超声造影联合VueBox软件定量分析对TI-RADS 4~5类甲状腺结节良恶性的鉴别诊断价值  

Value of contrast-enhanced ultrasound combined with VueBox software quantitative analysis to the differential diagnosis of thyroid TI-RADS 4to 5benign and malignant nodules

作　　者：陈阿倩 姜珏[1] 王娟[1] 何鑫[1] 梁汝娜 袁欣 王莎莎 张洁[1] 王理蓉 周琦[1] CHEN A-qian;JIANG Jue;WANG Juan;HE Xin;LIANG Ru-na;YUAN Xin;WANG Sha-sha;ZHANG Jie;WANG Li-rong;ZHOU Qi(Department of Ultrasound,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi 710004,China)

机构地区：[1]西安交通大学第二附属医院超声研究室,陕西西安710004

出　　处：《中华实用诊断与治疗杂志》2022年第10期1055-1059,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：陕西省重点研发计划一般项目(2021SF-346);国家自然科学基金面上项目(81871366)。

摘　　要：目的应用VueBox软件对甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)4~5类甲状腺结节患者超声造影动态图进行定量分析,探讨其对甲状腺结节良恶性的鉴别诊断价值。方法甲状腺TI-RADS 4~5类结节患者219例(232个结节),均行细针穿刺或手术切除标本组织病理检查,根据组织病理检查结果分为恶性组144例(145个结节)和良性组75例(87个结节)。2组患者均行常规超声及超声造影检查,比较2组常规超声声像图特征;应用VueBox软件对结节超声造影动态图进行定量分析,获得时间-强度曲线及12个血流灌注参数,比较2组血流灌注参数。绘制ROC曲线,评估超声造影血流灌注参数鉴别诊断TI-RADS 4~5类甲状腺结节良恶性的效能。结果恶性组结节边界不清、有血流信号比率(78.6%、44.1%)均高于良性组结节(63.2%、31.0%)(χ2=6.521,P=0.011;χ2=3.916,P=0.048),回声、纵横比、钙化情况与良性组结节比较差异均无统计学意义(P>0.05)。恶性组结节平均信号强度[(772.40±72.05)a.u.]、峰值强度[(1542.21±137.04)a.u.]、流入相比率[(409.86±43.67)a.u.]、流入相灌注指数[(983.67±87.44)a.u.]、流出相比率[(175.26±23.19)a.u.]、流入相曲线下面积[(6415.85±672.03)a.u.]、流出相曲线下面积[(15257.00±2173.67)a.u.]、流入相和流出相曲线下面积[(21672.85±2770.23)a.u.]均小于良性组结节[(1671.88±210.51)、(3559.76±487.68)、(1131.74±217.35)、(2303.52±314.31)、(501.30±127.28)、(15761.33±2420.69)、(38058.94±6308.57)、(52981.19±8503.09)a.u.](P<0.05),上升时间、平均渡越时间、达峰时间、下降时间与良性组结节比较差异均无统计学意义(P>0.05)。流入相比率、流出相比率以696.8、263.8a.u.为最佳截断值,鉴别诊断TI-RADS 4~5类甲状腺结节良恶性的AUC分别为0.874(95%CI:0.826~0.922,P<0.001)、0.888(95%CI:0.839~0.938,P<0.001),灵敏度分别为84.6%、95.9%,特异度分别为72.8%、68.5%。结论VueBox软Objective To quantitatively analyze the contrast-enhanced ultrasound(CEUS) dynamic images of patients with Thyroid Imaging Reporting and Data System(TI-RADS) 4-5 nodules using VueBox software, and to investigate the differential diagnostic value for benign and malignant thyroid nodules. Methods Totally 232 nodules in 219 patients with TI-RADS 4-5 nodules underwent histopathological examination by fine needle aspiration or surgical excision, and were divided into 87 nodules in 75 patients(benign group) and 145 nodules in 144 patients(malignant group) according to the histopathological examination results. Both two groups underwent conventional ultrasound and CEUS, and the sonographic characteristics of conventional ultrasound were compared between two groups. VueBox software was applied to quantify the ultrasonographic dynamic maps of the nodules, the optimized time-intensity curve and 12 quantitative parameters of blood perfusion were obtained, and the perfusion parameters were compared between two groups. ROC curves were plotted to assess the efficiency of perfusion parameters on the differential diagnosis of thyroid TI-RADS 4-5 benign and malignant nodules. Results The rates of nodules with indistinct borders and blood flow signals were higher in malignant group(78.6%, 44.1%) than those in benign group(63.2%, 31.0%)(χ^(2)=6.521, P=0.011;χ^(2)=3.916, P=0.048), and there were no significant differences in the echogenicity, aspect ratio and calcification between two groups(P>0.05).The mean signal intensity [(772.40±72.05)a.u.],peak enhancement [(1 542.21±137.04)a.u.],wash-in rate(WiR)[(409.86±43.67)a.u.],WiP index [(983.67±87.44)a.u.],wash-out rate(WoR)[(175.26±23.19)a.u.],wash-in area under the curve[(6 415.85±672.03)a.u.],wash-out area under the curve[(15 257.00±2 173.67)a.u.],and wash-in and wash-out area under the curve[(21 672.85±2 770.23)a.u.]in malignant group were lower than those in benign group [(1 671.88 ± 210.51),(3 559.76 ± 487.68),(1 131.74±217.35),(2 303.52±314.31),(501.30±127.28),(15

关 键 词：甲状腺结节 超声造影 血流灌注参数 VueBox软件 甲状腺影像报告和数据系统 

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] R736.1[医药卫生—临床医学]