常规超声联合弹性成像诊断甲状腺微小癌的价值  

Conventional Ultrasound Combined with Elastography in Diagnosis of Thyroid Microcarcinoma

作　　者：李晨[1] 高光旭 李建宁[1] 王勇[1] 杨玉辉[1] 秦川[1] 

机构地区：[1]新疆克拉玛依市中心医院超声科,新疆克拉玛依834000

出　　处：《中国医学影像学杂志》2016年第11期805-809,共5页Chinese Journal of Medical Imaging

摘　　要：目的甲状腺微小癌（TMC）病灶较小,缺乏临床特征,超声检查是发现和诊断TMC的主要方法之一,本研究旨在探讨常规超声（CUS）、弹性成像（UE）及两者联合对TMC的诊断价值。资料与方法回顾性分析经手术或穿刺活检病理证实的178例TMC患者（237个结节）的资料,所有结节均行CUS和UE检查。计算CUS、UE及两者并联/串联诊断TMC的敏感度、特异度、准确度、尤金指数、阳性预测值、阴性预测值,比较两者并联/串联与CUS诊断TMC的能效差异。结果 237个微小结节中病理诊断恶性108个（45.6%）,良性129个（54.4%）;CUS诊断良性结节133个,恶性结节104个;UE诊断良性结节88个,恶性结节149个。UE的敏感度高于CUS,特异度、阳性预测值低于CUS,差异有统计学意义（χ~2=7.38、15.28、6.79,P〈0.01）。两者并联/串联诊断良性结节72个/150个,恶性结节165个/87个,两者并联诊断敏感度、阴性预测值高于CUS,特异度、尤金指数、阳性预测值低于CUS,差异有统计学意义（χ~2=16.09、10.02、25.42、4.68、9.76,P〈0.05）;两者串联诊断特异度、阳性预测值高于CUS,差异有统计学意义（χ~2=4.43、4.38,P〈0.05）。结论 CUS和UE诊断TMC均存在一定的不足,与CUS相比,两者串联诊断可提高TMC诊断的特异度和阳性预测值,有较高的临床实用价值。Purpose Thyroid microcarcinoma（TMC） was characterized by little lesion, lacking of clinical features. Ultrasonography is one of the main methods to detect and diagnose TMC at the beginning. The present study aims to evaluate the value of conventional ultrasound（CUS）, ultrasonic elastography（UE） and the CUS combined with UE indiagnosing TMC. Materials and Methods Retrospectively analyzed 178 patients, who were confirmed TMC（237 thyroid nodules） either by surgery or biopsy. All nodules were examined both by CUS and UE. The sensitivity, specificity, accuracy, Eugene index, positive predictive value and negative predictive value of CUS, UE and their combination were calculated respectively. Compared the efficiency difference among parallel and serial combination of CUS＋UE, as well as CUS in diagnosing TMC. Results Among 237 pathologically confirmed micro nodules, 108（45.6%） nodules were malignant and 129（54.4%） nodules were benign. By using either CUS or UE, 133 and 88 nodules were diagnosed benign, respectively; 104 and 149 were diagnosed malignant, respectively. Compared with CUS methods, the diagnostic sensitivity of UE was significantly higher（χ~2=7.38, P0.01）, while the specificity and positive predictive value were significantly lower（χ~2=15.28 and 6.79, P0.01）. By using CUS＋UE either parallel or series, 72 and 150 nodules were diagnosed benign, respectively; 165 and 87 nodules were diagnosed malignant, respectively. Compared with CUS, the diagnostic sensitivity and negative predictive value by using CUS＋UE parallel method were significantly higher（χ~2=16.09 and 10.02, P0.05）; the diagnostic specificity, Eugene index and positive predictive value were significantly lower（χ~2=25.42, 4.68 and 9.76, P0.05）; the diagnostic specificity and positive predictive value by using CUS＋UE series method were significantly higher compared with CUS（χ~2=4.43 and 4.38, P0.05）. Conclusion Both CUS and UE methods are proper for TMC diagnosis, but still not good enough. Compa

关 键 词：甲状腺肿瘤 超声检查 多普勒 彩色 弹性成像技术 病理学 临床 诊断 鉴别 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]