超声造影联合弹性成像对桥本甲状腺炎背景下TI-RADS 4类结节良恶性的诊断价值  

The value of contrast-enhanced ultrasound combined with elastography in differentiation between benign and malignant(TI-RADS-4)thyroid nodules in Hashimoto’s thyroiditis

作　　者：韩旭 周娜[2] 翟虹[2] HAN Xu;ZHOU Na;ZHAI Hong(Department of Abdominal Ultrasound,Hospital of Traditional Chinese Medicine Affiliated of Xinjiang Medical University,Urumqi 830000,China;不详)

机构地区：[1]新疆医科大学第四临床医学院,新疆乌鲁木齐830001 [2]新疆医科大学附属中医医院腹部超声科,新疆乌鲁木齐830000

出　　处：《中国中西医结合影像学杂志》2021年第3期224-228,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：新疆医科大学附属中医医院院级课题(ZYY201818)。

摘　　要：目的:探讨超声造影(CEUS)联合弹性成像对桥本甲状腺炎(HT)背景下甲状腺影像学报告及数据系统(TI-RADS)4类甲状腺良恶性结节的诊断价值。方法:收集经手术病理证实的HT背景下常规超声诊断TI-RADS 4类甲状腺结节患者92例,共100个甲状腺结节;分析术前CEUS及超声弹性成像的造影模式、弹性评分等指标;以病理结果为金标准,探讨CEUS、弹性成像及CEUS联合弹性成像对TI-RADS 4类甲状腺结节的诊断价值。结果:CEUS、弹性成像及两者联合诊断HT背景下甲状腺结节的准确率分别为92.00%、91.00%、94.00%;敏感度分别为98.28%、89.65%、89.66%;特异度分别为83.33%、92.85%、100.00%;阳性预测值分别为89.06%、94.54%、100.00%;阴性预测值分别为97.22%、86.67%、87.50%;阳性似然比分别为5.89、0.12、+∞;阴性似然比分别为0.02、0.11、0.10;约登指数分别为0.81、0.83、0.89;与病理结果的Kappa一致性分析显示,Kappa值分别为0.83、0.82、0.87。CEUS与联合诊断结果差异有统计学意义(P<0.05),弹性成像与联合诊断结果差异无统计学意义(P>0.05)。ROC曲线分析显示,以CEUS评分4分为诊断临界点,AUC为0.903,敏感度、特异度、准确率分别为98.30%、83.30%、92.00%;以弹性评分3分为诊断临界点,AUC为0.958,敏感度、特异度、准确率分别为89.70%、92.90%、91.00%;以CEUS与弹性成像联合评分7分为诊断临界点,AUC为0.977,敏感度、特异度、准确率分别为98.30%、97.60%、93.00%;联合评分法的敏感度与单独使用CEUS评分法相同,且高于单独使用弹性成像评分法,特异度、准确率及AUC均高于单独评分法,联合诊断效能高于单独诊断效能。结论:CEUS联合弹性成像有助于提高HT背景下TI-RADS 4类甲状腺结节良恶性的诊断准确性。Objective:To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS)combined with elastography in differentiation between benign and malignant(TI-RADS-4)thyroid nodules in Hashimoto’s thyroiditis(HT).Methods:A total of 92 patients with 100 TI-RADS-4 thyroid nodules in HT detected by conventional ultrasound and confirmed by operation and pathology were recruited.Imaging mode,elasticity score and other indicators of preoperative CEUS and elastography were analyzed.With pathological results as the gold standard,the diagnostic value of CEUS,elastography and CEUS combined with elastography for TI-RADS-4 thyroid nodules was explored.Results:The diagnostic accuracy rate of CEUS,elastography and CEUS combined with elastography for thyroid nodules in HT was 92.00%,91.00%and 94.00%,the sensitivity was 98.28%,89.65%and 89.66%,the specificity was 83.33%,92.85%and 100.00%,the positive predictive value was 89.06%,94.54%and 100.00%,the negative predictive value was 97.22%,86.67%and 87.50%,the positive likelihood ratio was 5.89,0.12 and+∞,the negative likelihood ratio was 0.02,0.11 and 0.10,the Youden index was 0.81,0.83 and 0.89,respectively.The consistency analysis showed that Kappa value was 0.83,0.82 and 0.87.The difference between CEUS and CEUS combined with elastography was statistically significant(P<0.05),and the difference between elastography and CEUS combined with elastography was not statistically significant(P>0.05).Analysis using the ROC curve showed that with CEUS score 4 as the critical point for diagnosis,the AUC was 0.903,the sensitivity,specificity,and accuracy were 98.30%,83.30%and 92.00%,respectively;with elastography score 3 as the critical point for diagnosis,the AUC was 0.958,the sensitivity,specificity,and accuracy were 89.70%,92.90%,and 91.00%,respectively;with CEUS combined with elastography score 7 as the critical point for diagnosis,the AUC was 0.977,the sensitivity,specificity,and accuracy were 98.30%,97.60%and 93.00%,respectively.The sensitivity of the combined scoring method was

关 键 词：桥本病 超声检查 弹性成像技术 甲状腺结节 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581.4[医药卫生—诊断学]