超声量化评分在甲状腺良恶性结节鉴别诊断中的应用价值

目的 探讨超声对甲状腺良恶性结节的鉴别诊断价值,尝试建立超声量化评分系统。方法 应用超声量化评分对332个甲状腺结节进行评分,与手术组织病理结果进行对照,评价超声量化评分法诊断甲状腺良恶性结节的准确性。结果 手术组织病理证实良性结节248个,恶性结节84个;在边界、边缘、内部结构、回声、纵横比、微钙化及后方声衰减7项超声特征方面,甲状腺恶性结节与良性结节比较差异有统计学意义（P〈0.01）;AUC为0.940时,以超声量化评分≥3分为恶性结节判定标准,超声量化评分诊断甲状腺恶性结节的敏感性、特异性、准确性分别为85.71%、92.74%、90.96%,诊断甲状腺良性结节的敏感性、特异性、准确性分别为92.74%、85.71%、90.96%。结论 超声量化评分有助于甲状腺良恶性结节的鉴别诊断。     

Computerized detection and quantification of microcalcifications in thyroid nodules

To improve the ultrasonographic detection rates of thyroid cancers with microcalcifications, we propose to enhance the sensitivity of sonographic calcifications detection and to avoid interobserver variation by a computerized quantification method in a prospective setting. A total of 227 participants with 258 nodules were evaluated. Among them, two nodules were excluded for suspicious aspiration cytology results without pathologic proof. Among the remaining 256 nodules, the diagnosis of 181 nodules was verified by surgical pathology and the diagnosis of 75 was based on fine needle aspiration (FNA) biopsy results. There were 173 benign thyroid nodules and 83 malignant thyroid nodules, which included 74 papillary carcinomas. Patient clinical data were collected and the presence of calcifications on conventional gray-scale ultrasound images was retrospectively reviewed by a thyroid specialist. Quantification of cystic components and calcifications was automatically performed by a proprietary program (AmCAD-UT) implemented with methods proposed in this article. The calcification index (CI) was calculated after the cystic component was excluded. The CI between benign and malignant nodules diagnosed by combined FNA biopsy and surgical pathology results (total number, 256) showed a significant difference (p < 0.0001, AUC = 0.746). Furthermore, we excluded patients without surgical pathology results for further validation and the CI between benign and malignant nodules confirmed by pathology results (total number, 181) showed a significant difference (p < 0.0001, AUC = 0.763). To learn whether our computer program increased our diagnostic capabilities, we analyzed human investigators and their abilities to detect and evaluate. In this study, calcifications were noted in 48.19% (40 of 83) of malignant thyroid nodules and in 10.98% (19 of 173) of benign nodules. This new computer-aided diagnosis method to evaluate the sonographic calcifications of thyroid nodules is a more sensitive and more objective method. It can provide better sensitivity than conventional methods in the diagnosis of thyroid malignancies containing microcalcifications.     

超声诊断指标量化评估甲状腺结节

目的 探讨超声鉴别诊断甲状腺结节良、恶性的价值,尝试建立量化分级系统.方法 对1206例患者1329个甲状腺结节的14项超声特征进行评估,计算每项指标的OR值及其赋值,对每个结节进行综合评分,建立量化分级系统.结果 超声诊断指标评分≤3分、4～5分、6～7分、8～9分、10～11分、12～13分、14～15分、16～17分、18～19分、20～21分、22～23分、24～25分、≥26分的各组中,恶性病灶构成比分别为0(0/309)、1.98％ (4/202)、4.40％ (7/159)、14.29％(11/77) 、21.84％(19/87)、59.52％ (25/42)、63.27％(31/49)、81.13％ (43/53)、83.93％ (47/56)、88.33％(53/60)、90.57％ (48/53) 、94.44％(51/54) 、98.44％(126/128).通过ROC曲线得出12分为区分良、恶性结节的最佳界点.根据以上两项结果,初步建立一个分级系统,共分为5级:1级:≤3分(恶性率0),2级:4～7分(恶性率1％～5％),3级:8～11分(恶性率6％～25％),4级:12～21分(恶性率26％～90％),5级:≥22分(恶性率≥90％).结论 量化分级系统使超声报告更加客观化、规范化和标准化,可用于临床评估甲状腺结节恶性风险度.     

