超声弹性成像色彩评分系统、二维超声及能谱CT对甲状腺良恶性结节诊断鉴别价值比较

目的比较超声弹性成像、二维超声及能谱CT对甲状腺良、恶性结节诊断价值。方法以2018年1月至2019年6月于本院检查并经术后病理证实的75例(104个结节)甲状腺结节患者为研究对象,患者均有完整二维超声、超声弹性成像及能谱CT影像报告,以病理诊断结果为“金标准”,分析超声弹性成像、二维超声及能谱CT对甲状腺良、恶性结节诊断效能。结果75例患者104个结节,经病理证实良性结节73个,恶性结节31个;超声检查根据TIRADS分类,检出良性78个,恶性26个;弹性成像根据色彩评分检出良性75个,恶性29个;能谱CT根据形态学以及碘浓度、能量曲线斜率阈值进行诊断,检出良性72个,恶性32个。超声诊断甲状腺良、恶性结节灵敏度、特异度、准确度分别为69.23%、83.33%、79.81%;超声弹性成像分别为89.66%、93.33%、92.31%;能谱CT分别为90.61%、97.22%、95.19%。经配对χ^(2)检验两两比较发现,超声弹性成像、能谱CT诊断灵敏度、准确度均显著高于超声(P<0.05),但超声弹性成像、能谱CT比较差异无统计学意义(P>0.05)。结论超声弹性成像、二维超声及能谱CT均可用于甲状腺良、恶性结节诊断,但相比之下超声弹性成像、能谱CT较常规二维超声能更好检出甲状腺结节良恶性状态。

CDFI对甲状腺结节良、恶性程度的鉴别诊断价值

目的:评价彩色多普勒超声(Color Doppler flow imaging,CDFI)对甲状腺结节(Thyroid nodules,TN)良、恶性程度的鉴别诊断价值。方法:选取我院2018年2月至2019年2月期间收治并经病理检查确诊为TN的患者76例,根据TN良、恶性程度分为良性组(n=44)和恶性组(n=32)。采用CDFI测定患者结节内部血流情况,如:血流阻力指数(Resistance index,RI)、收缩期峰值流速(Peak systolic velocity,PSV)、舒张末期血流速度(End Diastolic blood flow velocity,EDV)以及内部回声、包膜以及边界情况;同时以病理诊断结果作为金标准,分析CDFI检查对TN良、恶性程度的诊断符合率。结果:良性组患者PSV、RI水平均明显低于恶性组(P<0.05),EDV水平明显高于恶性组(P<0.05);良性组混合回声、强回声、有包膜、边界清晰占比皆高于恶性组(P<0.05),而低回声、无包膜、边界模糊占比皆低于恶性组(P<0.05);CDFI诊断符合率为90.79%、灵敏度90.63%、特异度90.91%。结论:CDFI检查可有效显示TN良、恶性程度的影像学表现特征,用于TN良、恶性程度的鉴别诊断,但需结合形态及强化表现进行综合诊断。

Combination of acoustic radiation force impulse imaging, serological indexes and contrast-enhanced ultrasound for diagnosis of liver lesions

AIM To assess the value of combined acoustic radiation force impulse(ARFI) imaging, serological indexes and contrast-enhanced ultrasound(CEUS) in distinguishing between benign and malignant liver lesions. METHODS Patients with liver lesions treated at our hospital were included in this study. The lesions were divided into either a malignant tumor group or a benign tumor group according to pathological or radiological findings. ARFI quantitative detection, serological testing and CEUS quantitative detection were performed and compared. A comparative analysis of the measured indexes was performed between these groups. Receiver operating characteristic(ROC) curves were constructed to compare the diagnostic accuracy of ARFI imaging, serological indexes and CEUS, alone or in different combinations, in identifying benign and malignant liver lesions. RESULTS A total of 112 liver lesions in 43 patients were included, of which 78 were malignant and 34 were benign. Shear wave velocity(SWV) value, serum alpha-fetoprotein(AFP) content and enhancement rate were significantly higher in the malignant tumor group than in the benign tumor group(2.39 ± 1.20 m/s vs 1.50 ± 0.49 m/s, 18.02 ± 5.01 ng/m L vs 15.96 ± 4.33 ng/m L, 2.14 ± 0.21 d B/s vs 2.01 ± 0.31 d B/s; P < 0.05). The ROC curve analysis revealed that the areas under the curves(AUCs) of SWV value alone, AFP content alone, enhancement rate alone, SWV value + AFP content, SWV value + enhancement rate, AFP content + enhancement rate and SWV value + AFP content + enhancement rate were 85.1%, 72.1%, 74.5%, 88.3%, 90.4%, 82.0% and 92.3%, respectively. The AUC of SWV value + AFP content + enhancement rate was higher than those of SWV value + AFP content and SWV value + enhancement rate, and significantly higher than those of any single parameter or the combination of any two of parameters.CONCLUSION The combination of SWV, AFP and enhancement rate had better diagnostic performance in distinguishing between benign and malignant liver lesions than the use of any single parameter or the combination of any two of parameters. It is expected that this would provide a tool for the differential diagnosis of benign and malignant liver lesions.

动态增强MRI在乳腺肿瘤检查中的诊断价值及应用研究

目的:分析动态增强MRI在乳腺肿瘤检查中的诊断价值,并探讨其对乳腺肿瘤的应用价值。方法:回顾性分析2007年3月～2010年3月期间收治的乳腺肿瘤患者145例,患者均先进行常规MRI平扫,再对患者进行动态增强MRI扫描。观察两组患者MRI平扫和动态增强MRI征象,测定并比较动态增强MRI扫描良、恶性肿瘤的Emax、Tmax以及Slopemax等值。结果:常规MRI平扫良、恶性肿瘤显示率(22.37%、34.87%)均明显低于动态增强MRI显示率(40.13%、53.95%),差异有统计学意义(P<0.05);良性肿瘤动态参数Emax(76.84±50.55)%和Slopemax(2.75±2.87)%/s均低于恶性肿瘤〔(115.70±28.01)%/s和(6.39±2.03)%/s〕,有统计学意义(P<0.05),Tmax(422.03±119.45)s明显高于恶性肿瘤(157.5±490.91)s,差异有统计学有意义(P<0.05)。结论:动态增强MRI对乳腺肿瘤的检出率和准确率极高,并且可以很好地鉴别良恶性乳腺肿瘤,所以是诊断方法中良好的选择。