血流阻力指数与搏动指数对甲状腺实性结节鉴别诊断价值分析

目的：探讨频谱多普勒超声测定甲状腺结节内血流阻力指数（resistanceindex，RI）和搏动指数（pulseindex，PI）对鉴别结节良恶性的价值。方法：对2012-0106-2012-12-26宜昌市中心人民医院528例患者的178个甲状腺实性结节行超声检查，观察结节的大小、边界、周边声晕、内部回声、后方回声、钙化、结节与甲状腺被膜的关系等灰阶超声表现；彩色多普勒超声检测结节周边及内部的血流，测量每个结节的RI和PI值。根据细针抽吸活纽织检查或术后病理结果将结节分为良性和恶性，应用ROC曲线分析灰阶超声、RI和PI值鉴别甲状腺结节良恶性的价值。结果：甲状腺恶性结节与纵横比≥1、边界不规则、周边无声晕、微小钙化、低回声、后方回声衰减及结节突破甲状腺被膜等灰阶超声特征显著相关。RI和PI值在良恶性结节之间差异有统计学意义，P〈0．01；ROC曲线分析RI和PI值预测恶性结节的最佳临界值分别为0．70和1．04，曲线下面积分别为0．805和0．819。灰阶超声、RI≥0．70、PI≥1．04及灰阶超声联合RI和PI值鉴别结节良恶性的准确率分别为87．6％、72．5％、66．9％和91．0%。结论：超声测定甲状腺结节内血流的RI和PI值有助于鉴别其良恶性，结合灰阶超声表现可提高对甲状腺结节良恶性诊断的敏感性、特异性及准确率。

Value of resistance index and pulsatility index in differentiation between malignant and benign thyroid solid nodules

OBJECTIVE： To evaluate the utility of the resistance index （RI） and pulsatility index （PI） in the diagno sis of benign and malignant thyroid solid nodules. METHODS： Prospective cervical ultrasound （US） examinations were performed in 528 patients （127 male,401 female） with 178 thyroid solid nodules confirmed by pathology post surgery or fine-needle aspiration biopsy （FNAB）. Each nodule was described according to size, borders, peripheral halo formation, pa renchymal echogenicity,astern echoes,the presence of calcification and the relationship between thyroid capsule and nodule. All nodules were examined by color Doppler flow imaging to observe the peripheral and internal blood flow of the nod ules. RI and PI values were calculated from the central and peripheral arteries of thyroid nodules by standard software of US equipment. RESULTS： FNAB and surgical pathological examination were used as a proof of final diagnosis to categorize all nodules as benign or malignant. Gray scale US, the cutoff value of the RI and PI values in the diagnosis of benign and malignant nodules were analysed using ROC analysis. A significant relationship was observed between malignancy and tallerhan-wide shape,irregular margins, absence of peripheral halo, microcalcification, hypoechoic, astern echoes attenuation, breakthrough thyroid envelope on ultrasound examination. There were significant differences between benign and ma lignant thyroid nodules on the RI and PI values（P〈0.01）. The cutoff value of RI and PI values at maximum sensitivity and specificity for nodules were respectively 0.70 （AUC：0. 805） and 1.04 （AUC：0. 819）. The accuracy of gray-scale US, RI values,PI values,gray-scale US combined RI and PI values in the diagnosis of benign and malignant nodules were respectively 87.6% ,72.5% ,66.9%和91.0%. CONCLUSIONS： RI and PI values are useful in distinguishing malignant frombenign thyroid nodules. Combination RI and PI values and gray-scale US might remarkably increase the sensitivity, specifitivity and accuracy of differential diagnosis of benign and malignant thyroid nodules.