多参数MRI在甲状腺良恶性结节诊断中的应用价值  

Value of multi-parameter MRI in the diagnosis of thyroid benign and malignant nodules

作　　者：吴美妮 梁龙飞 张妙如 刘周 胡尔曼·巴合提别克 王士旭 龙莉 邓文明 魏明辉 罗德红 Wu Meini;Liang Longfei;Zhang Miaoru;Liu Zhou;Huerman·Bahetibieke null;Wang Shixu;Long Li;Deng Wenming;Wei Minghui;Luo Dehong(Department of Radiology,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,China;Department of Head and Neck Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,China;Department of Radiology,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院,深圳医院放射诊断科,518116 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院深圳医院头颈外科,518116 [3]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院影像诊断科,100021

出　　处：《中华放射学杂志》2021年第7期710-715,共6页Chinese Journal of Radiology

基　　金：中国医学科学院肿瘤医院深圳医院院内科研课题(SZ2020ZD005)。

摘　　要：目的探讨甲状腺多参数MRI在甲状腺结节良恶性鉴别诊断的应用价值。方法回顾性分析2018年12月至2020年5月中国医学科学院北京协和医学院肿瘤医院深圳医院经手术病理证实的78例共91枚甲状腺结节的MRI表现,观察结节的部位、大小、形态、边界、信号、是否伴囊变、增强程度、强化方式及周围结构侵犯,测量ADC值,绘制动态增强时间-信号强度曲线(TIC)并分型,采用Mann-WhitneyU检验、χ^(2)检验或Fisher确切概率法比较良恶性结节MRI征象。通过多因素logistic回归分析筛选独立预测因素并建立联合诊断模型,绘制ROC曲线分析评价MRI征象和联合模型的诊断性能。结果良恶性甲状腺结节间结节大小、形态、边缘、囊变、T1WI信号、ADC值、强化方式、TIC类型及甲状腺被膜是否侵犯的差异有统计学意义(P<0.05)。多因素logistic回归分析显示边界不清楚(OR=77.61)、无囊变(OR=36.11)和TIC类型(OR=83.41)是甲状腺恶性结节的独立预测因素,其ROC曲线下面积(AUC)分别为0.879、0.788、0.751。将三者联合建立诊断模型,其AUC为0.977,灵敏度为0.986,特异度为0.904。结论甲状腺多参数MRI可用于良恶性结节的鉴别诊断,联合独立危险因素边界不清楚、无囊变、平台型或流出型TIC类型的诊断模型具有较高的诊断效能。Objective To explore the value of multi-parametric MRI for thyroid gland in differentiating benign and malignant thyroid nodules.Methods From December 2018 to May 2020,78 patients with 91 post-surgically pathologically confirmed thyroid nodules were enrolled in Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College.For each patient,the following MRI findings were obtained including the nodules′location,size,shape,margin,signal intensity,cystic change,degree and pattern of contrast enhancement,involvement of surrounding structure,and ADC values.The time-intensity curve(TIC)were plotted and subtyped based on dynamic contrast enhancement MRI.The MRI findings between the benign and malignant thyroid nodules were compared using Mann-Whitney U test,χ^(2) test or Fisher exact test.Multiple logistic regression analysis was used to select independent predictive variables and build a combined model,and the ROC curve was used to evaluate the diagnostic performance of each MRI finding and the combined model.Results Between the benign and malignant thyroid nodules,the significant differences were found in size,shape,margin,presence of cystic changes,T1WI signal intensity,ADC value,enhancement homogeneity,TIC subtypes and presence of thyroid capsule involvement(P<0.05).Multivariate logistic analysis showed that ill-defined margin(OR=77.61),no presence of cystic changes(OR=36.11)and difference between TIC subtypes(OR=83.41)were independent predictive variables,and the area under the ROC curve(AUC)was 0.879,0.788,and 0.751,respectively.The AUC,sensitivity and specificity of the combined model were 0.977,0.986,and 0.904,respectively.Conclusions Thyroid multi-parametric MRI derived findings can be used for the differential diagnosis of benign and malignant nodules.Combined with the independent risk factors with ill-defined margin,no presence of cystic changes,TIC of type plateau or washout,the diagnostic model has a higher diagnostic efficiency.

关 键 词：甲状腺结节 磁共振成像 表面线圈 

分 类 号：R581[医药卫生—内分泌] R445.2[医药卫生—内科学]