超声造影参数成像在TI—RADS3～4级甲状腺微小癌鉴别诊断中的应用价值  

The value of contrast-enhanced ultrasonography in differential diagnosis of thyroid microcarcinoma of TI-RADS grade 3-4

作　　者：张隽 陈辽[1] 胡伟[1] 孙彬[1] 黄鑫[1] 黄星月[1] 陈文卫[1] 

机构地区：[1]武汉大学人民医院超声影像科,430060

出　　处：《中华超声影像学杂志》2017年第10期855-860,共6页Chinese Journal of Ultrasonography

摘　　要：目的通过分析超声造影相关参数，为TI-RADS3～4级甲状腺微小癌的鉴别诊断提供参考依据。方法使用SonoLiver软件分析112个TI～RADS3～4级甲状腺微小结节的超声造影过程，自动获取超声造影的动态血管模式曲线（DVPc）和时间-强度曲线（TIc），总结两种曲线的类型及特征，通过软件得到上升时间（RT）、达峰时间（TTP）、平均渡越时间（mTT）、峰值强度（IMAX％）、曲线下面积（AUC）、灌注指数（PI）相关指标，行ROC曲线获得截断值。结果TI—RADS3～4级甲状腺微小癌TIC主要表现为慢升慢降及慢升快降波，DVPC主要表现为负向波及负正双向波，当IMAX为96．5％、AUC为443．08、PI为47．64时是鉴别良恶性结节的最佳截断值，即当IMAX〈96．5％，AUC〈443．08，PI〈47．64时高度可能为甲状腺微小癌。结论分析超声造影参数可为TI—RADS3～4级甲状腺微小癌的鉴别诊断提供有效的参考依据。Objective To provide a reference for differential diagnosis of thyroid microcarcinoma classified as TI-RADS 3-4 grade using contrast-enhanced ultrasound. Methods SonoLiver software was used to analyze the process of contrast-enhanced ultrasound of 112 thyroid small nodules classified as TI- RADS 3-4 grade. The dynamic vascular pattern curve （DVPC） and the time-intensity curve （TIC） were automatically acquired for summarization of the types and characteristics of the two curves. The relevant parameters such as the rise time （RT）, time to peak （TTP）, maximum intensity （IMAX%）, mean transit time （mTT）, area under curve （AUC） and perfusion index （PI） were acquired and calculated using the software. Receiver operating curve （ROC） analysis was used to achieve the cut-off value of these parameters for differential diagnosis. Results For thyroid microcarcinoma which TI-RADS assessment of grade 3-4,TIC showed as slow rise and slow drop wave or slow rise and fast drop wave, DVPC showed negative waveform or negative-positive bi-directional waveform. ROC analysis demonstrated that IMAX of 96.5 %, AUC of 443.08 and PI of 47.64 were the best cut-off values for the differential diagnosis of benign and malignant nodules. When IMAX〈96.5 %, AUC〈443.08, PI〈47.64, the nodules were highly likely to be thyroid rnicrocarcinoma. Conclusions The contrast-enhanced ultrasound parameters can provide effective reference for the differential diagnosis of thyroid carcinoma with grade 3-4 in TI-RADS classification.

关 键 词：超声造影 甲状腺微小癌 TI-RADS 时间强度曲线 动态血管模式 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]