超高速剪切波弹性成像对离体猪肝微波消融效果的评价研究

目的探讨超高速剪切波弹性成像(SSI)在评价离体猪肝微波消融效果的价值。方法于离体猪肝消融前后分别测量拟消融部位的杨氏模量值;消融结束即刻用二维超声和SSI测量消融灶最大横切面的左右径及前后径。消融结束后将最大横切面的消融灶标本行病理学检查。结果共制备20个消融灶,微波消融前后消融部位的杨氏模量值比较,差异有统计学意义(P0.01);微波消融术后二维超声及SSI测量消融灶最大横切面的左右径比较,差异有统计学意义(P0.01);SSI所测得前后径、左右径与消融灶大体标本测量值比较,差异无统计学意义。结论 SSI能够定量分析微波消融前后离体猪肝的硬度变化,有助于评估微波消融效果;SSI评价微波消融效果优于二维超声。     

实时剪切波弹性成像诊断甲状腺微小癌的临床应用价值

目的应用剪切波弹性成像测定甲状腺微小乳头状癌的杨氏模量值及实时剪切波速度值,探讨其在甲状腺微小癌诊断中的价值。方法对83例共134个甲状腺实性结节(最大径线均≤1 cm)进行检查,采用剪切波组织弹性成像技术测量剪切波速度最大值(V_(max))、平均值(V_(mean))及杨氏模量最大值(E_(max))、平均值(E_(mean)),以病理结果为诊断金标准,构建ROC曲线,评价SWE定量测值在甲状腺微小癌诊断方面的价值。结果恶性结节E_(max)为(45.07±10.68)kPa,E_(mean)为(30.66±8.16)kPa,V_(max)为(3.79±0.61)m/s,V_(mean)(3.13±0.45)m/s;良性结节E_(max)为(25.03±5.37)kPa,E_(mean)为(18.62±5.06)kPa,V_(max)为(2.87±0.31)m/s,V_(mean)为(2.45±0.37)m/s。甲状腺微小癌的E_(max)、E_(mean)、V_(max)、V_(mean)均高于甲状腺良性微小结节,差异均有统计学意义(E_(max) t=10.120、P<0.001,E_(mean) t=6.151、P<0.001,V_(max) t=7.895、P<0.001,V_(mean) t=1.687、P<0.001)。甲状腺微小结节以E_(max)=35 kPa为临界值时,诊断良恶性病变的敏感度为90.9%,特异度为98.2%;以E_(mean)=26 kPa为临界值,诊断良恶性病变的敏感度为79.7%,特异度为94.5%;以V_(max)=3.35 m/s为临界值时,诊断良恶性病变的敏感度为84.8%,特异度为96.4%;以V_(mean)=2.95 m/s为临界值时,诊断良恶性病变的敏感度为76.7%,特异度为94.5%。受试者工作特征曲线下面积分别为0.952、0.896、0.900、0.876(P<0.05)。结论通过剪切波弹性成像测定甲状腺微小结节的杨式模量值和实时剪切波速度值,有助于甲状腺微小癌的鉴别诊断。     

实时剪切波弹性成像和超声造影对BI-RADS 4类乳腺病变诊断效能的对比研究

目的比较实时剪切波弹性成像(SWE)与超声造影对乳腺BI-RADS 4类病变的诊断价值。方法对70例BI-RADS 4类乳腺病变患者(共72个乳腺病变)分别行SWE和超声造影检查,测量其最大弹性模量值(E_(max)),应用超声造影5分法对病灶进行评分。以手术及病理结果为金标准,构建受试者工作特征曲线,计算其曲线下面积(AUC)并比较两种方法的诊断效能。结果 41个乳腺良性病变的E_(max)值和超声造影评分分别为23.58 k Pa、(2.56±0.64)分;31个恶性病变的E_(max)值和超声造影评分分别为61.45 k Pa、(3.95±0.88)分,差异均有统计学意义(均P0.01)。E_(max)值和超声造影评分诊断BI-RADS 4类乳腺病变的AUC分别为0.840、0.754,差异无统计学意义。SWE对BI-RADS 4A类乳腺病变的诊断准确率为93.9%,高于超声造影(75.7%),差异有统计学意义(P0.05);对于BI-RADS 4B和4C类乳腺病变,两种检查方法诊断准确率比较差异均无统计学意义。结论 SWE和超声造影在乳腺BI-RADS 4类病变的良恶性鉴别诊断中均有较高的诊断价值,SWE对于BI-RADS 4A类病变具有更好的诊断价值。     

