. In 275 thyroid nodules, there were 143 benign ones and malignant 132 ones. To surgical results as the gold standard, to draw the receiver operating characteristic(ROC) curve of TI-RADS, ultrasound elastography and combined application of both, to calculate the area under the ROC curve. Calculating the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of TI-RADS, ultrasound elastography and their combination in the diagnosis of thyroid carcinoma. Results Of 275 thyroid nodules, the area under the ROC curve of TI-RADS, ultrasound elastography and their combination were 0.966,0.941 and 0.892. The sensitivity and negative predictive value of TI-RADS[100.0%(132/132)、100.0%(97/97)] were higher than UE [93.9%(124/132)、93.4%(114/122)] and combined application of both(99.2%(131/132)、99.2%(117/118))But the specificity, positive predictive and accuracy value of combined application of both [81.8%(117/143)、83.4%(131/157)、90.2%(248/275)] were higher than UE [79.7%(114/143)、81.0%(124/153)、86.5%(238/275)]and TI-RADS(67.8%(97/143)、74.2%(132/178)、83.3%(229/275))Conclusions Ultrasound should be the first choice of the diagnosis of thyroid carcinoma. UE should be used as an adjunct of the former. The differential diagnostic level of thyroid nodules by combined application of both can be furtherly improved.