超声弹性成像技术对伴或不伴桥本甲状腺炎的甲状腺微小结节良恶性的鉴别诊断价值  

Differential diagnosis value of ultrasonic elastography on benign and malignant small thyroid nodules with or without Hashimoto thyroiditis

作　　者：赵海娜[1] 马步云[1] 骆洪浩[1] 

机构地区：[1]四川大学华西医院超声科,成都610041

出　　处：《中国普外基础与临床杂志》2017年第11期1342-1346,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省科技厅资助项目(项目编号:2015SZ0159)

摘　　要：目的评估超声弹性成像特征在伴或不伴桥本甲状腺炎背景下鉴別诊断甲状腺微小结节良恶性的价值及诊断标准。方法收集2014年1月至2015年4月期间在四川大学华西医院行甲状腺超声检查的病例,纳人其中行常规超声检查甲状腺超声影像干和数据报告系统分类在4A类及以上且最大直径≤1 cm的甲状腺结节,对其应用实时组织弹性成像技术进一步检查,记录甲状腺结节的弹性评分与弹性应变率比值,再行超声引导下细针穿刺细胞学检查诊断,以术后病理诊断为金标准,根据是否伴有桥水甲状腺炎进行分析,比较伴或不伴桥本甲状腺炎患者的甲状腺结节的弹性评分及弹。性应变率比值的差异。结果最终纳入共402例患者424枚结节伴桥本甲状腺炎者103枚,其中恶性结节70枚,良。性结节33枚;不伴桥本甲状腺炎者321枚,其中恶性结节259枚,良性结节62枚。弹性评分诊断伴或不伴桥小甲状腺炎甲状腺良恶性结节的受试者操作特征(ROC)曲线下面积分别为0.685和0.692,其临界值分别为3分和4分时的诊断效能最佳,其相应的敏感度、特异度、准确度分别为75.7%、57.6%、68.0%和57.5%、74.2%、69.2%。弹性应变率比值诊断伴或不伴桥本甲状腺炎甲状腺良恶,性结节的ROC曲线下面积分别为0.676和0.692.其临界值分别为2.45和2.84时的诊断效能最佳,其相应的敏感度、特异度、准确度分別为75.7%,60.6%、67.6%和76.1%、59.7%、67.7%。结论超声弹性成像技术行肋有助于甲状腺微小纳结节良恶·性的鉴别诊断,但其在伴或不伴桥本甲状腺炎时鉴別诊断良恶性结节的标准略有不同,与不伴桥本甲状腺炎背景下相比较。Objective To compare differences of characteristics of ultrasonic elasticity imaging for benign and malignant small thyroid nodules with or without Hashimoto thyroiditis （HT）. Methods The thyroid nodules with ≤ 1 cm size and the category 4A, 4B, 4C, and 5 of Thyroid Imaging Reporting and Data System （TI-RADS） were included into this study, and a further examination of real-time elastography was performed. The final diagnosis was relied on the pathological diagnosis. The elasticity score and strain ratio （SR） were recorded and compared between these two groups, respectively. Results Of the 424 nodules, 103 nodules were accompanied with HT （thyroid nodule with HT group）, 321 nodules were not accompanied with HT （thyroid nodule without HT group）. In the thyroid nodule with HT group, the area under the receiver operator characteristic （ROC） curve （A UCs） of the elasticity score and the SR was 0.685 and 0.676, respectively; the optimal cut offs of the elasticity score and the SR was 3 points and 2.45 respectively, their corresponding sensitivity, specificity, and accuracy was 75.7%, 57.6%, 68.0% and 75.7%, 60.6%, 67.6%, respectively. In the thyroid nodule without HT group, the A UCs of the elasticity score and the SR was 0.692 and 0.692, respectively; the optimal cut offs of the elasticity score and the SR was 4 points and 2.84, respectively; their corresponding sensitivity, specificity, and accuracy was 57.5%, 74.2%, 69.2% and 76.1%, 59.7%, 67.7%, respectively. Conclusions Elastography is helpful in differential diagnosis of benign and malignant small thyroid nodules. While, standards of elasticity score and SR value in differential diagnosis are different between benign and malignant small thyroid nodules with HT and without HT, elasticity score and SR ratio decrease in benign and malignant small thyroid nodules with HT.

关 键 词：甲状腺结节 桥本甲状腺炎 弹性成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]