实时定量超声弹性成像技术检测肱二头肌横切面与纵切面弹性差异

目的研究声束平行于肌纤维(纵切面)和声束垂直于肌纤维(横切面)时肱二头肌的杨氏模量值差异。方法 141例男性志愿者,年龄16～34岁,平均22岁,均无上肢外伤史、重症肌无力、进行性肌营养不良、周期性瘫痪、代谢性肌病等病史。使用法国Supersonic Imagine公司的AixPlore型实时定量剪切波超声弹性成像超声诊断仪,L4-15线阵探头。探头平行于肱二头肌肌纤维(纵切面)和垂直于肱二头肌肌纤维(横切面)时分别测量肱二头肌杨氏模量值并进行比较。结果松弛状态下,肱二头肌纵切面杨氏模量值为(45.658±13.479)kPa,横切面杨氏模量值为(7.334±1.612)kPa,差异有统计学意义(P=0.0000);收缩状态下,肱二头肌纵切面杨氏模量值为(123.658±31.392)kPa,横切面杨氏模量值为(13.261±4.045)kPa,差异有统计学意义(P=0.0000)。结论肱二头肌纵切面杨氏模量值明显大于横切面杨氏模量值;肱二头肌弹性模量的各向异性,提示在检查心肌、肾脏等组织结构具有各向异性的脏器时,应注意到超声检查切面角度可能会影响其杨氏模量测量值大小;横切面检查和纵切面检查相结合也许能为疾病的诊断提供更多的信息和依据。     

剪切波弹性成像鉴别乳腺肿块性质的价值

目的探讨剪切波弹性成像(shear-wave elastography, SWE)定性、定量分析在乳腺肿块良、恶性鉴别诊断中的应用价值。方法乳腺肿块患者128例,依据穿刺活检组织病理分为乳腺癌组64例,良性组64例。2组均行超声检查,记录不同SWE图像分型患者乳腺癌比率;以组织病理为金标准,评估SWE图像分型诊断乳腺癌的效能;比较2组组织弹性杨氏模量最大值(E_(max))、均值(E_(mean))、最小值(E_(min));绘制ROC曲线,评估其诊断乳腺癌的效能。结果 SWE图像Ⅲ、Ⅳ型者乳腺癌比率(94.3%、93.3%)高于Ⅰ、Ⅱ型(0、12.0%)(P0.05),Ⅲ型与Ⅳ型、Ⅰ型与Ⅱ型者乳腺癌比率比较差异无统计学意义(P0.05)。与组织病理结果进行对照,SWE图像特征定性诊断乳腺癌的准确率为95.3%,灵敏度为95.3%,特异度为93.7%。乳腺癌组E_(max)值[(151.1±55.3)kPa]、E_(mean)值[(53.3±50.0)kPa]、E_(min)值[(49.1±40.8)kPa]均大于良性组[(36.3±32.2)、(26.6±12.6)、(11.1±9.0)kPa](P0.05)。ROC曲线分析结果显示,E_(max)以69.5 kPa为最佳截断值,诊断乳腺癌的AUC为0.965(95%CI:0.931～0.999,P0.001),准确率为93.8%,灵敏度为93.8%,特异度为96.9%。结论 SWE图像定性分析及E_(max)值定量分析在乳腺肿块性质的鉴别诊断中具有较高价值。     

