切换至 "中华医学电子期刊资源库"

中华诊断学电子杂志 ›› 2016, Vol. 04 ›› Issue (02) : 73 -77. doi: 10.3877/cma.j.issn.2095-655X.2016.02.001

所属专题: 文献

影像学诊断研究

超声造影在甲状腺结节鉴别诊断中的价值
吕志红1, 俞磊1,(), 韩鄂辉1, 柯建梅1, 洪玮1, 胡小娟1   
  1. 1. 435000 黄石市中心医院超声影像科
  • 收稿日期:2015-10-13 出版日期:2016-05-26
  • 通信作者: 俞磊
  • 基金资助:
    黄石市科技计划资助项目(2013-1-048)

Differential diagnostic value of contrast-enhanced ultrasonography in thyroid nodules

Zhihong Lyu1, Lei Yu1,(), Ehui Han1, Jianmei Ke1, Wei Hong1, Xiaojuan Hu1   

  1. 1. Department of Ultrasound Imaging, Huangshi Central Hospital, Huangshi 435000, China
  • Received:2015-10-13 Published:2016-05-26
  • Corresponding author: Lei Yu
  • About author:
    Corresponding author: Yu Lei, Email:
引用本文:

吕志红, 俞磊, 韩鄂辉, 柯建梅, 洪玮, 胡小娟. 超声造影在甲状腺结节鉴别诊断中的价值[J/OL]. 中华诊断学电子杂志, 2016, 04(02): 73-77.

Zhihong Lyu, Lei Yu, Ehui Han, Jianmei Ke, Wei Hong, Xiaojuan Hu. Differential diagnostic value of contrast-enhanced ultrasonography in thyroid nodules[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2016, 04(02): 73-77.

目的

探讨超声造影对甲状腺影像报告和数据系统(TI-RADS)分类的甲状腺结节进一步鉴别诊断的价值。

方法

对295例387个常规超声TI-RADS分类的甲状腺结节行超声造影检查,观察造影后甲状腺结节的微循环灌注特征和应用SonoLiver CAP软件获得的时间-强度曲线各定量参数分析,综合进行两次TI-RADS分类评估,并与术后病理结果进行对照,计算常规超声TI-RADS、超声造影后TI-RADS分类诊断甲状腺恶性结节的敏感度、特异度、准确度、阳性预测值、阴性预测值,并绘制常规超声TI-RADS、超声造影后二次TI-RADS分类诊断甲状腺恶性结节的受试者操作特性(ROC)曲线,计算ROC曲线下面积。

结果

295例387个常规超声TI-RADS分类2~5类的甲状腺结节,术后病理结果为恶性82例121个、良性213例266个。常规超声TI-RADS分类诊断恶性结节的敏感度63.64 %(77/121)、特异度73.87%(229/310)、准确度79.07%(306/387)、阳性预测值45.83%(77/168)、阴性预测值83.88%(229/273),而超声造影后二次TI-RADS分类诊断恶性结节的敏感度85.95%(104/121)、特异度92.93%(263/283)、准确度94.83%(263/387)、阳性预测值83.87%(104/124)、阴性预测值93.93%(263/280),超声造影后二次TI-RADS分类诊断甲状腺恶性结节的敏感度、特异度、准确度、阳性预测值、阴性预测值均高于常规超声TI-RADS分类诊断,差异有统计学意义(χ2 =5.92,4.38,7.31,7.45,3.13;P<0.05)。常规超声TI-RADS、超声造影后二次TI-RADS分类诊断甲状腺恶性结节的ROC曲线下面积分别为0.753,0.834。二次TI-RADS分类评估后甲状腺结节恶性组的超声造影增强模式:≥1 cm实性结节早期快速不均匀增强伴灌注缺损区,<1 cm实性结节呈不均匀低增强;实性结节良性组增强模式表现为均匀高或等增强以及结节周边环状高增强,两者比较差异有统计学意义(χ2 =43.86,12.54;P<0.05);良恶性组间在增强水平、增强边界、始退特点、相对平均渡越时间、峰值强度、平均强度均具有统计学意义(χ2 =51.48,17.91,47.25,8.92,3.37,4.05;P<0.05);而增强范围、平均强度、峰值强度在良恶性组间均无统计学意义(χ2 =2.87,0.95,0.88;P>0.05)。

结论

超声造影对常规超声TI-RADS分类的甲状腺结节可以做进一步良恶性鉴别,提高术前诊断准确率。

Objective

To investigate the value of contrast-enhanced ultrasonography(CEUS) in the diagnosis of thyroid nodules under Thyroid Imaging Reporting and Data System (TI-RADS) classification.

