Ultrasound Strain Elastography for Circumscribed Solid Thyroid Nodules without Malignant Features Categorized as Indeterminate by B-Mode Ultrasound

The aim of this study was to evaluate the diagnostic performance of ultrasound strain elastography (USE) for circumscribed solid thyroid nodules without malignant or benign features seen on US. This retrospective study included 197 thyroid nodules in 196 patients who underwent USE with color mapping and strain ratio measurement between 2010 and 2014. Of the 197 nodules, 24 (12.2%) were malignant. No significant differences in color mapping or strain ratio were observed between benign and malignant nodules. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 29.2% (95% confidence interval [CI]: 13.8%–49.4%), 77.5% (95% CI: 75.3%–80.3%), 15.2% (95% CI: 7.2%–25.8%), 88.7% (95% CI: 86.3%–92.0%), and 71.6% (95% CI: 67.8%–76.5%) for color mapping and 50.0% (95% CI: 30.%–69.5%), 57.2% (95% CI: 54.5%–59.9%), 14.0% (95% CI: 8.5%–18.4%), 89.2% (95% CI: 85.0%–93.4%) and 56.3% (95% CI: 51.6%–61.1%) for strain ratio measurement, respectively. USE with color mapping and strain ratio measurement has a limited ability to differentiate benign from malignant nodules for circumscribed solid thyroid nodules without definite malignant features categorized as indeterminate by B-mode US.     

Thyroid Nodules and Shear Wave Elastography: A New Tool in Thyroid Cancer Detection

This study determines the performance of virtual touch imaging quantification (VTIQ), a non-invasive shear wave elastography method for measuring thyroid nodule (TN) stiffness, in distinguishing benign from malignant TNs. This prospective study evaluates 707 TNs in 676 patients with fine-needle aspiration biopsy (FNAB). Before FNAB, both conventional B-mode ultrasound and shear wave elastography were performed. Surgical resection was recommended for FNAB results that were not clearly benign. Surgical pathology confirmed 82 malignant TNs. The receiver operating curve identified a single cut-off of 3.54 m/s as the maximum shear wave velocity (SWV) for predicting thyroid cancer (TC). The sensitivity and specificity were 79.27% and 71.52%, respectively. Positive predictive value (PPV) was 26.75% and negative predictive value (NPV) was 96.34%. Compared with B-mode US features for predicting malignancy, SWV ≥3.54 m/s has a higher sensitivity, specificity, PPV and NPV. TN stiffness measured by VTIQ-generated shear wave elastography is an independent predictor of TC.     

实时超声弹性成像技术在甲状腺实性病变诊断中的应用价值

目的探讨实时超声弹性成像技术对甲状腺实性结节的鉴别诊断价值。方法选择我院2009年1月~2010年1月经手术证实的91例104个甲状腺实性结节进行常规二维、彩色多普勒超声联合及实时超声弹性成像检查,并与病理检查结果进行对照分析。结果本组经常规二维及彩色多普勒超声联合检查诊断为甲状腺恶性肿瘤66个,与病理检查结果一致54个;诊断为甲状腺良性病变36个,与病理检查结果一致20个,联合诊断灵敏度为73.0%,特异度为57.2%,准确率为71.2%;实时超声弹性成像检查诊断的灵敏度、特异度、准确率分别为92.0%、86.0%、90.0%,明显高于常规二维及彩色多普勒联合检查,差异有统计学意义(P<0.05)。结论实时超声弹性成像技术可为常规超声发现的甲状腺实性结节的进一步鉴别诊断提供更多信息。     

应变弹性成像在甲状腺结节良恶性鉴别中的应用价值分析

目的：评估应变弹性成像技术在甲状腺结节良恶性鉴别诊断中的应用价值。方法：对收入我院进行检查的31例患者31个甲状腺结节进行常规超声及弹性成像检查,分析弹性评分法及SR比值法对甲状腺良恶性结节的检出率情况,并分别计算三种方法在甲状腺良恶性结节鉴别诊断中的灵敏度、特异度、阳性预测值、阴性预测值。结果：31个甲状腺结节,经病理检查良性结节15个,恶性结节16个。弹性评分法及SR比值法阳性检出率均高于常规超声;弹性评分法及SR比值法的灵敏度、特异度、阳性预测值、阴性预测值均高于常规超声。结论：弹性成像技术有助于鉴别诊断甲状腺结节的良恶性。     