剪切波弹性成像弹性模量值与乳腺癌临床病理及分子分型的关系

目的探讨超声剪切波弹性成像(SWE)弹性模量值与乳腺癌临床病理的关系,并分析SWE弹性模量值在不同分子分型乳腺癌中的差异。方法选取2018年10月—2020年12月收治的93例女性乳腺癌(112个病灶)为研究对象。术前均行SWE检查,记录各病灶的病理特征及弹性模量最大值(E_(max))和平均值(E_(mean))。Pearson相关性分析E_(max)和E_(mean)值与乳腺癌不同分子分型及临床病理的关系。结果病理类型以浸润性导管癌最多,占比77.68%(87/112);分子分型以Luminal A型病灶最多,占比41.96%(47/112);三阴性乳腺癌和人表皮生长因子受体-2(HER-2)过表达型病灶的E_(max)、E_(mean)值均高于Luminal A型(P0.05);不同组织学分级、肿瘤直径及HER-2表达乳腺癌病灶的E_(max)、E_(mean)值比较差异均有统计学意义(P0.05,P0.01)。E_(max)、E_(mean)值与分子分型、组织学分级、肿瘤直径、HER-2表达均呈显著正相关(P0.05,P0.01)。结论 SWE中E_(max)、E_(mean)值均随乳腺癌分子分型的升高而增大,且上述弹性模量值与病灶组织学分级、肿瘤直径及HER-2表达水平均有一定关联,临床可将E_(max)、E_(mean)值作为诊治乳腺癌的重要参考指标。     

剪切波弹性成像鉴别乳腺影像报告和数据系统(BI-RADS)4类乳腺肿块

目的探讨剪切波弹性成像(SWE)鉴别乳腺影像报告和数据系统(BI-RADS)4类乳腺肿块的价值。方法回顾性分析经术后病理证实的96个BI-RADS 4类乳腺肿块,比较良性(良性组,n=43)及恶性肿块(恶性组,n=53)剪切波参数,包括弹性最大值(SWE max)、最小值(SWE min)和平均值(SWE mean);以受试者工作特征(ROC)曲线确定SWE max、SWE min及SWE mean的截断值,比较其ROC曲线下面积(AUC)、敏感度、特异度和准确率,评价并比较SWE对BI-RADS 4a、4b及4c亚分类的诊断准确率。结果良性组SWE max和SWE mean均低于恶性组(P均<0.01),组间SWE min差异无统计学意义(P>0.05);SWE max、SWE mean的AUC分别为0.86、0.83,均高于SWE min的AUC(0.59,P均<0.01);SWE max诊断敏感度、特异度和准确率分别为96.23%、81.40%和89.58%,SWE mean分别为94.34%、76.74%和86.46%,均明显高于SWE min的34.00%、37.21%和35.42%(P均<0.01);SWE max和SWE mean的AUC及其诊断BI-RADS 4类乳腺良恶性肿块的敏感度、特异度、准确率差异均无统计学意义(P均>0.05)。SWE max和SWE mean对BI-RADS 4a、4b及4c乳腺肿块的诊断准确率明显高于SWE min(P<0.05)。结论BI-RADS 4类乳腺恶性肿块的SWE max和SWE mean均高于良性肿块。高频超声SWE可有效鉴别BI-RADS 4类乳腺良恶性肿块,SWE max和SWE mean的诊断效能优于SWE min。     

