超声造影对甲状腺影像报告和数据系统4类结节的诊断价值

目的 探讨超声造影(contrast-enhanced ultrasound, CEUS)对甲状腺影像报告和数据系统(thyroid imaging reporting and data system,TI-RADS)4类结节的恶性风险及临床诊断价值。方法 分析226例甲状腺患者的结节特征,依据Kwak制定标准进行分类,其中TI-RADS 4A、4B和4C类结节纳入研究中,所有结节均行CEUS检查。CEUS结果与病理结果对照。结果 226个TI-RADS 4类结节中,CEUS诊断恶性为106个,良性为120个,术后病理诊断恶性110为个,良性为116个,CEUS诊断4类结节的准确性、敏感度、特异度、阳性预测值及阴性预测值,分别为91.15%、89.09%、93.10%、89.91%和89.74%。CEUS诊断4类结节结果和病理结果比较,具有较高的一致性,Kappa值0.823(P＜0.001)。CEUS诊断4A、4B和4C类结节的实际恶性率,分别为14.06%(9/64)、47.53%(48/101)和86.89%(53/61)。 结论 CEUS检查对TI-RADS 4类甲状腺结节具有较高的诊断价值。有助于指导TI-RADS 4类甲状腺可疑结节临床后续决策。

Diagnostic Value of Contrast-enhanced Ultrasound in Four Nodules of Thyroid Imaging Reporting and Data System

Objective To explore the malignant risk and clinical diagnostic value of contrast-enhanced ultrasonography(CEUS)for thyroid imaging reporting and data system(TI-RADS)class 4 thyroid nodules. Methods The characteristics of nodules in 226 thyroid patients were analyzed and classified according to Kwak criteria. TI-RADS 4A, 4B and 4C nodules were included in the study. All nodules were examined by CEUS. The results of CEUS were compared with those of pathology. Results Of 226 TI-RADS 4 nodules, 106 were malignant and 120 were benign by CEUS, 110 were malignant and 116 were benign by pathology after operation. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of CEUS in the diagnosis of 4 types of nodules were 91.15%, 89.09%, 93.10%, 89.91% and 89.74%, respectively.The results of CEUS in the diagnosis of 4 types of nodules were consistent with those of pathology. The Kappa value was 0.823 (P < 0.001).The actual malignant rates of CEUS in the diagnosis of 4A, 4B and 4C nodules were 14.06% (9/64), 47.53% (48/101) and 86.89% (53/61), respectively.Conclusion CEUS examination has high diagnostic value for TI-RADS class 4 thyroid nodules. It is helpful to guide the clinical follow-up decision-making of TI-RADS class 4 thyroid suspected nodules.