2015ATA超声指南、超微血管成像技术和频谱多普勒在甲状腺结节良恶性鉴别中的应用价值  

The role of ATA(2015)guidelines,superb microvascular imaging,and spectral Doppler in differentiation between malignant and benign thyroid nodules

作　　者：李月华[1] 温德惠[2] 李朝喜[2] 李小娟[2] 薛刚[3] LI Yuehua WEN Dehui LI Chaozi LI Xiaojuan XUE Gang(Hebei North University, Zhangjiakou, 075000, China Department of Ultrosonography, the First Affiliated Hospital of Hebei North University Departrnent of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University)

机构地区：[1]河北北方学院,河北张家口075000 [2]河北北方学院附属第一医院超声医学科 [3]河北北方学院附属第一医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第15期1152-1156,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨2015ATA指南超声模式、彩色多普勒(CDFI)、超微血管成像技术(SMI)和频谱多普勒诊断良恶性甲状腺结节的价值。方法:收集经超声检出并经细针穿刺细胞学(FNAC)或病理学证实的254个甲状腺结节作为研究对象,对每个结节分别行二维超声、CDFI、SMI和频谱多普勒检查,参考Kim甲状腺结节血流分布模式的标准,分别观察同一病灶在不同技术所显示的血流分布情况。使用受试者工作特征曲线(ROC)计算得出RI、PI鉴别甲状腺结节良恶性的最佳诊断界点。结果:(1)SMI对良性甲状腺结节的周边型以及恶性甲状腺结节中央型血流分布模式更敏感,且差异有统计学意义(P<0.05);(2)RI、PI对鉴别甲状腺结节的良恶性有统计学意义(P<0.05);(3)2015ATA+SMI联合诊断模式的特异性和敏感性明显高于其他单一诊断模式,且差异有统计学意义;(4)2015ATA+SMI+频谱多普勒联合诊断模式和2015ATA+SMI联合诊断模式对比,敏感性、特异性和准确性均有所提高,但三者的差异无统计学意义。结论:SMI血流检出率更高,在甲状腺结节的良恶性鉴别诊断中有一定的应用价值。2015ATA+SMI联合诊断模式能够提高超声对甲状腺良恶性结节的诊断效能。Objective：To evaluate the diagnostic value of ultrasound patterns of 2015 American Thyroid Asso ciation（ATA） guidelines, color Doppler flow imaging（CDFI）, superb microvascular imaging（SMI）, and spectral Doppler in the differentiation of benign and malignant thyroid nodules. Method： The study included 254 thyroid nodules confirmed by fine needle aspiration cytology（FNAC） or histopathologic examination. All nodules were de- tected by uhrasonography, SMI, CDFI and spectral Doppler respectively. Blood flow detection technologies（CDFI and SMI） were used to classify flow distribution characteristics of thyroid nodules according to Kim＇s grading trite ria. The optimal threshold drawing from ROC curve is calculated to obtain the cut-off value of. spectral Doppler. Result： （1）For benign solid nodules with peripheral flow distribution and malignant solid nodules with central blood flow distribution, the display rates of SMI are higher than those of the CDFI, the differences were statistically sig- nificant（P〈0.05）. （2）There was a significance difference in detecting benign and malignant nodules using spectral Doppler（P〈0.05）. （3）The specificity and accuracy of combinative modality 2015 ATA4-SMI was significantly higher than that of ATA, SMI, and spectral Doppler. There was no significant difference between ATA＋ SMI and ATA＋SMI＋aspectral Doppler for the sensitivity, specificity, and accuracy. Conclusion.. SMI had a better de tection rate of blood vessels than CDFI and contribute a certain value in differential diagnosis of benign and malig- nant thyroid nodules. The combination of 2015ATA and SMI can improve diagnostic value in the differentiation between benign and malignant thyroid nodules.

关 键 词：甲状腺结节 超声检查 超微血管成像技术 频谱多普勒 

分 类 号：R581[医药卫生—内分泌]