MRI、超声显像在乳腺良性结节微波消融治疗中的应用

目的探讨磁共振成像(magnetic resonance imaging,MRI)和超声(ultrasound,US)显像评价乳腺良性结节微波消融治疗的价值。材料与方法选择超声引导下穿刺活检经病理证实的乳腺良性结节患者20例共41个结节,微波消融治疗前分别行US和MRI检查,观察结节的位置、大小、边界、内部回声、血流分布及造影增强等情况,超声引导定位,精确地将微波电极穿入结节内行微波消融,治疗后利用MRI和US显像判断消融治疗的效果。结果消融治疗前后结节平均大小分别为(17.5±5.6) mm和(15.9±6.9) mm,差异有统计学意义(t=2.752,P=0.012)。消融治疗前,灰阶超声结节表现为低回声,边界多清楚(83%);超声造影(contrast-enhanced ultrasound,CEUS)和MRI增强扫描显示结节内均有不同程度增强。消融治疗后,灰阶超声显示原结节区域呈不均匀高回声,边界不清;CEUS检查结节呈无增强35个(85%),结节边缘少量星点状增强6个,经再次消融治疗后结节内无增强;MRI显示结节内均呈无增强,消融区域周边见水肿带。超声引导下穿刺活检,消融区呈凝固样坏死。结论 MRI有助于全面了解结节的大小、空间结构及血流分布;US显像术前了解结节情况,实时引导和监测消融过程,两者联合应用对制定正确的消融策略和远期疗效的评价有重要作用。     

超声医务工作者双上肢肌肉弹性的实时定量弹性成像研究

正骨骼肌是人体运动最大的动力器官,人们在生活、工作及体育锻炼过程中的各种动作,均是通过骨骼肌的收缩和舒张完成的。前期研究[1-2]发现肱二头肌收缩状态下的弹性模量值大于放松状态,纵切面杨氏模量值大于横切面。超声医务工作者因其工作的特殊性是慢性肌肉骨骼损伤的高危人群,本组应用实时剪切波超声弹性成像(SWE)对超声医务工作者上肢肌肉弹性进行研究。资料与方法一、临床资料2014年7月至2014年8月,选取北京某单位的超声科医师,     

超声引导经皮微波消融治疗乳腺良性结节

目的 探讨超声引导经皮微波消融(MWA)治疗乳腺良性结节的可行性和疗效。方法 选择经超声引导穿刺活检病理证实的109例共207个乳腺良性结节。MWA治疗前分别行超声和(或)MR检查,后行超声引导经皮MWA治疗,消融后超声和(或)MRI显像判断治疗效果。结果 消融治疗后1 h结节最大径及体积增大,治疗后1、3、6及12个月后结节逐渐缩小。消融治疗前,灰阶超声显示结节呈均匀低回声,边界清楚;CDFI显示结节内血流信号为0~Ⅱ占93.24%(193/207);超声弹性成像评分为1~2分占87.92%(182/207);CEUS和(或)MR增强扫描显示结节内均有不同程度增强。消融治疗后,灰阶超声显示原结节区域呈不均匀高回声,边界不清;治疗后1、3、6及12个月,超声检查显示结节边界逐渐清晰,回声较治疗前轻度增强;CDFI显示血流分级为0级占89.85%(186/207);消融治疗后1 h,超声弹性成像显示结节硬度较治疗前均有所增加;治疗后1、3、6及12个月复查,结节硬度逐渐下降;CEUS和(或)增强MRI显示结节完全消融或大部分消融且消融后可见消融灶周边环状水肿带。穿刺活检见消融区呈凝固样坏死改变。结论 超声引导经皮MWA治疗乳腺良性结节创伤小、恢复快、无瘢痕,具有患者易耐受、可门诊治疗等优势,是治疗乳腺良性结节安全、有效、可行的新方法。     

