动态超声造影定量分析技术对甲状腺微小结节良恶性的诊断价值  

Value of Dynamic Contrast-Enhanced Ultrasound Quantitative Analysis in Differential Diagnosis of Small Thyroid Nodules

作　　者：曹司琪 黄韵琳 程娟[1] 王胜桥 王颖[1] 董怡 王文平 CAO Siqi;HUANG Yunlin;CHENG Juan;WANG Shengqiao;WANG Ying;DONG Yi;WANG Wenping(Department of Ultrasound,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Ultrasound,Zhongshan Hospital,Fudan University)

机构地区：[1]上海交通大学医学院附属新华医院超声科,上海市200092 [2]复旦大学附属中山医院超声科

出　　处：《中国医学计算机成像杂志》2024年第3期376-380,共5页Chinese Computed Medical Imaging

摘　　要：目的:对甲状腺微小结节(最大径≤1 cm)进行动态超声造影(DCE-US)定量分析,评估其对甲状腺微小结节良恶性的诊断价值。方法:回顾性分析2021年10月至2023年4月收集的经手术或穿刺病理证实的甲状腺微小结节(最大径≤1 cm)患者的常规超声和超声造影(CEUS)图像,应用VueBox软件(Bracco,意大利,7.0版本)对甲状腺结节CEUS DICOM动态图像进行定量分析,获得时间-强度曲线(TICs),经曲线拟合后得到超声造影定量参数。应用受试者工作特征(ROC)曲线评估DCE-US定量参数对甲状腺微小结节良恶性的诊断效能。结果:在最终纳入研究的55例甲状腺结节中,37例(67%)为甲状腺乳头状癌(PTC)和18例(33%)为良性结节,包括1例炎性结节,12例桥本甲状腺炎结节,5例结节性甲状腺肿。常规CEUS显示,62%(23/37)的恶性结节在动脉期呈等增强,生成的TIC曲线形态对比,甲状腺恶性结节TIC曲线表现为动脉期上升较缓慢,峰值强度(PE)较低,曲线下面积较小。经过曲线拟合后,DCE-US定量参数中,甲状腺恶性微小结节的PE、曲线上升支斜率(WiR)、曲线下降支斜率(WoR)显著低于良性结节(P≤0.01)。以定量参数PE、WiR及WoR预测甲状腺微小结节良恶性的ROC曲线下面积分别为0.847、0.857、0.732(P≤0.01)。结论:通过动态超声造影定量显示甲状腺微小结节内部的微循环灌注的差异,有助于术前无创诊断甲状腺微小结节的良恶性。Purpose:To explore the potential value of dynamic contrast enhanced ultrasound(DCE-US)and quantitative parameters for preoperative diagnosis of small solid thyroid nodules(maximum diameter≤1.0 cm).Methods:From October 2021 to April 2023,thyroid nodules(maximum diameter≤1 cm)which were proved by biopsy/operation and histopathological results were included in this retrospective study.Both B mode ultrasound and contrast enhanced ultrasound(CEUS)images were reviewed and recorded.The CEUS DICOM cine loops of thyroid nodules were quantitatively analyzed using VueBox?software(Bracco,Italy,version 7.0).The time-intensity curves(TICs)were created.The DCE-US quantitative parameters were obtained after curve fitting.The diagnostic efficiency of the diagnostic performance of DCE-US quantitative parameters was evaluated using receiver operating characteristic(ROC)curve analysis.Results:Among the 55 thyroid nodules,37(67%)were papillary thyroid carcinoma(PTC)and 18(33%)were benign lesions.The benign nodules included 1 inflammatory nodule,12 Hashimotos thyroiditis,and 5 nodular goiters.Among the 37 PTC,23(62%)showed iso-enhancement during the arterial phase of CEUS.The TIC of malignant lesions showed relatively slow and lower enhancement during the arterial phase,with decreased area under the curve while comparing to benign ones.Among all DCE-US quantitative parameters,the peak enhancement(PE),wash-in rate(WiR),and wash-out rate(WoR)in malignancies were significantly lower than those in benign nodules(P≤0.01,respectively).The area under the ROC curve(AUC)of PE,WiR,and WoR were 0.847,0.857,0.732(P≤0.01)in differentiation between benign and malignant small solid thyroid nodules(≤1.0 cm).Conclusion:The difference of microvascularization perfusion of small solid thyroid nodules(≤1.0cm)was quantitatively showed by DCE-US,which provide added values for preoperatively differential diagnosis of small solid thyroid nodules(≤1.0 cm).

关 键 词：甲状腺结节 超声造影 动态超声造影定量分析 诊断 时间-强度曲线 

分 类 号：R445.1[医药卫生—影像医学与核医学]