C-TIRADS联合AP技术对甲状腺皱缩结节和乳头状癌的鉴别诊断价值[ ]

摘要 目的 探讨2020甲状腺结节超声恶性危险分层中国指南（C-TIRADS）联合平面波超微细敏感血流显像（AP）技术在甲状腺皱缩结节（MTN）和乳头状癌（PTC）鉴别诊断中的价值。方法 前瞻性纳入2020年5月至2022年11月在珠海市香洲区人民医院及中山大学附属第五医院接受治疗的甲状腺结节患者234例，共234个结节，根据超声随访及病理结果分为MTN组112例和PTC组122例，分析所有结节的二维超声特征和AP血流分级，并根据AP技术校正前后的C-TIRADS进行分类诊断，构建ROC曲线分析C-TIRADS联合AP技术对MTN和PTC的诊断效能。结果 MTN与PTC相比，极低回声、垂直位和彗星尾伪像等二维超声特征差异具有统计学意义（P＜0.05）；MTN血流以0～I级为主，PTC以II～III级为主，差异具有统计学意义（P＜0.05）；校正后的C-TIRADS分类诊断能够更好地区分MTN和PTC（2 =155.564，P＜0.05）；C-TIRADS联合AP技术的ROC曲线下面积（0.928）、灵敏度（85.25%）、特异度（95.54%）、准确度（90.17%）、阳性预测值（95.41%）和阴性预测值（85.60%）均高于C-TIRADS（P＜0.05）。结论 AP技术能够清晰显示甲状腺结节内部血流特点，联合C-TIRADS可以明显提高MTN和PTC的鉴别诊断能力，有助于减少误诊。

Value of C-TIRADS combined with AP technology in differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas

ABSTRACT Objective To investigate the value of 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules (C-TIRADS) combined with angio plus planwave ultrasensitive imaging (AP) technology in the differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas. Methods A total of 234 patients who received treatment in the Xiangzhou District People''s Hospital and the Fifth Affiliated Hospital of Sun Yat-sen University from May 2020 to November 2022 were prospectively included. There were 234 thyroid nodules, which were divided into MTN group (112 cases) and PTC group (122 cases) according to ultrasonic follow-up and pathological results, and the two-dimensional ultrasound features and AP blood flow grading were analyzed. All the nodules were classified based on C-TIRADS with or without AP technology, and the ROC curve was constructed to analyze the diagnostic efficacy of C-TIRADS combined with AP technology for MTN and PTC. Results There were statistically significant differences in markedly hypoechoic, vertical orientation and comet-tail artifacts between the MTN and PTC groups (P＜0.05) . The blood flow of MTN was mainly grade 0 to I, while that of PTC was mainly grade II to III, and the difference was statistically significant (P＜0.05). After correction with AP technology, C-TIRADS could better distinguish MTN and PTC (2 =155.564，P＜0.05). The area under curve (0.928), sensitivity (85.25%), specificity (95.54%), accuracy (90.17%), positive predictive value (95.41%) and negative predictive value (85.60%) of C-TIRADS combined with AP technology were higher than those of C-TIRADS (P＜0.05). Conclusion AP technology can clearly show the blood flow characteristics in thyroid nodules, which combined with C-TIRADS can significantly improve the differential diagnostic ability of MTN and PTC, and is helpful to reduce misdiagnosis.