舒张期血流消失或反向在良恶性甲状腺结节鉴别中的应用价值探讨  

Discussion on the Application Value of the Differentiation of Benign and Malignant Thyroid Nodules

作　　者：陈松丽 李志强 周爱云[1] 张妍 戚琪 黄幸芝 徐盼[1] Chen Songli;Li Zhiqiang;Zhou Aiyun;Zhang Yan;Qi Qi;Huang Xingzhi;Xu Pan(Department of Ultrasound,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Ultrasound,Yichun People's Hospital,Yichun 336000,China;Department of Ultrasound,Hashan Hospital Affiliated to Fudan University,Shanghai 200032,China)

机构地区：[1]南昌大学第一附属医院超声科,南昌市330006 [2]宜春市人民医院超声科,宜春市336000 [3]复旦大学附属华山医院超声科,上海市200032

出　　处：《中国超声医学杂志》2022年第2期137-141,共5页Chinese Journal of Ultrasound in Medicine

基　　金：江西省重点研发计划(No.20181BBG70031)。

摘　　要：目的拟探讨结节内出现舒张期血流消失(ADF)或反向(RDF)在鉴别甲状腺结节良恶性中的诊断价值。方法共纳入153例结节,良性88例,恶性65例。记录两组二维超声及多普勒超声特征并测量阻力指数(RI),计算ADF及RDF的诊断特异度,并将ADF及RDF分别加入美国放射学会超声甲状腺影像报告和数据系统(ACR-TIRADS)和中国超声甲状腺影像报告和数据系统(C-TIRADS)分类系统中,比较加入指标后两个分类系统的诊断稳定性。结果ADF及RDF在恶性结节的比例更高(P=0.017)。RDF的特异度为0.977%,ADF的特异度为0.920%。未加入指标前C-TIRADS及ACR-TIRADS诊断良恶性曲线下面积(AUC)分别为0.851、0.897,两者有统计学意义(P=0.019)。无论ADF或RDF,新的C-TIRADS及ACR-TIRADS诊断效能无明显下降(P>0.05),且C-TIRADS效能仍然高于ACR-TIRADS(P<0.05)。结论ADF或RDF在鉴别甲状腺结节良恶性中具有很高的特异度,并且ADF或RDF不影响ACR TIRADS或C-TIRADS的诊断效能。ADF或RDF可以作为诊断恶性甲状腺结节的辅助指标。Objective This study intends to explore the differential diagnosis value of reversed diastolic flow(RDF)and absent diastolic flow(ADF)in benign and malignant thyroid nodules.Methods A total of 153 cases of nodules were included in this study,88 cases were benign and 65 cases were malignant.The two-dimensional ultrasound and Doppler ultrasound characteristics of two groups were recorded and the resistance index(RI)was measured,and the diagnostic specificity of ADF and RDF was calculated.ADF and RDF were added to the ACR-TIRADS(American College of Radiology Thyroid Imaging Reporting and Data System)and C-TIRADS(Chinese-TIRADS)classification systems,respectively,to compare the diagnostic stability of the two classification systems after parameters was added.Results ADF and RDF nodules had a higher possibility of malignant(P=0.017).The specificity of RDF was 0.977,and the specificity of ADF was 0.920.The area under the curve(AUC)of C-TIRADS and ACR-TIRADS for diagnosing benign and malignant was 0.851 and 0.897,respectively,and there was a statistical difference between the two systems(P=0.019).After ADF and RDF was added,whether ADF or RDF,the diagnostic performance of the new C-TIRADS and ACR-TIRADS did not decrease significantly(P>0.05),and the performance of C-TIRADS was still higher than that of ACR-TIRADS(P<0.05).Conclusions ADF and RDF have high specificity in differentiating benign and malignant thyroid nodules,and RI>1 and RI=1 do not affect the diagnostic efficiency of ACR TIRADS or C-TIRADS.ADF and RDF are used as auxiliary indicators for the diagnosis of malignant thyroid nodules.

关 键 词：甲状腺 鉴别诊断 多普勒超声 阻力指数 

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