超声造影在甲状腺结节鉴别诊断中的价值

目的探讨超声造影对甲状腺影像报告和数据系统(TI-RADS)分类的甲状腺结节进一步鉴别诊断的价值。 方法对295例387个常规超声TI-RADS分类的甲状腺结节行超声造影检查,观察造影后甲状腺结节的微循环灌注特征和应用SonoLiver CAP软件获得的时间-强度曲线各定量参数分析,综合进行两次TI-RADS分类评估,并与术后病理结果进行对照,计算常规超声TI-RADS、超声造影后TI-RADS分类诊断甲状腺恶性结节的敏感度、特异度、准确度、阳性预测值、阴性预测值,并绘制常规超声TI-RADS、超声造影后二次TI-RADS分类诊断甲状腺恶性结节的受试者操作特性(ROC)曲线,计算ROC曲线下面积。 结果295例387个常规超声TI-RADS分类2～5类的甲状腺结节,术后病理结果为恶性82例121个、良性213例266个。常规超声TI-RADS分类诊断恶性结节的敏感度63.64 %(77/121)、特异度73.87%(229/310)、准确度79.07%(306/387)、阳性预测值45.83%(77/168)、阴性预测值83.88%(229/273),而超声造影后二次TI-RADS分类诊断恶性结节的敏感度85.95%(104/121)、特异度92.93%(263/283)、准确度94.83%(263/387)、阳性预测值83.87%(104/124)、阴性预测值93.93%(263/280),超声造影后二次TI-RADS分类诊断甲状腺恶性结节的敏感度、特异度、准确度、阳性预测值、阴性预测值均高于常规超声TI-RADS分类诊断,差异有统计学意义(χ² ＝5.92,4.38,7.31,7.45,3.13;P<0.05)。常规超声TI-RADS、超声造影后二次TI-RADS分类诊断甲状腺恶性结节的ROC曲线下面积分别为0.753,0.834。二次TI-RADS分类评估后甲状腺结节恶性组的超声造影增强模式：≥1 cm实性结节早期快速不均匀增强伴灌注缺损区,<1 cm实性结节呈不均匀低增强;实性结节良性组增强模式表现为均匀高或等增强以及结节周边环状高增强,两者比较差异有统计学意义(χ² ＝43.86,12.54;P<0.05);良恶性组间在增强水平、增强边界、始退特点、相对平均渡越时间、峰值强度、平均强度均具有统计学意义(χ² ＝51.48,17.91,47.25,8.92,3.37,4.05;P<0.05);而增强范围、平均强度、峰值强度在良恶性组间均无统计学意义(χ² ＝2.87,0.95,0.88;P>0.05)。 结论超声造影对常规超声TI-RADS分类的甲状腺结节可以做进一步良恶性鉴别,提高术前诊断准确率。     

超声鉴别甲状腺峡部结节良恶性的研究

目的研究通过甲状腺峡部结节的超声特征鉴别其良恶性。 方法回顾分析2016年1月至12月于上海交通大学医学院附属瑞金医院行甲状腺全切术及颈部中央组淋巴结清扫术,且有病灶位于峡部的196个甲状腺结节的超声特征,根据手术石蜡病理将结节分为良恶性2组,对2组结节的超声特征进行分析比较。回顾分析同期于本院行甲状腺全切术及颈部中央组淋巴结清扫术,且位于甲状腺侧叶的239个甲状腺恶性结节的超声特征,比较分析峡部与侧叶甲状腺恶性结节各超声特征的差异。验证2种甲状腺影像报告和数据系统（TI-RADS）对甲状腺峡部结节的诊断效能。用独立样本t检验比较良恶性结节患者年龄及结节大小有无显著差异;用χ²检验比较良恶性结节各超声特征及患者性别有无显著差异;用χ²检验,必要时用Fisher确切概率法比较峡部与侧叶恶性结节各超声特征有无显著差异。 结果低回声、实性结构、边缘不光整、微钙化、周围型血供、低血供等超声特征为甲状腺峡部结节恶性风险的独立危险因素（P均<0.05）。峡部恶性甲状腺结节比侧叶恶性甲状腺结节更易表现为纵横比≤1、甲状腺外侵犯、与包膜接触面积>25%、周围型血供、低血供（P均<0.05）,且更易发生颈部中央组淋巴转移（P=0.041）。本组4A、4B类甲状腺峡部结节的实际恶性率皆明显高于2种TI-RADS的推荐恶性率。 结论纵横比>1并非鉴别甲状腺峡部结节良恶性的良好超声指标,周围型血供、低血供等非灰阶超声特征可协助峡部结节的良恶性鉴别;与侧叶结节不同,当甲状腺峡部结节为低回声时,就应提高警惕;当对峡部结节进行风险分层时,应适当升级。     

