CT影像特征联合C-TIRADS分类、超微细血流显像鉴别甲状腺结节良恶性的价值分析  

Analysis of the Value of CT Imaging Features Combined with C-TIRADS Classification and Microvascular Imaging in Differentiating the Benign and Malignant Characteristics of Thyroid Nodules

作　　者：马炎[1] 许文哲 赵玮 霍晓光[1] MA Yan;XU Wenzhe;ZHAO Wei(Ultrasound Department,Zibo City Central Hospital,Zibo City,Shandong Province 255000,P.R.China)

机构地区：[1]淄博市中心医院超声科,255000

出　　处：《临床放射学杂志》2025年第3期423-428,共6页Journal of Clinical Radiology

基　　金：淄博市医药卫生科研项目(编号:20230902083);山东省医药卫生科技项目(编号:202309030858)。

摘　　要：目的探讨CT影像特征联合中国超声甲状腺影像报告和数据系统(C-TIRADS)分类、超微细血流显像(SMI)鉴别甲状腺结节良恶性的应用价值。方法回顾性搜集2023年1月至2024年1月于淄博市中心医院检查发现甲状腺结节的178例患者。所有患者均行颈部CT、常规超声、SMI检查。比较良恶性甲状腺结节的CT影像特征、超声C-TIRADS分类结果、超声影像特征、SMI的Adler血流信号分级分布和血流形态分级分布;Logistic回归分析CT影像特征、超声影像特征与甲状腺结节良恶性鉴别的关系;计算并比较CT影像特征、超声C-TIRADS分类和SMI分级对甲状腺结节良恶性的诊断效能。结果良性组的形态规则、边界清晰、粗颗粒钙化、包膜完整、结节位于腺体内、均匀强化、囊实性检出率高于恶性组,纵横比≥1、钙化、低回声检出率低于恶性组;良性组4B以上分类的甲状腺结节少于恶性组;良性组的2~3级血流信号比例和Ⅲ~Ⅳ级血流形态比例低于恶性组;Logistic回归分析显示形态、边界、钙化程度、包膜完整度、结节位置是CT鉴别甲状腺结节良恶性的独立影响因素,边界、纵横比、钙化程度、回声、囊性变是超声鉴别甲状腺结节良恶性的独立影响因素;CT单独检查敏感度较低,特异度较高,其准确率、阳性预测值与C-TIRADS、SMI相当,C-TIRADS和SMI单独检查均具有较高的敏感度,但特异度、准确率、阳性预测值均低于三者联合检测(均P<0.05)。结论相较于CT、C-TIRADS分类和SMI单独应用,三者联合可提高对甲状腺良恶性结节诊断的敏感度、特异度和准确率,其诊断效能最佳。Objective To explore the application value of CT imaging features combined with the Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)classification and Superb Microvascular Imaging(SMI)in differentiating between the benign and malignant nature of thyroid nodules.Methods A retrospective collection of 178 patients with thyroid nodules discovered during examinations at Zibo City Central Hospital from January 2023 to January 2024.All patients underwent CT,conventional ultrasound,and SMI examinations.The CT imaging features,ultrasound C-TIRADS classification results,ultrasound imaging features,the distribution of Adler blood flow signal grades in SMI,and the distribution of blood flow morphology grades were compared between benign and malignant thyroid nodules.Logistic regression analysis was performed to assess the relationship between CT imaging features and ultrasound imaging features in differentiating the nature of thyroid nodules.The diagnostic efficacy of CT imaging features,ultrasound C-TIRADS classification,and SMI grading was calculated and compared.Results The benign group displayed regular morphology,clear boundaries,coarse granular calcification,intact capsule,nodules located within the gland,homogeneous enhancement,and a higher rate of cystic-solid detection compared to the malignant group.The ratio of aspect ratio≥1,calcification,and low echo detection rates was lower in benign nodules.The number of benign nodules classified as 4B or above was fewer than that of malignant nodules.The proportion of grade 2-3 blood flow signals andⅢ-Ⅳgrade blood flow morphology was lower in the benign group compared to the malignant group.Logistic regression analysis showed that morphology,boundaries,degree of calcification,capsule integrity,and nodular location were independent influencing factors for differentiating benign and malignant thyroid nodules via CT.For ultrasound,boundaries,aspect ratio,degree of calcification,echogenicity,and cystic changes were independent influencing factors.CT alone had lo

关 键 词：甲状腺结节 CT影像 C-TIRADS指南 超微细血流显像 预测价值 

分 类 号：R736.1[医药卫生—肿瘤] R730.44[医药卫生—临床医学]