超声PSV、PI、RI对甲状腺癌淋巴结转移的预测价值研究  

Value of peak systolic velocity and pulsatility index and resistance index in predicting lymph node metastasis of thyroid cancer

作　　者：赵凤群 易展雄 阎静 张颖[1] 尉建安 ZHAO Fengqun;YI Zhanxiong;YAN Jing(Department of Ultrasound,Beijing Friendship Hospital,Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京友谊医院超声科,北京市101100 [2]首都医科大学附属北京友谊医院放射介入科,北京市101100

出　　处：《河北医药》2024年第21期3268-3271,共4页Hebei Medical Journal

摘　　要：目的分析超声收缩期峰值流速(PSV)、搏动指数(PI)、阻力指数(RI)对甲状腺癌淋巴结转移的预测价值。方法选择2020年9月至2023年9月就诊的114例甲状腺癌患者设为试验组,另选取同期体检中心114例健康体检者设为健康组,均给予彩色多普勒超声检查,比较2组PSV、PI、RI,比较甲状腺癌患者中有无淋巴结转移、PSV、PI、RI、血流信号分级、超声特征,绘制受试者工作曲线(ROC),分析PSV、PI、RI对淋巴结转移的预测效能。结果试验组PSV高于健康组(P<0.05),试验组PI、RI均低于健康组(P<0.05)。淋巴结转移组PSV高于无淋巴结转移组(P<0.05),淋巴结转移组PI、RI均低于无淋巴结转移组(P<0.05)。淋巴结转移组血流信号分级以2级、3级为主,分别占54.17%、29.17%,无淋巴结转移组血流信号分级以0级、1级为主,分别占25.56%、55.56%,淋巴结转移组、无淋巴结转移组血流信号分级比较,差异有统计学意义(P<0.05)。淋巴结转移组血流信号杂乱(66.67%)、血流丰富(83.33%)、微钙化(50.00%)、边界不清(45.83%)、内部回声不均(58.33%)、L/S<2率(54.17%)均高于无淋巴结转移组[(40.00%)、(44.44%)、(24.44%)、(22.22%)、(32.22%)、(22.22%)],差异有统计学意义(P<0.05)。PSV最佳截断值取17.82 cm/s,PI最佳截断值取1.31,RI最佳截断值取1.29,PSV、PI、RI联合预测淋巴结转移的曲线下面积(AUC)是0.855,95%CI置信区间是0.814~0.957,PSV、PI、RI联合检测灵敏度(94.62%)高于单一检测(78.96%、76.36%、73.82%)(P<0.05),PSV、PI、RI联合检测特异度(84.13%)与单一检测(78.64%、80.18%、76.07%)比较,差异无统计学意义(P>0.05)。结论甲状腺癌患者PSV、PI、RI相对高于正常人,且PSV、PI、RI增高与淋巴结转移存在一定的关系,联合检测PSV、PI、RI,可提高对淋巴结转移的预测灵敏度。Objective To analyze the value of peak systolic velocity(PSV),pulsatility index(PI)and resistance index(RI)in predicting lymph node metastasis(LNM)of thyroid cancer(TC).Methods One hundred and fourteen TC patients treated from September 2020 to September 2023 were selected as the experimental group,and 114 health examination subjects during the same period were selected as the healthy group.All of them were managed by color Doppler ultrasonography,aiming to compare PSV,PI and RI.Meanwhile,the comparisons of PSV,PI,RI,blood flow grading and ultrasound features in TC patients with LNM(LNM group)or without LNM(non-LNM group)were conducted.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of PSV,PI and RI for LNM.Results The experimental group presented significantly higher PSV,and lower PI and RI than the healthy group(all P<0.05).LNM group had significantly higher PSV,and lower PI and RI than the non-LNM group(all P<0.05).The blood flow grading in the LNM group was mainly grade 2 and grade 3,while that in the non-LNM group was mainly grade 0 and grade 1,and with statistically significant difference between groups(P<0.05).The proportions of patients with chaotic blood signals(66.67%vs 40.00%),rich blood flow(83.33%vs 44.44%),micro calcification(50.00%vs 24.44%),unclear border(45.83%vs 22.22%),uneven internal echo(58.33%vs 32.22%),lymph node(LN)long-to-short diameter(L/S)ratio<2(54.17%vs 22.22%)in the LNM group were significantly higher than those in the non-LNM group(P<0.05).The optimal cut-off value of PSV,PI and RI was 17.82cm/s,1.31 and 1.29,respectively.The area under the curve(AUC)of combination of PSV,PI,and RI in predicting LNM was 0.855[95%confidence interval(CI:0.814-0.957)].The sensitivity of combined detection of PSV,PI and RI was significantly higher than that of single detection(94.62%vs 78.96%,76.36%,73.82%,P<0.05).The specificity of combined detection of PSV,PI and RI was comparable to that of single detection(84.13%vs 78.64%,80.18%,76.07%,P>0.05).Conclusion TC p

关 键 词：彩色多普勒超声 收缩期峰值流速 搏动指数 阻力指数 甲状腺癌 淋巴结转移 

分 类 号：R445.14[医药卫生—影像医学与核医学]