Quantitative Analysis of Dynamic Power Doppler Sonograms for Patients with Thyroid Nodules

To clarify and determine whether power Doppler sonograms are useful for the detection of malignant thyroid nodules, a computerized quantification method was used to evaluate the vascular density of a thyroid nodule in a prospective setting. Sonographic power Doppler images were collected in consecutive frames (45 frames of images), and a proprietary program (AmCAD-UV) was implemented using methods proposed in this article automatically calculated a quantified power Doppler vascular index (PDVI). The minimum PDVI value (PDVI_min) was suggested as a measure of the vascular density of the nodule. The vascular densities of the peripheral and central areas of the nodule, referred to as central PDVI_min and Ring PDVI_min, respectively, were also evaluated. For 238 tumors (79 malignant and 159 benign) from 208 patients, all of the proposed indices of benign lesions were significantly higher than those of the malignant lesions. The area under the receiver operating characteristic curve (AUC) reaches 71% with the PDVI_min. When the vascular patterns were further classified into intra-nodular and peripheral vascularity types, no vascularity type was observed significantly more frequently in malignant nodules than in benign nodules. These proposed computerized vascular indices provide a quantification method to objectively evaluate thyroid nodules and have potential as predictors of thyroid malignancy. The conventional vascular characterizations of malign nodules, that is, more vessels are observed in malignant nodules than in benign nodules, are shown to be unreliable in our study. Instead, a higher value of the quantified power Doppler vascular density was observed in benign nodules.     

彩色多普勒超声在甲状腺结节良恶性鉴别诊断中的应用

目的 探讨彩色多普勒超声在甲状腺结节良恶性鉴别诊断中的应用价值,为甲状腺结节的定性诊断提供可靠依据,减少漏误诊.方法 回顾性分析105例经手术病理证实的甲状腺结节患者的超声资料,并总结其声像图特征.结果 105例病例中,病理诊断良性结节71例,甲状腺癌34例,超声诊断符合率81.9%,误诊18例(17.1%).良恶性结...     

甲状腺实性结节超声诊断的Logistic回归分析

目的 应用二分类Logistic回归模型分析甲状腺实性结节超声检查各指标对良恶性结节鉴别诊断的意义.方法 总结经手术病理证实的118个甲状腺结节术前的二维灰阶、彩色多普勒及弹性成像的各项超声诊断指标,采用多因素回归分析方法,建立Logistic回归模型.结果 共有3个变量进入回归方程,分别为弹性评分、弹性应变率和结节形态,该Logistic模型对甲状腺结节良恶性预报的正确率为86.4%(102/118),ROC曲线下面积为0.931.结论 二分类Logistic回归模型分析能筛选出对甲状腺实性结节有鉴别诊断意义的特征变量及弹性成像方法所反应出来的硬度信息,在良恶性结节的鉴别诊断中具有较高的临床应用价值.     

Quantitative Shear Wave Velocity Measurement on Acoustic Radiation Force Impulse Elastography for Differential Diagnosis between Benign and Malignant Thyroid Nodules: A Meta-analysis

The aim of this study was to evaluate the diagnostic performance of quantitative shear wave velocity (SWV) measurement on acoustic radiation force impulse (ARFI) elastography for differentiation between benign and malignant thyroid nodules using meta-analysis. The databases of PubMed and the Web of Science were searched. Studies published in English on assessment of the sensitivity and specificity of ARFI elastography for the differentiation of thyroid nodules were collected. The quantitative measurement of ARFI elastography was evaluated by SWV (m/s). Meta-Disc Version 1.4 software was used to describe and calculate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and summary receiver operating characteristic curves. We analyzed a total of 13 studies, which included 1,854 thyroid nodules (including 1,339 benign nodules and 515 malignant nodules) from 1,641 patients. The summary sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules by SWV were 0.81 (95% confidence interval [CI]: 0.77–0.84) and 0.84 (95% CI: 0.81–0.86), respectively. The pooled positive and negative likelihood ratios were 5.21 (95% CI: 3.56–7.62) and 0.23 (95% CI: 0.17–0.32), respectively. The pooled diagnostic odds ratio was 27.53 (95% CI: 14.58–52.01), and the area under the summary receiver operating characteristic curve was 0.91 (Q* = 0.84). In conclusion, SWV measurement on ARFI elastography has high sensitivity and specificity for differential diagnosis between benign and malignant thyroid nodules and can be used in combination with conventional ultrasound.     

