超级微血管成像技术在甲状腺实性结节良恶性鉴别诊断中的应用价值

目的通过比较彩色多普勒血流成像（CDFI）、超级微血管成像（SMI）显示甲状腺实性结节的血供特征、血流分布模式，探讨SMI技术对甲状腺实性结节良恶性鉴别诊断的应用价值。 方法选择2014年5至7月复旦大学附属华东医院收治的甲状腺结节患者47例，共68个甲状腺实性结节。所有甲状腺实性结节均经手术病理证实。应用CDFI、SMI观察甲状腺实性结节的血供特征、血流分布模式，并对甲状腺实性结节血流分布模式进行分型。采用χ²检验比较CDFI与SMI显示甲状腺结节血流分布模式差异。以手术病理结果作为金标准，计算CDFI、SMI鉴别诊断甲状腺实性结节良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值。 结果68个甲状腺实性结节中，良性结节41个，恶性结节27个。CDFI、SMI显示良性甲状腺实性结节以周边型（Ⅱ型）、混合型（Ⅳ型）血流分布模式为主；恶性甲状腺实性结节多为中央型（Ⅲ型）血流分布模式。SMI显示血流更敏感；SMI对良性甲状腺实性结节Ⅱ型、恶性甲状腺实性结节Ⅲ型血流分布模式显示率均高于CDFI68.3%（28/41） vs 46.3%（19/41），77.8%（21/27） vs 37.0%（10/27）]，且差异均有统计学意义（χ²=4.04，P<0.05；χ²=9.16，P<0.01）；而SMI对良性甲状腺实性结节Ⅰ、Ⅲ、Ⅳ型，恶性甲状腺实性结节Ⅰ、Ⅱ、Ⅳ型血流分布模式显示率与CDFI比较差异均无统计学意义。以手术病理结果作为金标准，以Ⅱ型、Ⅳ型血流分布模式诊断为良性甲状腺实性结节，Ⅲ型血流分布模式诊断为恶性甲状腺实性结节，CDFI、SMI鉴别诊断甲状腺实性结节良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为63.0%、80.5%、73.5%、68.0%、76.7%，88.9%、95.1%、92.9%、92.6%、92.3%。 结论SMI对血流显示更敏感，对甲状腺实性结节良恶性的鉴别诊断具有一定价值。

The value of superb micro-vascular imaging for diagnosis of thyroid nodules

ObjectiveTo evaluate the value of superb mircovascular imaging (SMI) for differentiating benign from malignant thyroid nodules by observing the flow distribution characteristics of thyroid solid nodules. MethodsFrom May to June 2014, patients, come from Huadong Hospital of Fudan University, with 68 thyroid nodules were preoperatively evaluated with color Doplor flow image (CDFI) and SMI. All the thyroid nodules were confirmed by pathology. The flow pattern and the color characteristics of thyroid nodule were observed and compared between those two flow imaging technology. The Chi-square test was used to compare the distribution of nodules blood flow patterns between CDFI and SMI and the results were compared with the pathology results. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated and analyzed. ResultsFor 68 nodules, 41 were benign and 27 were malignant. Both CDFI and SMI showed that malignant nodules were mostly central type vascularization (Ⅲ), whereas the benign nodules were mainly peripheral (Ⅱ) and mixed type vascularization (Ⅳ). SMI is more sensitively in display the nodules blood flow. For benign solid nodules with blood flow distribution type Ⅱ and malignant type Ⅲ, the display rates of SMI are higher than those of the CDFI 68.3% (28/41) vs 46.3% (19/41), 77.8% (21/27) vs 37.0% (10/27)], the differences were statistically significant (χ²=4.04, P<0.05; χ²=9.16, P<0.01). For benign solid nodules with blood flow distribution type Ⅰ, Ⅲ and Ⅳ and malignant solid nodules with blood flow distribution type Ⅰ, Ⅱ and Ⅳ, there were no significant differences between SMI and CDFI. In this study, pathological diagnosis was used as gold standard, nodules with blood flow type Ⅱ and Ⅳ were diagnosed as benign and nodules with blood flow type Ⅲ diagnosis were diagnosed as malignant. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SMI and CDFI in the diagnosis of thyroid solid nodules were 63.0% vs 88.9%, 80.5% vs 95.1%, 73.5% vs 92.9%, 68.0% vs 92.6%, 76.7% vs 92.3%, respectively. ConclusionSMI is more sensitive to show the real flow and contribute a certain value in differential diagnosis of benign and malignant thyroid nodules.