DWI联合超声评估无淋巴结转移单发甲状腺微小乳头状癌侵袭性的研究  

DWI combined with ultrasound in predicting the invasiveness of single papillary thyroid microcarcinoma without lymph node metastasis

作　　者：黄元发 邓峰[4] 许辉[2] 刘峰[1] 杜红[1] 王爱华[1] 胡兆鹏 刘凯 HUANG Yuan-fa;DENG Feng;XU Hui(Department of Radiology,People's Hospital of Pingxiang,Jiangxi 337000,China)

机构地区：[1]萍乡市人民医院影像科,江西337000 [2]萍乡市人民医院超声科,江西337000 [3]萍乡市人民医院病理科,江西337000 [4]南昌大学第一附属医院放射科,南昌330006 [5]华中科技大学同济医学院附属同济医院肿瘤科,武汉430030

出　　处：《放射学实践》2020年第7期850-854,共5页Radiologic Practice

摘　　要：目的:探讨磁共振扩散加权成像(DWI)联合超声对单发无淋巴结转移甲状腺微小乳头状癌(PTMC)侵袭性的评估价值。方法:选择经手术确诊的单发无淋巴结转移的PTMC患者62例作为研究对象,分为甲状腺外侵犯(ECE)组(12例)和无ECE组(50例)。比较两组患者的超声及DWI征象差异,分析超声及DWI诊断单发无淋巴结转移PTMC侵袭性的准确性,计算两种检查方式联合诊断的诊断效能。结果:超声征象中,ECE组边界不清比例、甲状腺被膜回声中断比例高于无ECE组,差异均有统计学意义(P<0.05)。ECE组的ADC值显著低于无ECE组,差异有统计学意义(P<0.05)。超声诊断单发无淋巴结转移PTMC侵袭性的敏感度(46.15%)低于DWI(100.00%),但特异度(77.55%)高于DWI(70.00%)。超声联合DWI诊断单发无淋巴结转移PTMC侵袭性的准确性最佳(AUC=0.922),其敏感度为83.33%,特异度为88.00%,拟合方程为Logit(P)=5.628-4.818×ADC值+2.025×甲状腺被膜回声中断。结论:超声和DWI分别从形态学和功能成像的角度来综合判断PTMC的侵袭性,两者联合应用能够提高单发无淋巴结转移PTMC侵袭性的诊断准确率。Objective:To explore the value of diffusion-weighted imaging(DWI)combined with ultrasound in predicting the invasiveness of single papillary thyroid microcarcinoma(PTMC)without lymph node metastasis.Methods:A total of 62 patients with single PTMC without lymph node metastasis confirmed by surgery were recruited.They were divided into the extracapsular extension(ECE)group(n=12)and no ECE group(n=50).The differences of the characteristics in ultrasound and DWI were compared between the two groups.The accuracy of ultrasound and DWI in predicting the invasiveness of single PTMC without lymph node metastasis was analyzed.The diagnostic efficacy of the combination of the two methods was explored.Results:In the ultrasound characteristics,the proportions of unclear boundary and the interrupted thyroid capsule echo in ECE group were higher than those in no ECE group(P<0.05).In magnetic resonance imaging,the ADC value of ECE group was significantly lower than those of no ECE group(P<0.05).The sensitivity(46.15%)of ultrasound in predicting the invasiveness of single PTMC without lymph node metastasis was lower than that(100.00%)of DWI.The specificity(77.55%)of ultrasound was higher than that(70.00%)of DWI.The combination of ultrasound and DWI in predicting the invasiveness of single PTMC without lymph node metastasis was the best(AUC=0.922).The sensitivity was 83.33%,and the specificity was 88.00%.The fitting equation was Logit(P)=5.628-4.818×ADC value+2.025×Interrupted thyroid capsule echo.Conclusion:Ultrasound and DWI can comprehensively judge the invasiveness of PTMC from the perspective of morphological and functional imaging.Their combination can improve the predicting accuracy in the invasiveness of single PTMC without lymph node metastasis.

关 键 词：超声 磁共振成像 扩散加权成像 甲状腺肿瘤 甲状腺乳头状瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]