超声造影结合剪切波弹性成像对肝硬化背景下肝实质内良恶性结节诊断价值分析

目的：探讨超声造影（CEUS）结合剪切波弹性成像（SWE）对肝硬化背景下肝实质内良恶性结节诊断价值研究。方法：选择2019年1月至2021年2月本院收治的92例肝硬化合并肝实质内结节患者的临床资料，根据病理结果分为恶性组（52例）和良性组（40例）。所有患者术前均行CEUS、SWE检查，比较两组之间各参数的差异，并分析CEUS、SWE单独或联合诊断恶性结节的价值。结果：肝实质内结节动脉期、门脉期及延迟期的CEUS特征在恶性组与良性组之间差异具有统计学意义（P<0.05），其中恶性组肝实质内结节大多呈“快进快出”表现，而良性组大多呈“慢进慢出”表现。恶性组肝实质内结节的杨氏模量最大值（Emax）为（42.36±5.37）kPa，而良性组为（36.49±6.12）kPa，且两组之间比较差异具有统计学意义（P<0.05）。与CEUS、SWE单独诊断相比较，CEUS结合SWE联合诊断恶性结节的准确性、敏感度、特异度、阳性预测值、阴性预测值最高，且差异具有统计学意义（P<0.05）。结论：CEUS结合SWE有助于提高对肝硬化背景下肝实质内良恶性的鉴别诊断价值，对临床治疗方案的选择有一定指导意义。     

超声引导经皮微波消融甲状腺良性结节的应用研究

目的探讨超声引导下经皮穿刺微波消融治疗甲状腺良性结节的临床疗效及并发症等情况.方法选取本院诊治的甲状腺良性结节患者86例（156个结节）,术前细胞学检查确定为良性结节,行超声引导下经皮穿刺结节微波消融术后即刻超声造影,对不全消融结节行二次消融.在术后随访观察消融术后结节大小变化及并发症情况.同时与此期间在我院行甲状腺次全切除术的65例甲状腺良性结节患者作为对照组,分析两组患者的术后并发症出现人数及甲状腺功能恢复等.结果仅4/156枚需二次消融,一次消融率达97.4%.消融后第1、3、6及12个月体积缩小率分别为20.98%,45.37%,75.12%和86.83%;23/156（14.7%）枚结节在随访6-12个月内消失.观察组患者甲状腺功能恢复人数多于对照组,其术后并发症出现人数少于对照组（均P〈0.05）.结论微波消融治疗甲状腺良性结节疗效显著,并发症少,是传统手术治疗的一个有效补充.     

CEUS Versus MRI in Evaluation of the Effect of Microwave Ablation of Breast Cancer

Percutaneous microwave ablation (MWA) is a new minimally invasive technique for breast cancer treatment. The aim of this research was to compare the differences in performance between contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) with respect to the curative effect of MWA in the treatment of breast cancer. Between 2015 and 2019, 26 patients with breast cancer underwent ultrasound-guided MWA. All patients underwent both CEUS and MRI within 3 d after ablation. If either of the two imaging modalities revealed suspicious enhancement of the ablation zone and the ultrasound-guided biopsy confirmed residual tumor in the suspicious area, supplementary MWA was applied. The diagnostic efficacy of CEUS and MRI within 3 d after ablation was evaluated based on a >6-mo follow-up of 26 patients. Two cases were diagnosed with residual tumors by ultrasound that were missed by MRI. Three cases were diagnosed with residual tumors by MRI that were missed by CEUS. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS in the diagnosis of complete ablation were 100%, 40%, 87.5%, 100% and 88.5%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of MRI in the diagnosis of complete ablation were 100%, 60%, 91.3%, 100% and 92.3%, respectively. Within 3 d, both CEUS and MRI can efficiently assess the efficacy of MWA of breast cancer.     

Performance of Shear Wave Elastography in Delineating the Radiofrequency Ablation Boundary: An in Vivo experiment

This study was aimed at exploring the cutoff value of Young's modulus of ablated tissue and the optimal scale at which shear wave elastography (SWE) can delineate the ablation boundary. The livers of 30 rabbits were radiofrequency (RF) ablated, and ultrasonic imaging, including SWE and contrast-enhanced ultrasound (CEUS), was performed. The ablation boundary in the SWE image was located using CEUS, and the SWE parameters of the boundary were measured to calculate the cutoff value of Young's modulus. The cutoff value of the ablated tissue was 48–50 kPa 2 h to 28 d post-ablation. The regions of increased stiffness in SWE images at a scale of 0–50 kPa overlapped well with the non-enhanced regions of CEUS images in 88% of specimens. Therefore, elasticity values differed significantly between ablated and non-ablated tissues, and the cutoff value for Young's modulus differentiated these tissues. SWE delineated the ablation boundary well at the optimal SWE scale with respect to the cutoff value.     