实时超声弹性成像定量参数分析在甲状腺结节诊断中的初步应用

目的 探讨实时超声弹性成像定量参数分析在鉴别诊断甲状腺良恶性结节中的价值.方法 分析86例甲状腺结节患者的超声弹性图像,计算病灶与周围组织的应变比值(strain ratio),分别统计良恶性病灶的比值均数,并通过ROC曲线分析取得最合适的临界值.所有病例均经手术及病理证实.结果 良性结节的应变比值平均2.18,而恶性结节为8.48,两者差异有统计学意义(P<0.05).通过ROC曲线分析,取得最合适诊断临界点为3.3.结论 实时超声弹性成像定量分析为甲状腺结节的良恶性鉴别诊断提供了一种新的方法.     

甲状腺结节超声造影研究进展

甲状腺的各种肿物统称为甲状腺结节,临床当中诊断甲状腺结节良恶性的主要方式之一为超声造影。本文通过梳理超声造影对甲状腺结节诊断的发展,并将研究超声造影诊断甲状腺结节良恶性的文章进行归纳,分析超声造影在定性法和定量法两方面对甲状腺结节的诊断,总结目前对于甲状腺结节诊断的其他方式,介绍说明超声造影诊断联合应用其他诊断方式(如剪切波弹性成像、CT、MRI)的适用方面和临床效果。     

Diagnosis of Thyroid Nodules Using Virtual Touch Tissue Quantification Value and Anteroposterior/Transverse Diameter Ratio

This paper proposes an effective approach to differential diagnosis of thyroid nodules using a hierarchical classification model based on the Virtual Touch tissue quantification (VTQ) value and anteroposterior/transverse diameter (A/T) ratio. One hundred twenty nodules (92 benign, 28 malignant) were analyzed using this approach by combining the quantitative elastic characteristic with the conventional sonographic feature. First, nodules were classified as benign (VTQ values <2.27 m/s), malignant (VTQ values >2.73 m/s) and indeterminate (2.27 m/s ≤ VTQ values ≤2.73 m/s) using two cutoff points selected on the basis of receiver operating characteristic analysis. Second, the indeterminate nodules were separated into malignant and benign nodules using an A/T ratio ≥1. The advantage of this approach was that it could alleviate the limitation of an overlap in VTQ values between benign and malignant nodules. According to the pathologic results, the accuracy of this approach was 95%. The proposed approach may potentially improve diagnostic accuracy.     

多模态超声检查对甲状腺弥漫性病变合并结节的诊断分析

目的:探讨分析多模态超声检查对甲状腺弥漫性病变合并结节的诊断价值。方法:选取2017年5月-2019年5月我院收治的甲状腺弥漫性病变合并结节患者400例,所有患者均在我院接受超声检查。并且全部患者均通过穿刺活检或者手术病理检查确诊。观察比较与病理诊断结果相比超声检查的准确性;良性结节与恶性结节在不同超声特征方面的差异。结果:所有400例患者的病理诊断结果提示,共检查出甲状腺结节:418个,其中,良性结节:148个,恶性结节:270个;超声检查共检查出甲状腺结节408个,其中,良性结节:144个,恶性结节:264个,与病理诊断相比,超声检查在甲状腺结节方面的检出率并无显著差异(P>0.05)。恶性结节与良性结节在不同超声特征:形态、纵横比、边界、边缘、声晕、内部回声、钙化灶、后方回声、相对运动、血流分布、阻力指数、硬度等方面均存在显著差异(P<0.05)。结论:甲状腺弥漫性病变合并结节使用多模态超声检查诊断的准确率较高,且通过多模态超声检查也能够有效地区分良性结节与恶性结节,值得应用。     

甲状腺良恶性结节的弹性成像和常规超声特征及联合诊断效能

目的 探讨甲状腺良恶性结节的声像图诊断特点,及弹性成像联合常规超声诊断的价值。方法 分别对240例患者的280个甲状腺结节行常规超声和弹性成像检查,分析其超声特点。根据各诊断标准将所有结节进行良恶性归类,并与病理结果比较。结果 常规超声、弹性成像鉴别甲状腺结节良恶性的敏感度、特异度、准确率分别为71.67%(43/60)、81.82%(180/220)、79.64%(223/280),85.00%(51/60)、88.18%(194/220)、87.50%(245/280)。弹性成像联合常规超声鉴别甲状腺结节良恶性的敏感度、特异度及准确率分别为91.67%(55/60)、98.18%(216/220)及96.78%(271/280),其诊断价值高于单纯弹性成像和常规超声检查(P<0.05)。结论 甲状腺良恶性结节的常规超声、弹性成像表现较具特征性,联合诊断对鉴别甲状腺结节良恶性有较高的效能。     

