实时超声弹性成像技术结合TI-RADS分级标准在良恶性甲状腺结节鉴别诊断中的应用价值  

Application value of real-time ultrasound elastography combined with TI-RADS standard in differential diagnosis of benign and malignant thyroid nodules

作　　者：刘畅 殷军[2] 何志容[2] 徐新雅 陈文 周丹 LIU Chang;YIN Jun;HE Zhirong;XU Xinya;CHEN Wen;ZHOU Dan(Department of Special Examination,Xincheng Community Health Service Center of Fuling District,Chongqing 408100,China)

机构地区：[1]重庆市涪陵区新城区社区卫生服务中心特检科,408100 [2]重庆市涪陵中心医院超声科 [3]重庆市涪陵区妇幼保健院超声科 [4]重庆市涪陵区中医院超声科

出　　处：《临床超声医学杂志》2018年第7期465-467,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨实时超声弹性成像技术结合甲状腺影像学报告及数据系统(TI-RADS)分级标准在良恶性甲状腺结节鉴别诊断中的应用价值。方法选取经手术病理证实的甲状腺结节患者125例(共190个结节),根据结节直径分为<1 cm 64个(<1 cm组)和≥1 cm 126个(≥1 cm组)。所有患者均接受常规超声和超声弹性成像检查,参考TI-RADS分级标准和弹性评分评估结节性质,绘制超声弹性成像和TI-RADS分级标准诊断甲状腺恶性结节的ROC曲线,评估两种方法单独应用和联合应用对甲状腺结节的鉴别诊断价值。结果超声弹性成像诊断甲状腺恶性结节的敏感性87.72%、特异性87.22%、准确率90.53%;TI-RADS分级标准诊断甲状腺恶性结节的敏感性71.93%、特异性84.21%、准确率80.53%;两者联合诊断的敏感性91.23%、特异性88.72%、准确率93.16%。<1 cm组中超声弹性成像诊断准确率为90.63%,TI-RADS分级标准诊断准确率为76.56%,两者比较差异有统计学意义(χ2=5.211,P<0.05);≥1 cm组中,TI-RADS分级标准诊断准确率为87.30%(110/126),超声弹性成像诊断准确率为77.78%(98/126),两者比较差异有统计学意义(χ2=3.439,P<0.05)。超声弹性成像诊断甲状腺恶性结节的ROC曲线下面积大于TI-RADS分级标准(0.926 vs.0.869),两者联合诊断的ROC曲线下面积(0.973)明显高于其单独应用,差异均有统计学意义(均P<0.05)。结论超声弹性成像联合TI-RADS分级标准对甲状腺良恶性结节的鉴别诊断具有较高的诊断效能,可弥补单一技术在鉴别诊断中的缺陷与不足,具有较好的临床应用价值。Objective To investigate the application value of real-time ultrasound elastography(UE)combined with TI-RADS standard in differential diagnosis of benign and malignant thyroid nodules.Methods One hundred and twenty-five patients with 190 thyroid nodules confirmed by surgery and pathology were selected.The patients were subsequently divided into two groups(64 nodules in<1 cm group and 126 nodules in≥1 cm group).After the conventional ultrasound and UE examination,TI-RADS were used to evaluate the nodule characteristics.ROC curve of UE and TI-RADS were constructed to analyze the efficiency of each method for differential diagnosis of thyroid nodules.Results The sensitivity,specificity and accuracy of UE in diagnosing thyroid malignant nodules were 87.72%,87.22%and 90.53%,respectively,and sensitivity,specificity and accuracy of TI-RADS were 71.93%,84.21%and 80.53%,respectively,while the combined diagnosis achieved a diagnostic accuracy of 93.16%with 91.23%sensitivity and 88.72%specificity.The diagnostic accuracy of UE in<1 cm group was significantly higher than that of TI-RADS(90.63%vs.76.56%,χ2=5.211,P<0.05).However,the diagnostic accuracy of UE in≥1 cm group was lower than that of TI-RADS(77.78%vs.87.30%,χ2=3.439,P<0.05).The area under ROC curve of UE was significantly larger than that of TI-RADS(0.926 vs.0.869).The AUC of the combined diagnosis(0.973)was statistically higher than that of each alone(all P<0.05).Conclusion The combination of TI-RADS and UE has high diagnostic efficiency in differential diagnosis of benign and malignant thyroid nodules.

关 键 词：超声弹性成像 实时 TI-RADS分级标准 甲状腺结节 良恶性 鉴别诊断 

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