灰阶及彩色多普勒血流成像在甲状腺癌诊断中的应用

目的　评价灰阶和彩色多普勒超声在甲状腺癌诊断中的作用。方法　分析经手术及病理证实 89例甲状腺癌的 98个病灶的灰阶及彩色多普勒声像图表现。结果　所有甲状腺癌肿超声显示 5 9.1% (5 8/ 98)边界不清 ,76.5 % (75 / 98)低回声或稍低回声 ,76.5 % (75 / 98)内部回声不均 ,88.8% (87/ 98)无暗环 ,46.9% (4 6/ 98)内部出现微钙化点 ,95 .9% (94/98)无液化 ,63 .6% (14 / 2 2 )内部出现丰富动脉血流 ,85 .7% (18/ 2 1)阻力指数RI≥ 0 .70。结论　根据肿瘤灰阶及彩色多普勒超声的特征性表现 ,有助于甲状腺癌的正确诊断     

超声弹性面积比值法与声脉冲辐射力成像鉴别诊断甲状腺结节的对比研究

目的 对比评价超声弹性成像面积比值法(EIAR)及声脉冲辐射力成像(ARFI)在鉴别诊断甲状腺良恶性结节中的价值.方法 对65例患者共78个甲状腺结节进行EIAR和ARFI检测,以病理结果为金标准,构建EIAR与ARFI鉴别诊断甲状腺结节良恶性的ROC曲线,分析两者曲线下面积,并比较其敏感性和特异性.结果 EIAE曲线下面积(0.840)与ARFI曲线下面积(0.856)差异无统计学意义(P＞0.05);以EIAR值≥1.23、ARFI测值≥3.18 m/s为诊断临界值,诊断甲状腺恶性结节的敏感性、特异性分别为71.4％、86％和85.7％、74.0％.结论 EIAR与ARFI技术鉴别诊断甲状腺良恶性结节的价值无明显差别,但均对甲状腺良恶性结节的鉴别诊断具有重要作用.     

CDFI与超声造影联合检测对甲状腺结节良恶性鉴别诊断的价值

【目的】分析彩色多普勒血流显像（CDFI）与超声造影（CEUS）对良恶性甲状腺结节的超声诊断特征,为其鉴别诊断提供参考。【方法】回顾性分析本院2013年6月至2015年9月手术治疗的132例甲状腺结节患者超声诊断资料,以术后病理结果为金标准,观察良恶性结节内CDFI显示的血流形态、血流丰富程度,CEUs增强模式和增强强度特征;比较两种方法单独诊断及联合诊断的准确性。【结果】CDFI显示良恶性甲状腺结节血流形态及血流丰富程度比较差异具有显著性,良性结节血流形态以Ⅰ／Ⅱ型为主,血流丰富程度以0～1级居多,而恶性结节血流形态多为ⅢjⅣjV型,血流丰富程度多为2～3级（P〈0．05）;CEUS显示良恶性甲状腺结节增强模式和增强强度比较差异具有显著性,良性结节增强模式多为环状周边增强,增强强度多为稀疏增强,而恶性结节增强模式以弥漫性整体增加居多,增强强度多为高增强（P〈0．05）;TIC曲线定量分析,良性甲状腺结节AT、TTP、△I参数高于恶性甲状腺结节,但IPI、PPI、8参数低于恶性甲状腺结节（P〈0．05）。CDFI与CEUS联合诊断准确性、敏感性、特异性、阳性和阴性预测值均高于单独诊断。【结论】良恶性甲状腺结节CDFI特征较明显,但微小病灶的鉴别诊断有一定难度,CEUS可提高血流检出率,二者联合具有较高的临床价值。     