剪切波弹性成像联合CEUS校正乳腺影像报告和数据系统3~5类乳腺病变

目的 探讨剪切波弹性成像（SWE）联合CEUS在校正乳腺影像报告和数据系统（BI-RADS）3~5类乳腺肿瘤中的应用价值。方法 收集50例乳腺病变患者（57个病灶）,其中良性病灶28个,恶性29个。对所有病灶术前行常规超声、SWE和CEUS检查,以常规超声进行BI-RADS分类,并采用SWE、CEUS及SWE联合CEUS对BI-RADS分类进行校正。以病理结果为金标准,计算常规超声、SWE、CEUS及SWE联合CEUS诊断乳腺良恶性病灶的敏感度、特异度和诊断正确率。结果 SWE参数最大杨氏模量值（E_max）诊断乳腺良恶性病灶的临界值为87.2 kPa,CEUS的临界值为8.5分,SWE联合CEUS的多因素Logistic回归模型为Y（P）=-18.785+0.161X₁+11.822X₂,X₁为E_max,X₂为增强后病灶大小改变。SWE联合CEUS将11个病灶正确降为3级,4个病灶误诊;SWE联合CEUS诊断乳腺良恶性病灶的敏感度、特异度和诊断正确率分别为100%（29/29）、85.71%（24/28）和92.98%（53/57）。结论 SWE联合CEUS对BI-RADS 3~5类乳腺病灶具有良好的校正作用,可提高超声诊断正确率。     

Role of Contrast-Enhanced Ultrasound in Diagnosis of Thyroid Nodules in Acoustic Radiation Force Impulse “Gray Zone”

The aim of this study was to evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of thyroid nodules in the acoustic radiation force impulse (ARFI) “gray zone” (the shear wave velocity is in the range 2.5–3 m/s). ARFI was performed before thyroidectomy in 70 patients with 200 thyroid nodules, and then CEUS was performed in 40 thyroid nodules in the “gray zone.” The accuracy of ARFI for the 200 thyroid nodules was 82% (164/200). The accuracy of ARFI for the 40 “gray zone” thyroid nodules was 70% (28/40), whereas the accuracy of CEUS for the “gray zone” thyroid nodules was 90% (36/40). There was a significant difference in accuracy (p < 0.05). CEUS has better accuracy for thyroid nodules in the ARFI “gray zone.” CEUS supplemented ARFI in differential diagnosis of benign and malignant thyroid nodules.     

Clinical Study of the Prediction of Malignancy in Thyroid Nodules: Modified Score versus 2017 American College of Radiology's Thyroid Imaging Reporting and Data System Ultrasound Lexicon

