超声弹性比值法鉴别诊断甲状腺实性结节及诊断一致性

目的 探讨实时超声弹性成像比值法鉴别诊断甲状腺实性结节良恶性的价值及不同医师之间的一致性。方法 由2名有经验的医生对72例共89个甲状腺实性结节进行超声弹性成像检查,测定结节与周围腺体的弹性指数比值,绘制ROC曲线并确定鉴别甲状腺实性结节良恶性的最佳诊断临界点,以病理结果为金标准,计算敏感度、特异度、准确率、阳性及阴性预测值。分析2名医师诊断的一致性。结果 2名医师应用ROC曲线获得最佳诊断临界点均为3.40。将弹性指数比值≥3.40诊断为恶性,医师1鉴别诊断甲状腺实性结节良恶性的敏感度、特异度、准确率、阳性及阴性预测值分别为90.24%(37/41)、85.42%(41/48)、87.64%(78/89)、84.09%(37/44)、91.11%(41/45);医师2分别为90.24%(37/41)、83.33%(40/48)、86.52%(77/89)、82.22%(37/45)、90.91%(40/44)。两名医师弹性诊断一致率为96.63%(86/89),ICC值为0.98。结论 超声弹性成像比值法为甲状腺实性结节良恶性的鉴别诊断提供了定量诊断指标,具有较好的应用价值,不同医师独立完成弹性成像的定量指数比值具有良好的一致性。

Ultrasound elastography ratio in differential diagnosis of thyroid solid nodules and the diagnostic consistence

Objective To explore the value of real-time ultrasound elastography ratio method in the differential diagnosis of benign and malignant thyroid solid nodules and the consistence performed by different physicians. Methods Ultrasound elastography was performed for 72 patients with 89 thyroid nodules by two experienced physicians. The elasticity index ratio of nodules and the surrounding tissue were evaluated, a ROC curve was obtained to define the optimal cut-off value in distinguishing the benign and malignant nodules. Taking pathological results as the golden standard, the sensitivity, specificity, accuracy, positive and negative predictive value were calculated. Results The optimal cut-off value of 3.40 was determined by two physicians, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value was 90.24% (37/41), 85.42% (41/48), 87.64% (78/89), 84.09% (37/44), 91.11% (41/44) by physician 1, while it was 90.24%(37/41), 83.33% (40/48), 86.52% (77/89), 82.22% (37/45), 90.91% (40/45) by physician 2, respectively. The diagnostic consistence rate of elastic index ratio method was 96.63% (86/89) between the two physicians and the ICC value was 0.98. Conclusion Ultrasound elastography ratio method offered a quantitative indicator and has a good value for differential diagnosis of benign and malignant thyroid solid nodules. The results of elastography quantitative index ratio performed respectively by different physicians achieve a good consistence.