Gray-Scale Ultrasonography Combined with Elastography Imaging for the Evaluation of Papillary Thyroid Microcarcinoma: As a Prognostic Clinicopathology Factor

Ultrasonography (US) is the preferred imaging modality for papillary thyroid microcarcinoma (PTMC). The aim of this study was to evaluate the importance of gray-scale ultrasound combined with elastography to predict extrathyroidal extension and cervical lymph node (LN) metastasis in patients with PTMC. We retrospectively evaluated gray-scale ultrasonic and elastographic results from 119 consecutive cases of PTMC with 138 nodules and correlated the histopathological findings. The results indicated that pathological extrathyroidal extension was significantly associated with T staging on US, extrathyroidal extension on US, bilaterality on US, boundary, strain ratio and hard malignancy as measured with the Rago score. Central LN metastasis on pathology was significantly associated with central LN metastasis on US, lateral LN metastasis on US, multifocality on US and bilaterality on US. Lateral LN metastasis on US was significantly associated with lateral LN metastasis on pathology. On multivariate analysis, T staging on US, extrathyroidal extension on US and hard malignancy as measured with the Rago score were significantly associated with pathological extrathyroidal extension. Lateral LN metastasis on US and bilaterality on US were independent factors in predicting central LN metastasis on pathology. Lateral LN metastasis on US was the predictive factor for lateral LN metastasis on pathology. US should be helpful in the diagnosis of PTMC and in the evaluation of possible PTMC recurrence on US in routine clinical practice.     

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.     

彩色多普勒超声与核素对甲状腺结节的诊断价值比较

目的比较彩色多普勒超声与核素检查对甲状腺结节的诊断价值。 方法对34例明确诊断的甲状腺结节的彩色多普勒超声与核素的检查结果进行回顾性分析。 结果2种影像学方法都可以显示甲状腺的形态、位置、大小,但彩色多普勒超声对甲状腺位置、大小、内部结构、回声、血流状况更为清晰有效。超声检查出的结节如果小于1cm,核素对其发现则显得困难。但核素可以反应甲状腺摄锝功能,可以反应甲状腺结节的寒热温良的特性。结节的囊实性和核素的寒热温良特性没有明显关联。 结论彩色多普勒超声和核素是从不同的侧面对甲状腺结节进行观察和说明。2种影像学方法都无创,有效,结合使用可提高诊断敏感性和准确性。     

声触诊组织量化成像技术联合超声造影技术在TI-RADS 4类甲状腺结节良恶性鉴别诊断中的应用价值

目的 探讨声触诊组织量化成像（VTIQ）技术及超声造影（CEUS）技术在TI-RADS 4 类甲状腺结节良恶性鉴别诊断中的应用价值。 方法 选取欲行手术切除并经病理证实的TI-RADS 4 类甲状腺结节患者86例（共98个结节），术前行VTIQ及CEUS检查，获取结节的剪切波速度（SWV）值（SWVmax、SWVmin、SWVmean、SWVratio）及超声造影特征，建立VTIQ联合CEUS技术Logistic 回归模型，通过曲线下面积比较VTIQ、CEUS及两者联合后的回归模型对TI-RADS 4 类甲状腺结节良恶性的鉴别诊断价值。结果 TI-RADS 4 类甲状腺良、恶性结节组内SWVmax、SWVmin、SWVmean、SWVratio值比较，差异均具有统计学意义（P均<0.05）。超声造影特征中，强化程度、强化均匀、强化方式、环状增强、消退方式在TI-RADS 4 类甲状腺良、恶性结节中差异有统计学意义（P均＜0.05）。多因素分析显示SWVmean（＞2.96m/s）、强化程度（低增强）是诊断TI-RADS 4 类甲状腺恶性结节的重要指标（P均＜0.05）。SWVmean、CEUS技术及Logistic回归模型诊断TI-RADS 4类甲状腺良、恶性结节的曲线下面积分别为0.862、0.835和0.933。结论 声触诊组织量化成像技术及超声造影技术均可鉴别TI-RADS 4类甲状腺结节良恶性，两者联合可明显提高对TI-RADS 4类甲状腺结节的诊断价值。     