The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer. In the present study, we developed a modified Thyroid Imaging Reporting and Data System (TI-RADS) score using gray-scale ultrasound, contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) images to predict malignancy of thyroid nodules and compared this modified score system with the subjective scoring criteria based on the Thyroid Imaging Reporting and Data System (TI-RADS, 2017 edition). The results revealed that by using SWE and CEUS (enhanced pattern) to downgrade TI-RADS category 4 and 5 nodules, the malignancy rate for TI-RADS category 4 and 5 nodules increased from 47.6% with American College of Radiology (ACR) TI-RADS assessment alone to 49.4% with ACR TI-RADS combined with shear wave elastography (SWE) and CEUS (enhanced pattern). Likewise, by using the modified TI-RADS to adjust TI-RADS category 3 nodules, the malignancy rate for TI-RADS category 3 nodules increased from 13.9%–20.0%. The discriminating power for detection of malignancy of the variable score 2 (ACR TI-RADS + SWE + CEUS), with an area under the curve (AUC) of 0.899 (95% confidence interval [CI]: 86.1%–93.6%), was higher than that of score 1 (ACR TI-RADS), with an AUC of 0.862 (95% CI: 81.9%–90.6%; p > 0.05). With a point 4.5 as the optimal cutoff value, a score of 1 predicted malignancy with an accuracy of 75.6%, sensitivity of 85.0% and specificity of 71.6%. However, with a point 5.5 as the optimal cutoff value, a score of 2 predicted malignancy with an accuracy of 84.9%, sensitivity of 81.0% and specificity of 86.6%. The modified TI-RADS based on ACR TI-RADS + SWE + CEUS (enhanced pattern) could contribute to a reduction in the number of biopsies performed on benign nodules and the implementation of consistent follow-up in clinical practice.     

CEUS的定性指标和定量参数在乳腺良恶性结节中的临床诊断价值

目的 探讨乳腺CEUS的定性指标和定量参数在鉴别乳腺良恶性结节中的诊断价值。方法 选取经超声引导下活检或术后病理证实的乳腺结节233例,其中恶性结节95例,良性结节138例。通过超声造影检查,观察乳腺病灶区的定性指标和定量参数,对其进行单因素分析,筛选出有统计学意义的定性指标和定量参数进行二元Logistic回归分析,得出ROC曲线评价其诊断恶性结节的效能。结果 单因素分析结果中显示CEUS的增强强度、增强速度、增强后形态、增强后范围、增强后边界、有无毛刺、有无灌注缺损和Peak%是诊断乳腺恶性结节的重要指标和参数（P<0.05）。Logistic回归分析结果得出,优化后的诊断指标和参数为增强后范围、有无灌注缺损、有无毛刺、增强后边界、增强后形态（P<0.05）。Logistic回归模型预测乳腺恶性结节的准确率为81.5%,ROC曲线下面积为0.894,敏感性和特异性分别为0.811、0.841。结论 乳腺CEUS的增强后范围、有无灌注缺损、有无毛刺、增强后边界、增强后形态建立的Logistic回归模型有助于诊断乳腺癌。     

多模态超声与超声引导下细针穿刺抽吸活检鉴别C-TIRADS 4类甲状腺良、恶性结节

目的 比较多模态超声与超声引导下细针穿刺抽吸（US-FNAB）活检鉴别中国甲状腺影像报告和数据系统（C-TIRADS）4类甲状腺良、恶性结节的价值。方法 回顾性分析201例甲状腺结节患者共247个甲状腺结节,包括193个恶性、54个良性,以术后病理为金标准,对比多模态超声[联合应用常规超声、剪切波弹性成像（SWE）及超声造影（CEUS）]与US-FNAB鉴别甲状腺良、恶性结节的价值。结果 常规超声诊断甲状腺恶性结节的敏感度、特异度、准确率、误诊率及漏诊率分别为86.53%、59.26%、80.57%、40.74%及13.47%;SWE分别为78.76%、74.07%、77.73%、25.93%及21.24%;CEUS分别为90.16%、77.78%、87.45%、22.22%及9.84%;多模态超声分别为97.93%、88.89%、95.95%、11.11%及2.07%;US-FNAB分别为89.64%、96.30%、91.09%、3.70%及10.36%。多模态超声鉴别甲状腺良、恶性结节的敏感度、特异度、准确率高于,而漏诊率和误诊率低于单一常规超声、SWE及CEUS（P均<0.05）;其敏感度、准确率和误诊率高于,而特异度和漏诊率低于US-FNAB（P均<0.05）。结论 对于鉴别C-TIRADS 4类甲状腺良、恶性结节,多模态超声敏感度、准确率较高但误诊率高,US-FNAB特异度较高但漏诊率高。