超微血管成像及超声造影在甲状腺结节鉴别诊断中的应用

目的：比较超微血管成像(superb microvascular imaging，SMI)与超声造影(contrast enhanced ultrasound，CEUS)对甲状腺结节鉴别诊断的价值，并进一步研究SMI和/或CEUS与二维超声甲状腺影像报告及数据系统(thyroid imagingreporting and data system，TI-RADS)联合应用是否可以提高其诊断价值。方法：分别运用SMI，CEUS，二维超声TIRADS，二维超声TI-RADS联合CEUS，二维超声TI-RADS联合SMI，二维超声TI-RADS与SMI和CEUS 3项联合对甲状腺结节进行良恶性鉴别诊断。将甲状腺结节二维超声TI-RADS分类4b~5类，CEUS低增强，SMI周边为主型血流分布并穿支血管检出作为恶性征象。以术后病理或细针穿刺细胞学检查结果作为参考标准对比其诊断效力。结果：237例患者共296个甲状腺结节被纳入研究。敏感性、特异性、准确率在二维超声TI-RADS诊断时分别为78.4%，77.7%，78.0%；在SMI诊断时分别为75.5%，86.6%，81.4%；在CEUS诊断时分别为82.0%，88.5%，85.5%；在二维超声TI-RADS与SMI和CEUS 3项联合诊断时分别为92.1%，90.4%，91.2%。受试者工作特征曲线下面积(area under the receiver operatingcharacteristic curve，AUROC)在SMI，CEUS，二维超声TI-RADS之间差异无统计学意义(χ2=4.29，P=0.117)；二维超声TI-RADS联合CEUS(χ2=39.62，P<0.001)，二维超声TI-RADS联合SMI(χ2=36.61，P<0.001)均优于二维超声TI-RADS；二维超声TI- RA DS与SMI，CEUS 3项联合诊断优于二维超声TI- RA DS联合SMI(χ2=4.50，P=0.033)或二维超声TI- RA DS联合CEUS(χ2=4.24，P=0.039)。结论：SMI周边为主型血流分布并穿支血管检出对诊断甲状腺癌具有较高的诊断价值，与CEUS低增强具有相当的诊断效力。SMI和/或CEUS与二维超声TI- RA DS联合应用均可以提高甲状腺结节的鉴别诊断效力。

Application of superb microvascular imaging and contrast enhanced ultrasound in the differential diagnosis of thyroid nodules

Objective: To compare the clinical value of superb microvascular imaging (SMI) and contrastenhanced ultrasound (CEUS) in the diff erential diagnosis of thyroid nodules, and to further studywhether the combination of SMI and/or CEUS with thyroid imaging reporting and data system(TI-RADS) can improve the diagnostic value of TI-RADS.Methods: SMI, CEUS, TI-RADS, TI-RADS combined with CEUS, TI-RADS combined with SMI,TI-RADS combined with SMI and CEUS were used to differentiate thyroid nodules. TI-RADS 4b,5 categories in two-dimensional ultrasound, hypoenhancement in CEUS, and peripheral blood flowwith penetrating vessels in SMI were considered malignant signs. The diagnostic efficacy of thesemethods was compared according to post-operative pathology or fine needle aspiration cytology.Results: A total of 237 patients with 296 thyroid nodules were included in the study. The sensitivity,specificity and accuracy for TI-RADS were 78.4%, 77.7% and 78.0% respectively, 75.5%, 86.6% and81.4% in SMI, 82.0%, 88.5% and 85.5% in CEUS, 92.1%, 90.4% and 91.2% in TI-RADS combinedwith SMI and CEUS. Area under the receiver operating characteristic curve (AUROC) showedno significant difference between SMI, CEUS, TI-RADS (χ2=4.29, P=0.117). AUROC of bothTI-RADS combined with CEUS (χ2=39.62, P<0.001), TI-RADS combined with SMI (χ2=36.61,P<0.001) were higher than TI-RADS. AUROC of TI-RADS combined with SMI and CEUS washigher than TI-RADS combined with SMI (χ2=4.50, P=0.033) or TI-RADS combined with CEUS(χ2=4.24, P=0.039).Conclusion: Peripheral blood flow with penetrating vessels in SMI possesses high diagnostic valuein differentiating thyroid cancer. The combination of SMI and/or CEUS with TI-RADS can be usedto improve the diagnostic efficacy of TI-RADS in differential diagnosis of thyroid nodules.