甲状腺恶性肿瘤的二维及彩色多普勒超声征象及其临床意义

目的：探讨二维及彩色多普勒超声对甲状腺恶性肿瘤的诊断价值。方法：对６８例经病理证实的甲状腺恶性肿瘤进行二维及彩色多普勒超声检查。结果：５７例（８４％）病变为低回声,５３例（７８％）结节性病变边界不整或欠规整,４８例（７１％）病变内部结构较周转甲状腺实质致密,３３例（４９％）病变内见点太强回声。１０例结甲伴微小癌变的超声表现缺乏上述特征。彩色多普勒显示６８例（１００％）病变内均通话因流,其中ＲＩ〉０     

超声诊断甲状腺良恶性结节的病理基础及鉴别诊断的价值

目的结合甲状腺良、恶性结节的病理基础,分析其声像图特点,探讨超声对甲状腺良、恶性结节鉴别诊断的临床应用价值。方法对89例甲状腺结节的患者术前行超声检查,术后根据病理结果对其超声征象进行良、恶性对照研究。结果89例甲状腺结节患者中,良性者76例共199个结节,恶性者13例共18个结节,甲状腺结节超声诊断与手术病理结果符合率为81.6%,其中结节性甲状腺肿的诊断符合率为85.2%,甲状腺腺瘤的诊断符合率为83.3%,甲状腺癌的诊断符合率为62.2%。结论超声对甲状腺良恶性结节的鉴别诊断有明确的临床应用价值,综合分析甲状腺良恶性结节的病理基础与超声征象可提高对其鉴别诊断的准确率。     

Comparative Study of Acoustic Radiation Force Impulse Imaging With Real-Time Elastography in Differential Diagnosis of Thyroid Nodules

The aims of this study were to evaluate whether acoustic radiation force impulse (ARFI) imaging of the thyroid gland and thyroid nodules yields reliable results and to compare the values of ARFI imaging with those of real-time elastography (RTE) in the differential diagnosis of thyroid nodules. RTE and ARFI were performed in 30 patients with 58 thyroid nodules. The results were compared with pathologic findings. Receiver operating characteristic curves were drawn to evaluate the diagnostic results. The area under the curve for RTE (0.78) was smaller than that for ARFI (0.94) (p < 0.01). ARFI imaging of thyroid tissue yields more reliable results than RTE.     

彩色多普勒超声在甲状腺肿块的鉴别诊断中的临床应用

目的：研究彩色多普勒超声诊断和鉴别甲状腺肿块疾病的临床价值.材料与方法：资料选自2011年1月-2014年1月在本院诊治的甲状腺肿块患者94例,予二维超声作对照组,予彩色的多普勒超声作研究组,并与病理结果比较,分析病理结果、诊断符合率,研究组血流分布及血流动力相关指标.结果：病理确诊良性甲状腺肿块64例,恶性甲状腺肿（甲状腺癌）32例;且研究组甲状腺瘤、结节性的甲状腺肿、乳头状的腺癌、滤泡状的腺癌及总符合率,均比对照组高（P＜0.05）;同时研究组结节性的甲状腺肿的内部与周边血流均不丰富,甲状腺癌内部与周边血流较丰富;甲状腺瘤、结节性甲状腺肿的血流动力相关Vmax与RI指标,分别与甲状腺癌差异显著（P＜0.05）.结论：对甲状腺肿块者予彩色的多普勒超声,分辨率高且诊断率高,同时二维与彩色的多普勒超声结合,能有效提升甲状腺肿块准确率,具有一定临床应用和研究价值.     

