超微血管显像技术在甲状腺2015ATA中高度可疑恶性结节诊断中的应用价值

目的:探讨了超微血管显像技术(SMI)评估2015ATA中高度可疑恶性结节性质的临床价值。方法:回顾分析了2017年10月-2019年7月在河北北方学院经超声检测的321例中高度可疑恶性甲状腺结节。应用CDFI和SMI技术对所有结节内部的血管分布模式进行观察，并对比二者的差异。依据受试者工作特征曲线，对照FNA和或手术病理学结果，计算SMI，常规二维超声以及SMI联合常规二维超声评估甲状腺结节性质的诊断效能，在放射医师对病理结果不知情的情况下，对纳入结节是否需要FNA进行判断，计算不必要FNA率。结果:与CDFI相比，SMI对结节内血管分布的检测能力更强，其检测出具有穿支型血管的高度可疑恶性结节数量显著高于CDFI；SMI联合常规二维超声鉴别中高度甲状腺结节的敏感性，特异性，准确性，阳性预测值和阴性预测值分别为89.2%，93.5%，91.9%，82.3%和98.4%，均显著高于上述两种单一诊断模式；在常规二维超声检查后引入SMI，中高度可疑恶性甲状腺结节的不必要恶性率分别为29.3%和2.8%，显著低于常规二维超声。结论:SMI不仅可以弥补二维超声的不足，提高2015ATA中高度可疑恶性结节良恶性的诊断价值，有助于降低不必要的FNA检查。

Diagnostic value of supermicrovascular imaging in evaluating the 2015ATA intermediate suspicion,high suspicion thyroid nodules

Objective:To explore the diagnostic value of SMI in evaluating the 2015ATA intermediate,high suspicion thyroid nodules.Methods:321 cases of intermediate and high suspicion thyroid noduleschecked at Hebei North University from October 2017 to July 2019 were retrospectively analyzed.CDFI and SMI techniques were used to observe the vascular distribution patterns in all nodules,and the differences in vascular distribution patterns between the two techniques were compared.According to the results of FNA or pathological results,the diagnostic efficacy of SMI,two-dimensional ultrasound,and SMI combined with two-dimensional ultrasound was calculatedusing the ROC curve.The radiologists determine whether FNA is needed for the nodules,blinded to FNA data and the final diagnoses.Thus the unnecessary FNA rate can be obtained. Results: Compared with CDFI,SMI had a stronger ability to detect the distribution of blood vessels.The number of high suspicion nodules with perforating vessels was significantly higher than that of CDFI.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of SMI combined with two-dimensional ultrasound to identify was 89.2%,93.5%,91.9%,82.3%,and 98.4%,which was significantly higher than those of the two single diagnostic modes.Introducing SMI after two-dimensional ultrasound examination,the unnecessary FNA rate of intermediate and high suspicion thyroid nodules was 29.3% and 2.8%,significantly lower than those of two-dimensional ultrasound. Conclusion: SMI can not only make up for the deficiency of two-dimensional ultrasound,but also increase the diagnostic value of 2015ATA intermediate,high suspicion thyroid nodules,which is beneficial to reduce the unnecessary FNA rate.