甲状腺实性结节的超声弹性成像定量参数分析

目的 探讨实时超声弹性成像定量参数分析在诊断甲状腺实性结节性质中的价值.方法分析112例(157个病灶)甲状腺实性结节患者的超声弹性图像,计算病灶与周围组织的应变率比值及其平均值,并通过受试者操作特点(ROC)曲线分析取得最合适的诊断甲状腺良恶性病灶临界值.所有病例均经手术及病理证实.结果 157个病灶中良性结节79个,应变率比值平均值为1.93±1.29;恶性病灶78个,应变率比值平均值为5.07±4.21,两者间差异有统计学意义(t=6.319,P<0.01).根据良恶性结节的应变率比值绘制ROC曲线,曲线下面积为0.861±0.031.通过ROC 曲线分析得出良恶性结节的弹性应变率比值临界点为2.96,其敏感度、特异度和准确性分别为73.1%(57/78)、88.6%(70/79)和80.9%(127/157).结论 实时超声弹性成像定量参数分析为甲状腺实性结节的良恶性鉴别诊断提供了一种新方法.     

量化评分鉴别诊断甲状腺结节良恶性的价值

目的：探讨量化评分鉴别诊断甲状腺结节良恶性的价值。方法回顾性分析2011年1月至2012年6月中国医科大学附属第一医院行甲状腺手术患者1360例,所有患者均经手术病理证实。其中甲状腺癌患者509例,结节性甲状腺肿患者851例。共评估甲状腺结节1508个。将甲状腺结节大小、位置、数目、低回声、界限不清、有包膜但不完整或无包膜、有晕环但不完整或无晕环、纵横比≥1、内部有血流、后方伴声衰减,内无囊性回声、微钙化、合并桥本甲状腺炎作为自变量,将甲状腺结节恶性作为应变量,进行Logistic回归分析,筛选甲状腺结节恶性相关因素。对1508个甲状腺结节的恶性相关因素进行评分。采用χ2检验比较结节性甲状腺肿与甲状腺癌患者的甲状腺结节评分。结果甲状腺结节的低回声、界限不清、有包膜但不完整或无包膜、有晕环但不完整或无晕环、纵横比≥1、内部有血流、后方伴声衰减、内无囊性回声、微钙化及合并桥本甲状腺炎与甲状腺结节恶性有相关性。结节性甲状腺肿患者与甲状腺癌患者甲状腺结节评分差异有统计学意义（χ2=802.08, P＜0.05）。768个评分＜6分的甲状腺结节中,742个为良性,24个为恶性;60个评分≥10分的甲状腺结节中,2个为良性,58个为恶性;314个评分8~9分的甲状腺结节中,60个为良性,254个为恶性;368个评分6~7分的甲状腺结节中155个为良性,213个为恶性。结论甲状腺结节的量化评分对鉴别诊断甲状腺结节良恶性有重要的临床意义。超过8分的甲状腺结节大部分为恶性,应外科手术治疗。     

钙化与甲状腺癌关系的再认识

目的：探讨不同类型钙化对甲状腺良恶性结节的鉴别诊断价值。方法2013年1至10月在华中科技大学同济医学院附属同济医院行甲状腺超声检查的195例患者共258个结节。重点观察甲状腺结节数目、回声以及结节内钙化灶的大小、形态和分布,将不同钙化模式分为3型：Ⅰ型微小点状微钙化,Ⅱ型粗大钙化,Ⅲ型周边钙化。结果甲状腺恶性结节钙化率为68.6%（81/118）,高于甲状腺良性结节钙化率40.0%（56/140）,且差异有统计学意义（χ2=21.096,P＜0.01）。Ⅰ型微小点状微钙化在甲状腺恶性结节中的发生率为72.8%（59/81）,高于其在甲状腺良性结节中的发生率41.1%（23/56）,且差异有统计学意义（χ2=13.906,P＜0.01）。Ⅱ型粗钙化在甲状腺良恶性结节中的发生率差异无统计学意义[23.5%（19/81）vs 37.5%（21/56）,χ2=3.159,P＞0.05]。Ⅲ型周边钙化在甲状腺良性结节中的发生率为21.4%（12/56）,高于其在甲状腺恶性结节中的发生率3.7%（3/81）,且差异有统计学意义（χ2=10.669,P＜0.05）。伴钙化的甲状腺单发结节、甲状腺极低回声结节恶变率分别为85.3%（58/68）、76.2%（48/63）,均高于伴钙化的甲状腺多发结节、甲状腺其他回声结节恶变率33.3%（23/69）、44.6%（33/74）,且差异均有统计学意义（χ2=38.261、14.057,均P＜0.01）。结论甲状腺结节内每种钙化都存在恶性风险,不同类型钙化对于甲状腺良恶性结节的鉴别具有重要价值。     