彩色多普勒超声在甲状腺病变诊断中的应用

应用ＣＤＦＩ超声对甲状腺疾病进行血流检测,并与２０例健康者对照。结果表明不同疾病甲状腺上动脉内径及血流参数测值不同。ＣＤＦＩ超声作为无创伤的检查方法,有重要的临床诊断价值。     

三维能量多普勒超声在良恶性甲状腺肿瘤中的诊断价值

[目的]探讨三维能量多普勒超声诊断良恶性甲状腺肿瘤中的诊断价值.[方法]回顾性分析2011年5月至2015年7月本院收治的76例经手术或病理确诊为甲状腺肿瘤患者的临床资料,所有患者入院后均已接受三维能量多普勒超声检查,且影像学资料完整,观察良恶性甲状腺肿瘤血流特点,评定三维能量多普勒超声在甲状腺良恶性肿瘤鉴别中的价值.[结果]①良性甲状腺肿瘤患者灰阶值(MG)高于恶性患者(P＜0.05),血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI)低于恶性肿瘤患者,其差异有统计学意义(P＜0.05);②良、恶性甲状腺肿瘤血流分级Ⅱ级所占比例比较差异无统计学意义(P ＞0.05),良性肿瘤患者血流Ⅰ级所占比例明显高于恶性者,Ⅲ级所占比例低于恶性者,其差异有统计学意义(P＜0.05);③良性甲状腺肿瘤血流分布外周所占比例、血管规则走行比例及空间分布对称比例均高于恶性肿瘤者,其差异有统计学意义(P＜0.05);④三维能量多普勒超声检出良性甲状腺肿瘤31例,其中29例确诊,2例误诊;恶性45例,其中40例确诊,5例误诊,其整体诊断符合率为90.79％(69/76).[结论]采用三维能量多普勒超声诊断甲状腺良恶性肿瘤,与病理诊断符合度高,可清晰显示肿瘤血流分布、血管特点及内部结构,且操作简单、无创,值得临床推广应用.     

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.     

声触诊组织成像鉴别诊断甲状腺结节良恶性病变的价值

目的 应用声触诊组织成像(VTI)技术,探讨VTI分级和VTI面积比鉴别诊断甲状腺良恶性结节的价值。 方法 选取2017年10月至2018年1月在天津医科大学总医院超声科进行常规超声和VTI检查的134例患者144例甲状腺结节。以细针穿刺活检以及手术病理作为金标准,采用受试者工作特征(Receiver Operating Characteristic,ROC)曲线评估和比较VTI分级、面积比以及基于logistic回归、二者联合的诊断性能。结果 甲状腺良、恶性结节在大小、位置、回声、边缘、血流方面比较差异均无统计学意义（均P>0.05）,仅在纵横比和有无钙化方面比较差异有统计学意义（P＜0.05）。良、恶性结节的VTI分级比较差异有统计学意义（P<0.05）,恶性结节VTI分级多表现为Ⅳ级至Ⅵ级;62例恶性结节的平均AR值为1.45±0.45,82例良性结节的平均AR值为1.09±0.15,差异有统计学意义（P＜0.05）。由ROC曲线分析得出,VTI分级的最佳临界值为IV级,敏感性、特异性、准确性、阳性预测值、阴性预测值和约登指数分别为 83.5%、90.2%、87.5%、86.7%、88.1%和0.741。面积比的最佳临界值1.22,敏感性、特异性、准确性、阳性预测值、阴性预测值和约登指数为79.0%、80.5%、79.9%、75.3%、83.5%和0.495。基于logistic回归、二者联合诊断的特异性、准确性、阳性预测值、约登指数均优于VTI分级或面积比。结论 VTI成像分级和AR都可以应用于甲状腺恶性结节的诊断。基于logistic回归、二者联合的诊断模型进一步提高了诊断效能。     

超声对甲状腺结节的定位定性诊断探讨

我们采用7.5及10MHz探头检查163例甲状腺结节,均为手术和病理证女,甲状腺结节的超声定位诊断符合率100%,检出最小结节直径0.4cm。定性诊断符合率93.3%(152/163例),恶性结节符合率88.5%(23/26例),良性结节符合率94.2%(129/137例)。为提高超声诊符合断率,本文分析了甲状腺结节的声像图特征并讨论了超声对甲状腺结节定位及定性诊断的价值。