超高频超声联合弹性成像技术对桥本病合并甲状腺结节良恶性的鉴别价值  

Ultra-high Frequency Ultrasound Combined Elasticity Imaging in the Differential Diagnosis of Benign and Malignant Nodules with Hashimoto Disease

作　　者：任春燕[1] REN Chunyan(Department of Ultrasound,the Fourth Hospital of Daqing,Daqing 613712,China)

机构地区：[1]大庆市第四医院超声科,黑龙江大庆613712

出　　处：《中国医学影像学杂志》2018年第10期752-755,757,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨超高频超声联合弹性成像技术在诊断桥本病合并甲状腺结节中的应用价值。资料与方法回顾性分析2013年9月-2017年12月于大庆市第四医院就诊的桥本病合并甲状腺结节患者100例,共128个甲状腺结节,在未经任何处置前分别行普通高频超声检查、超高频超声检查以及弹性成像检查,根据普通高频超声及超高频超声检查结果,参考甲状腺影像报告与数据系统分级标准,1～3级为良性,4～5级为恶性。参照5分评分法对肿块进行弹性评分,同时测量应变率比值。以病理结果为"金标准",绘制受试者工作特征(ROC)曲线,分析单独应用普通高频超声、超高频超声、弹性成像、普通高频超声与弹性成像联合应用、超高频超声与弹性成像联合应用的诊断效能,比较这5种方法诊断的敏感度和特异度。结果纳入病例中,良性结节占65.6%(84/128),其中结节性甲状腺肿最常见(68个),占良性结节的81.0%,其次为甲状腺腺瘤(14.3%,12/84)、结节腺瘤样变(2.4%,2/84)和增生结节(2.4%,2/84);恶性结节34.4%(44/128),其中乳头状甲状腺癌最常见(43个),占恶性结节的97.7%,其次为髓样癌(2.3%,1/44)。普通高频超声、超高频超声、弹性成像、普通高频超声联合弹性成像、超高频超声联合弹性成像对合并桥本病的甲状腺结节良、恶性诊断的敏感度分别为75.0%、95.4%、77.3%、90.9%和97.7%,特异度分别为88.1%、96.4%、83.3%、97.6%和98.8%;ROC曲线下面积分别为0.815、0.959、0.803、0.943和0.983。其中超高频超声联合弹性成像对合并桥本病的甲状腺结节良、恶性诊断的敏感度和特异度最高。结论超高频超声在甲状腺良、恶性结节鉴别诊断中的诊断效能优于普通高频超声。超声技术联合应用可以提高在桥本病背景下甲状腺结节鉴别诊断的能力。Purpose To explore the application value of ultra-high frequency ultrasound combined with elasticity imaging techniques in the diagnosis of thyroid nodules with Hashimoto disease.Materials and Methods One hundred patients with thyroid nodules and Hashimoto disease who received treatment in the Fourth Hospital of Daqing from September 2013 to December 2017 were retrospectively analyzed,with totally 128 thyroid nodules.General high frequency ultrasonic examination,ultra-high frequency ultrasound examination and elasticity imaging techniques were offered before any disposal.In line with results from general high frequency ultrasound and ultrahigh frequency ultrasound examinations,thyroid imaging-reporting and data system classification standards was referred to with 1-3 benign and 4-5 malignant.Likert scale was taken for elasticity evaluation of the masses and meanwhile strain rate ratio was measured.Taken pathological results as golden standards,receiver operating characteristic(ROC)was drawn to analyze diagnostic efficacy through simply applying general high frequency ultrasound,ultra-high frequency ultrasound,elasticity imaging techniques,general high frequency ultrasound combined elasticity and ultra-high frequency ultrasound combined elasticity imaging techniques.Sensitivity and specificity diagnosed with these five methods were compared.Results In the included cases,benign nodules occupied 65.6%(84/128)among which nodular goiter was the most common(68),accounting for 81.0%of benign nodules.Thyroid adenoma(14.3%,12/84),nodular adenomatoid lesions(2.4%,2/84)and hyperplastic nodules(2.3%,1/44)came next.Malignant nodules accounted for 34.4%(44/128),among which papillary thyroid carcinoma was the most common(43),occupying 97.7%of the malignant nodules.Medullary carcinoma(2.3%,1/44).Sensitivity of general high frequency ultrasound,ultra-high frequency ultrasound,elasticity imaging techniques,general high frequency ultrasound combined elasticity and ultra-high frequency ultrasound combined elasticity imaging techniqu

关 键 词：桥本病 甲状腺结节 甲状腺肿瘤 超声检查 弹性成像技术 诊断 鉴别 

分 类 号：R736.1[医药卫生—肿瘤] R730.41[医药卫生—临床医学]