Methods

Totally 295 patients were enrolled, 387 thyroid nodules underwent conventional ultrasonic TI-RADS classification CEUS.In order to observe the microcirculation perfusion characteristics of thyroid nodules, the time intensity curve was obtained by CAP SonoLiver software and compare with postoperative pathologic results.The quantitative parameters of the intensity curves were analyzed, and the two TI-RADS classification were performed.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of diagnosis of thyroid malignant nodules were calculated by conventional ultrasonic TI-RADS as well as the two TI-RADS classification.Meanwhile the TI-RADS (ROC) curves were plotted, and the area under the ROC curve was calculated.

Results

Three hundred and eight-seven conventional classification of TI-RADS 2~5 classes of thyroid nodules in 295 patients′ postoperative pathology were analyzed, 121 cases in 82 patients were malignant and 213 cases in 266 patients were benign.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of conventional ultrasound TI-RADS classification for diagnosis of malignant nodules were 63.64% (77/121), 73.87% (229/310), 79.07% (306/387), 45.83% (77/168), and 83.88% (229/273), while the two TI-RADS classification for diagnosis of malignant nodules were 85.95% (104/121), 92.93% (263/283), 94.83% (263/387), 83.87% (104/124), and 93.93% (263/280). The sensitivity, specificity, accuracy, positive predictive value, positive predictive value and negative predictive value of the two TI-RADS classification of thyroid malignant nodules were higher than those of conventional ultrasound(χ2=5.92, 4.38, 7.31, 7.45, 3.13; P<0.05). The area under the ROC curve of conventional ultrasonic and the two TI-RADS classification of thyroid malignant nodules were 0.753 and 0.834, respectively.Among cases that TI-RADS was classified as malignant thyroid nodules by CEUS, they exhibited the following features under ultrasound contrast-enhanced mode: solid nodules (≥1 cm) exhibited early rapid heterogeneous enhancement pattern together with perfusion defects, and solid nodules (<1 cm) also exhibited heterogeneous enhancement pattern.For cases that TI-RADS was classified as benign thyroid nodules by CEUS, nodules and their annular surroundings exhibited homogenous enhancement pattern.The differences in the features between malignant group and benign group were statistically significant (χ2=43.86, 12.54; P<0.05). The differences between malignant group and benign group were statistically significant (χ2=51.48, 17.91, 47.25, 8.92, 3.37, 4.05; P<0.05) in enhancement level, enhancement border, arrival to peak-time characteristics, quantitative parameters mean transit time(MTT), peak intensing(PI) and arrival intensing(AI), (χ2=51.48, 17.91, 47.25, 8.92, 3.37, 4.05; P<0.05), but not statistically significant in enhancement value range, quantitative parameters rise time(RT) and peak time(PT) (χ2=2.87, 0.95, 0.88; P>0.05).

Conclusion

CEUS can improve accuracy in TI-RADS classification of thyroid nodules.

