超声造影联合超声实时组织弹性成像在甲状腺良恶性结节诊断中的应用价值

目的：评价超声造影联合超声实时组织弹性成像（RTE ）在甲状腺良恶性结节诊断中的应用价值。方法分析85例甲状腺结节患者的超声造影和RTE的图像信息并与病理活组织检查（活检）相对比，评估单用两种方法及联合使用两种方法诊断的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率。结果85个甲状腺结节中，病理活检证实恶性病灶48个，良性病灶37个。恶性结节在注射造影剂后以不均匀低增强为主，早于周边甲状腺组织消退。良性结节则以弥散性等增强或高增强为主，晚于周围腺体廓清。超声造影的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为91.67％、81.08％、91.67％、81.08％、87.06％；RTE 则分别为87.50％、83.78％、87.50％、83.78％、85.89％；两者联合诊断的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率分别为97.92％、86.49％、90.38％、96.97％、92.94％。超声造影联合 RTE 灵敏度、特异度、阴性预测值及诊断符合率比单用超声造影或RTE高（均P＜0.05）。结论超声造影联合RTE可提高甲状腺良恶性结节诊断的准确性。

Value of contrast-enhanced ultrasound combined with ultrasound real-time elastography in diagnosis of thyroid malignant and benign nodules

Objective To evaluate contrast-enhanced ultrasound （CEUS）combined with real-time ultrasound elastography （RTE ）in diagnosing benign and malignant thyroid nodules. Methods Eighty-five thyroid nodules were evaluated by CEUS and RTE. Two methods were compared with biopsy,the sensitivity, specificity,positive predictive value,negative predictive value and diagnostic coincidence rate were calculated.Results All these thyroid nodules included 48 malignant lesions and 37 benign lesions which were confirmed by biopsy. Malignant nodules were tend to show heterogeneous low-enhancement after the injection of contrast agent,receded earlier than the surrounding thyroid tissue. Majority of the benign nodules exhibited diffuse isoenhancement or hyperenhancement,cleared later than the surrounding glands. The sensitivity,specific de-gree,positive predictive value, negative predictive value and diagnostic coincidence rate of CEUS were 91.67%,81.08%, 91.67%, 81.08% and 87.06%;and those of RTE were 87.50%, 83.78%, 87.50%,83.78% and 85.89%;and those of CEUS combined with RTE were 97.92%, 86.49%, 90.38%,96.97% and 92.94%. The sensitivity,specific degree,negative predictive value and diagnostic coincidence rate of CEUS combined with RTE were higher than those of CEUS or RTE （P＆lt;0.05 ）. Conclu-sions Contrast-enhanced ultrasound combined with elasticity imaging technology can improve the diagnosis of benign and malignant thyroid nodules.