平面波超微细敏感血流显像鉴别诊断甲状腺皱缩结节与甲状腺乳头状癌的临床价值  

Clinical value of angio plus planwave ultrasensitive imaging in the differential diagnosis of mummified thyroid nodules and papillary carcinomas

作　　者：王理萍 陈晓波[2] WANG Liping;CHEN Xiaobo(Department of Ultrasound,Xiangzhou District People’s Hospital of Zhuhai,Guangdong 519000,China)

机构地区：[1]广东省珠海市香洲区人民医院超声科,519000 [2]中山大学附属第五医院超声科

出　　处：《临床超声医学杂志》2024年第5期414-419,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的 应用平面波超微细敏感血流显像(AP)校正2020甲状腺结节超声恶性危险分层中国指南(C-TIRADS)分类,探讨其在鉴别诊断甲状腺皱缩结节(MTN)与甲状腺乳头状癌(PTC)中的临床应用价值。方法 选取在我院及中山大学附属第五医院经细针穿刺活检或手术病理证实的甲状腺结节患者234例,其中MTN 112例,PTC122例,均为单发病灶,比较二者二维超声图像特征和AP血流分级;绘制受试者工作特征(ROC)曲线分析AP校正前、后C-TIRADS分类鉴别MTN与PTC的诊断效能。结果 MTN与PTC在极低回声、垂直位、彗星尾伪像、AP血流分级比较差异均有统计学意义(均P<0.05),其中MTN的AP血流分级以0、Ⅰ级为主,PTC以Ⅱ、Ⅲ级为主;二者在结节最大径、实性、边缘模糊/甲状腺外扩展、可疑微钙化、CDFI血流分级方面比较差异均无统计学意义。112个MTN中,C-TIRADS 4A类17个,4B类45个,4C类49个,5类1个,AP校正后C-TIRADS 3类11个,4A类31个,4B类65个,4C类4个,5类1个;122个PTC中,C-TIRADS 4A类13个,4B类41个,4C类61个,5类7个,AP校正后C-TIRADS 4A类3个,4B类15个,4C类44个,5类60个。AP校正前、后C-TIRADS分类鉴别诊断MTN与PTC的灵敏度、特异度、准确率、阳性预测值、阴性预测值及曲线下面积分别为55.74%、55.36%、55.56%、57.63%、53.45%、0.570和85.25%、95.54%、90.17%、95.41%、85.60%、0.928,差异均有统计学意义(均P<0.05)。AP校正后C-TIRADS分类鉴别诊断最大径<10 mm和最大径≥10 mm MTN与PTC的灵敏度、特异度、准确率、阳性预测值、阴性预测值及曲线下面积分别为98.51%、83.15%、89.74%、81.48%、98.67%、0.927和88.37%、91.43%、89.74%、92.68%、86.49%、0.926,均高于校正前(52.75%、49.23%、51.28%、60.00%、42.67%、0.522和74.07%、58.82%、64.10%、48.78%、81.08%、0.675);除AP校正前、后C-TIRADS分类对最大径≥10 mm结节的诊断灵敏度和阴性预测值比较差异均无统计学意义外,其余诊断效能比较差异均�Objective To correct the classification of 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules(C-TIRADS)by angio plus planwave ultrasensitive imaging(AP),and to investigate the clinical value in the differential diagnosis of mummified thyroid nodules(MTN)and papillary thyroid carcinomas(PTC).Methods A total of 234 patients with thyroid nodules confirmed by fine needle aspiration or surgical pathology in our hospital and the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively selected,all of which were single lesions,including 112 cases of MTN and 122 cases of PTC,and the two-dimensional ultrasound characteristics and AP blood flow grading were compared.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of C-TIRADS classification for distinguishing MTN and PTC before and after AP correction.Results There were statistically significant differences in markedly hypoechoic,vertical orientation,comet-tail artifacts and AP blood flow grading between the MTN and PTC(all P<0.05),and the AP blood flow grading of MTN was mainly grades 0,Ⅰ,while that of PTC was mainly gradesⅡ,Ⅲ.There were no significant differences in maximum nodule diameter,solid,ill-defined margin/extrathyroidal extension,suspected microcalcifications and CDFI blood flow grading between the MTN and PTC.Among the 112 MTN,there were 17 nodules in C-TIRADS 4A,45 nodules in C-TIRADS 4B,49 nodules in C-TIRADS 4C,and 1 nodule in C-TIRADS 5.After AP correction,there were 11 nodules in C-TIRADS 3,31 nodules in C-TIRADS 4A,65 nodules in C-TIRADS 4B,4 nodules in C-TIRADS 4C,and 1 nodule in C-TIRADS 5.Among the 122 PTC,there were 13 nodules in C-TIRADS 4A,41 nodules in C-TIRADS 4B,61 nodules in C-TIRADS 4C,and 7 nodules in C-TIRADS 5.After AP correction,there were 3 nodules in C-TIRADS 4A,15 nodules in C-TIRADS 4B,44 nodules in C-TIRADS 4C,and 60 nodules in C-TIRADS 5.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and area un

关 键 词：超声检查 C-TIRADS 平面波超微细敏感血流显像技术 甲状腺皱缩结节 甲状腺乳头状癌 

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