三维能量多普勒超声血管成像在甲状腺结节良恶性诊断中的应用价值

背景与目的：三维能量多普勒超声血管成像(three-dimensional power Doppler angiography，3D-PDA)是一种新的血流成像技术，但在甲状腺领域的研究尚不多见。该研究观察甲状腺结节的3D-PDA特征，探讨3D-PDA对甲状腺良恶性结节的鉴别诊断价值。方法：采用3D-PDA对甲状腺结节及周边血流进行三维重建。分析血流分布、血管数量、血管走行是否规则、空间分布是否对称、结节内是否存在局限性血流丰富及周边实质是否存在局限性血流丰富。分析甲状腺结节的3D-PDA特征，比较良恶性结节之间的差异。结果：在103个甲状腺结节中，良性50个(48.5%)，恶性53个(51.5%)。在3D-PDA中，血管走行不规则、空间分布不对称、结节内局限性血流丰富及周边实质局限性血流丰富诊断甲状腺恶性结节的灵敏度分别为64.2%、56.0%、54.7%和60.4%，特异度分别为96.0%、88.0%、96.0%和94.0%。3D-PDA诊断甲状腺恶性结节的灵敏度、特异度、阳性预测值、阴性预测值和准确率分别为83.0%、94.0%、93.6%、83.9%和90.3%。结论：3D-PDA可以更好地观察甲状腺结节的血流分布及走行情况，对甲状腺结节的诊断有重要意义。

The value of three-dimensional Doppler angiography in the differentiation of benign and malignant thyroid nodules

Background and purpose:Three-dimensional power Doppler angiography (3D-PDA) is a new technique to investigate the vessels in the organs, but the research in thyroid is limited. The purpose of this research was to investigate three-dimensional power Doppler angiography (3D-PDA) in differentiating malignant from benign thyroid nod-ules.Methods:This study prospectively evaluated 103 lesions in 94 patients who were scheduled for surgery. The patients underwent preoperative 3D-PDA scanning. Analysis of the 3D-PDA characteristics includes blood flow pattern, the num-ber of blood vessels, the shape of vessels, the spatial distribution of the vessels, the existence of rich local blood flow within nodules or in the parenchyma surrounding the nodules. This study also analyzed the difference between the benign lesions and the malignant lesions.Results:There were 50 benign lesions and 53 malignant lesions. The sensitivity and specificity of irregular vessels, the asymmetry spatial distribution, rich local blood flow within nodules or in the parenchyma surround-ing the nodules were 64.2%, 96.0%; 56.0%, 88.0%; 54.7%, 96.0%; 60.4% and 94.0%, respectively. The sensitivity, speci-ficity, positive predictive value, negative predictive value and accuracy of 3D-PDA were 83.0%, 94.0%, 93.6%, 83.9% and 90.3%, respectively.Conclusion:3D-PDA provides a useful tool to investigate vascularization of thyroid leisions.This technique is feasible for clinical application and plays an important role in diagnosis of thyroid nodules.