表1 甲状腺结节常规超声与超声造影后 TI-RADS分类诊断结果比较(%,n=387)
表2 甲状腺影像报告和数据系统类甲状腺良恶性结节超声造影增强特征比较(个数)
表3 甲状腺影像报告和数据系统2~5类甲状腺良恶性结节超声造影指标比较(±s)
[1]
类维龙,孔令秋,伍洲, 等. 先天性主动脉瓣及瓣下狭窄左室流出道几何学研究[J/CD]. 中华诊断学电子杂志, 2015, 3(3): 190-191.
[2]
詹维伟,王文涵. 甲状腺结节的超声诊断价值[J]. 中国普外基础与临床杂志, 2014, 21(9): 1061-1065.
[3]
Gharib H,Papini E,Paschke R, et al.American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules [J]. J Endocrinol Invest, 2010, 33(5 Suppl): 1-50.
[4]
Ma BY,Parajuly SS,Peng YL, et al.The Value of Sonography in Thyroid Imaging Reporting and Data Systemfor Thyroid Nodule[J]. Chin J Bases Clin General Surg, 2011, 18(8): 898-901.
[5]
马姣姣,丁红. 超声新技术在甲状腺结节诊断中的应用进展[J/CD]. 中华临床医师杂志(电子版), 2012, 6(11): 3040-3042.
[6]
计静丹,詹维伟,徐上研. 彩色多普勒超声鉴别甲状腺结节良恶性价值的再探讨[J/CD]. 中华医学超声杂志(电子版), 2011, 8(6): 1289-1295.
[7]
胡菊萍,栗翠英,林红军. 超声造影对甲状腺良恶性结节的诊断价值[J]. 临床超声医学杂志, 2014(8): 534-537.
[8]
张渊,江泉,陈剑, 等. 甲状腺癌实时超声造影增强特征与肿瘤大小的关系[J]. 中国医学影像技术, 2012, 28(1): 82-85.
[9]
吴昊,陈琴,周青, 等. 评价剪切波弹性成像结合超声造影对甲状腺TI-RADS 3、4类结节的鉴别诊断价值[J]. 中国超声医学杂志, 2015, 31(8): 676-679.
[10]
张敏,谭利军,邓克文, 等. 精神分裂症患者血清甲状腺激素水平变化的临床意义[J/CD]. 中华诊断学电子杂志, 2014, 2(2): 46-49.
[11]
杨琛,钱超文,朱慧能, 等. 超声造影定量分析对甲状腺结节血流灌注的研究[J]. 中华超声影像学杂志, 2011, 20(1): 38-40.
[1] 章建全, 程杰, 陈红琼, 闫磊. 采用ACR-TIRADS评估甲状腺消融区的调查研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 966-971.
[2] 罗辉, 方晔. 品管圈在提高甲状腺结节细针穿刺检出率中的应用[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 972-977.
[3] 杨忠, 时敬业, 邓学东, 姜纬, 殷林亮, 潘琦, 梁泓, 马建芳, 王珍奇, 张俊, 董姗姗. 产前超声在胎儿22q11.2 微缺失综合征中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 852-858.
[4] 孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 884-889.
[5] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[6] 刘畅, 蒋洁, 胥雪冬, 崔立刚, 王淑敏, 陈文. 北京市海淀区医疗机构甲状腺超声检查及TIRADS分类基线调查[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 693-697.
[7] 李洋, 蔡金玉, 党晓智, 常婉英, 巨艳, 高毅, 宋宏萍. 基于深度学习的乳腺超声应变弹性图像生成模型的应用研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 563-570.
[8] 洪玮, 叶细容, 刘枝红, 杨银凤, 吕志红. 超声影像组学联合临床病理特征预测乳腺癌新辅助化疗完全病理缓解的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 571-579.
[9] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 470-476.
[10] 胡可, 鲁蓉. 基于多参数超声特征的中老年女性压力性尿失禁诊断模型研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 477-483.
[11] 张妍, 原韶玲, 史泽洪, 郭馨阳, 牛菁华. 小肾肿瘤超声漏诊原因分析新思路[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 500-504.
[12] 席芬, 张培培, 孝梦甦, 刘真真, 张一休, 张璟, 朱庆莉, 孟华. 乳腺错构瘤的临床与超声影像学特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 505-510.
[13] 杨敬武, 周美君, 陈雨凡, 李素淑, 何燕妮, 崔楠, 刘红梅. 人工智能超声结合品管圈活动对低年资超声医师甲状腺结节风险评估能力的作用[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 522-526.
[14] 钱警语, 郑明明. 《2024意大利妇产科学会非侵入性和侵入性产前诊断指南》解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 486-492.
[15] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
阅读次数
全文


摘要