基于多模态超声对cTI-RADS4类甲状腺结节的诊断研究  

Diagnostic Study of cTI-RADS Category 4 Thyroid Nodules Basedon Multimodal Ultrasound

作　　者：刘秀娟 蔡金华 廖立娟 Liu Xiujuan(Department of Ultrasound,Affiliated Hospital of Jinggangshan University,Ji’an City,Jiangxi Province,Ji’an Jiangxi 343000)

机构地区：[1]江西省吉安市井冈山大学附属医院超声科,江西吉安343000 [2]安福县人民医院普外科,江西吉安343200

出　　处：《黑龙江医药》2025年第1期4-8,共5页Heilongjiang Medicine journal

基　　金：江西省卫生健康委科技计划(编号:202410380)。

摘　　要：目的:探讨基于多模态超声对cTI-RADS4类甲状腺结节(TN)的诊断价值。方法:选取井冈山大学附属医院2023年1月至2024年6月收治的TI-RADS 4类TN患者80例(90个结节),均接受常规超声(US)、超声造影(CEUS)、剪切波弹性成像(SWE)和超微血管成像(SMI)检查,以最终经穿刺活检或术后病理结果为准,比较良、恶性TN超声影像学特征及CEUS、SWE、SMI参数差异,分析绘制受试者工作特征(ROC)曲线,分析US、CEUS、SWE、SMI诊断cTI-RADS 4类甲状腺结节的价值。结果:90个结节经病理检查证实为恶性结节58个(64.44%),良性结节32个(35.56%);恶性结节纵横比≥1、边界不清、有钙化和血流信号比例高于良性结节,有统计学差异(P<0.05);恶性结节CEUS的PEAK、TP、MTTc和SMI的微血流评分、微血管穿支数目均低于良性结节,SWE的E-mean、E-max、E-min均高于良性结节,有统计学差异(P<0.05);US、CEUS、SWE、SMI联合诊断cTI-RADS4类TN的曲线下面积(AUC)为0.903,灵敏度为0.931,约登指数化为0.806,均高于单一检测。结论:基于多模态超声诊断cTI-RADS4类TN能够提高诊断准确性。Objective:To explore the diagnostic value of multimodal ultrasound in cTI-RADS category 4 thyroid nodules(TN).Methods:We selected 80 patients(90 nodules)with cTI-RADS category 4 TN admitted to our hospital from January 2023 to June 2024.All patients underwent conventional ultrasound(US),contrast-enhanced ultrasound(CEUS),shear wave elastography(SWE),and super microvascular imaging(SMI)examinations.The final diagnosis was based on puncture biopsy or postoperative pathological results.We compared the ultrasonic imaging characteristics and CEUS,SWE,SMI parameter differences between benign and malignant TNs,analyzed and plotted the receiver operating characteristic(ROC)curve,and evaluated the diagnostic value of US,CEUS,SWE,and SMI in diagnosing cTI-RADS category 4 TN.Results:Among the 90 nodules,58(64.44%)were confirmed as malignant nodules and 32(35.56%)as benign nodules by pathological examination.Malignant nodules had a higher proportion of having an aspect ratio≥1,unclear boundaries,calcification,and blood flow signals compared to benign nodules.There is a statistical difference(P<0.05).The peak intensity(PEAK),time-to-peak(TP),mean time to decay(MTTc)of CEUS,and microvascular scoring and number of perforating vessels of SMI were lower in malignant nodules than in benign nodules,while the elastic mean(E-mean),elastic maximum(E-max),and elastic minimum(E-min)of SWE were higher in malignant nodules than in benign nodules.There is a statistical difference(P<0.05).The area under the curve(AUC)of the combined diagnosis of US,CEUS,SWE,and SMI for cTI-RADS category 4 TN was 0.903,with a sensitivity of 0.931 and a Youden’s index of 0.806,both higher than those of single detection.Conclusion:Multi modal ultrasound based diagnosis of cTI-RADS class 4 TN can improve diagnostic accuracy.

关 键 词：甲状腺结节 cTI-RADS 4类 常规超声 超声造影 剪切波弹性成像 超微血管成像(SMI) 

分 类 号：R581[医药卫生—内分泌] R445.1[医药卫生—内科学]