Quantitative Evaluation of Vascularity Using 2-D Power Doppler Ultrasonography May Not Identify Malignancy of the Thyroid

The purpose of this study was to evaluate the usefulness of a quantitative vascular index in predicting thyroid malignancy. A total of 1309 thyroid nodules in 1257 patients (mean age: 50.2 y, range: 18–83 y) were included. The vascularity pattern and vascular index (VI) measured by quantification software for each nodule were obtained from 2-D power Doppler ultrasonography (US). Gray-scale US + vascularity pattern was compared with gray-scale US + VI with respect to diagnostic performance. Of the 1309 thyroid nodules, 927 (70.8%) were benign and 382 (29.2%) were malignant. The area under the receiver operating characteristics curve (A_z) for gray-scale US (0.82) was significantly higher than that for US combined with vascularity pattern (0.77) or VI (0.70, all p < 0.001). Quantified VIs were higher in benign nodules, but did not improve the performance of 2-D US in diagnosing thyroid malignancy.     

甲状腺影像报告和数据系统在甲状腺结节分类中的前瞻性验证

目的：前瞻性验证甲状腺影像报告和数据系统（TI-RADS）对甲状腺结节分类的应用价值。方法根据2011年Kwak提出的TI-RADS分类标准对415例甲状腺结节患者的810个结节进行分类,并与病理结果对照,应用受试者操作特性（ROC）曲线评价TI-RADS鉴别甲状腺良恶性的价值,计算各分类的实际恶性百分率。结果经病理证实810个结节中恶性结节161个、良性结节649个;TI-RADS 2类11个（全部为良性结节）、TI-RADS 3类370个（良性结节368个,恶性结节2个）、TI-RADS 4a类150个（良性结节143个、恶性结节7个）、TI-RADS 4b类116个（良性结节87个、恶性结节29个）、TI-RADS 4c类146个（良性结节39个、恶性结节107个）;TI-RADS 5类17个（良性结节1个、恶性结节16个）。以病理诊断结果作为金标准,TI-RADS 2~5类ROC曲线下面积为0.81, TI-RADS 2、3、4a、4b、4c、5类的实际恶性百分率为0、0.5%、4.6%、25.0%、73.0%、94.0%。结论 Kwak等提出的TI-RADS经过验证,实际恶性百分率与理论恶性百分率有很高的符合度,在甲状腺结节性疾病超声检查中具有重要的诊断价值。     

超声造影和超声弹性成像对甲状腺良恶性结节的鉴别诊断价值

目的 评价超声造影和超声弹性成像在甲状腺良恶性结节中的鉴别诊断价值.方法 对82个经手术病理证实的甲状腺良恶性结节的超声造影和弹性成像特征进行对比分析,评估各诊断方法的灵敏度、特异度、阳性预测值、阴性预测值及诊断符合率.结果 82个甲状腺结节中,良性病灶48个,恶性病灶34个.良性结节在注射造影剂后均早于周围腺体增强,晚于周围腺体廓清,多数结节表现为周边环状增强;恶性结节大多以低增强为主,增强回声不均匀,早于周边甲状腺组织消退.超声造影的灵敏度、特异度、阳性预测值及阴性预测值分别为91.18%、93.75%、91.18%及93.75%,弹性成像的灵敏度、特异度、阳性预测值及阴性预测值分别为88.24%、91.67%、88.24%及91.67%,超声造影联合超声弹性成像的灵敏度、特异度、阳性预测值及阴性预测值分别为97.06%、85.42%、82.50%及97.62%.结论 超声造影和弹性成像对甲状腺良恶性结节有较高的鉴别诊断价值,两者结合可提高该病的诊断率.