常规超声诊断困难的甲状腺结节的超声造影定性及定量研究

目的 探讨超声造影定性指标及定量参数对常规超声诊断困难的甲状腺结节的诊断价值。方法 在2011年11月~2015年12月就诊于北京协和医院的甲状腺结节患者中,前瞻性纳入常规超声诊断困难结节,65例患者共71个结节,所有患者均经手术治疗,术前均行常规超声和超声造影检查。以手术病理结果为金标准,分析超声造影灌注模式及时间强度曲线指标在良恶性鉴别中的意义。结果 恶性组10个(14.1%)结节,其中5个乳头状癌,5个滤泡癌;良性组61个(85.9%)结节,其中44个(72.1%)结节性甲状腺肿,14个(23.0%)腺瘤,3个(4.9%)桥本甲状腺炎。恶性组最大径2.80±1.48cm,良性组最大径2.89±1.35cm,两组比较差异无统计学意义(P>0.05)。超声造影灌注增强模式在良恶性组间差异有统计学意义(P<0.05),不均匀增强的模式更易发生于恶性病变,诊断敏感度、特异性、阳性预测值及阴性预测值分别为50.0%、95.1%、62.5%、92.1%。余超声造影定性指标(增强方向、增强程度)和超声造影定量参数(增强始增时间、达峰时间、峰值强度、峰值降半时间和相对达峰时间、相对达峰强度)在良恶性病变中差异均无统计学意义(P>0.05)。结论 超声造影增强模式有助于鉴别常规超声诊断困难的甲状腺结节,其他指标均无法有效鉴别良恶性。

Qualitative and Quantitative Diagnosis of Indeterminate Thyroid Nodules Evaluated by Conventional Ultrasound Using Contrast-enhanced Ultrasound

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in qualitative and quantitative diagnosis of indeterminate thyroid nodules evaluated by conventional ultrasound (CUS). Methods From November 2011 to December 2015 at Peking Union Medical College Hospital, 71 thyroid nodules in 65 patients were prospectively enrolled in this study. All of them had surgical excision, and CUS and CEUS examinations were performed before operation. With surgical pathology as gold standard of diagnosis, the value of patterns of CEUS and indices of time-intensity curves in the differentiation of indeterminate thyroid nodules was analyzed. Results There were 10 nodules (14.1%) in malignant group (5 papillary thyroid carcinomas and 5 follicular carcinomas), 44 nodules (85.9%) in benign group (44 goiters, 14 adenomas and 3 Hashimoto''s thyroiditis). There was no statistical difference between the largest diameter of malignant and benign groups (2.80±1.48cm vs 2.89±1.35cm). The patterns of CEUS were statistically different between two groups. Heterogeneous enhancement were common in malignant nodules, and the sensitivity, specificity, positive predictive value and negative predictive value were 50.0%, 95.1%, 62.5% and 92.1%, respectively. Others indices were all insignificant, such as direction and intensity of enhancement, arrival time/time to peak/peak intensity/time from peak to one half/ relative time to peak/ relative peak intensity of time-intensity curves(P>0.05). Conclusion Enhancement patterns of CEUS were helpful in diagnosis of the indeterminate thyroid nodules of CUS. Other indices of CEUS were not useful.