天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (1): 69-73.doi: 10.11958/20201168

• 临床研究 • 上一篇    下一篇

多模态超声在中、高度可疑恶性甲状腺结节鉴别中的诊断价值#br#

陆海永，李朝喜，温德惠△，王义成   

  1. 河北北方学院附属第一医院超声医学科（邮编075000）
  • 收稿日期:2020-04-27 修回日期:2020-09-02 出版日期:2021-01-15 发布日期:2021-03-12
  • 通讯作者: 李朝喜 E-mail:19519591997@163.com
  • 基金资助:
    张家口市科技局指导项目（1821052D）

Diagnostic values of multimodal ultrasound imaging in the differentiation of moderate and highly suspected malignant thyroid nodules

LU Hai-yong, LI Chao-xi, WEN De-hui△, WANG Yi-cheng   

  1. Department of Ultrosonography, the First Affiliated Hospital of Hebei North University, Hebei 075000, China
  • Received:2020-04-27 Revised:2020-09-02 Published:2021-01-15 Online:2021-03-12

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摘要： 摘要：目的　探讨多模态超声对甲状腺中、高度可疑恶性结节的诊断价值。方法　以2015美国甲状腺协会（ATA）指南为参考，采用多模态超声成像［二维超声（US）、超微血管显像技术（SMI）和剪切波弹性成像（SWE）］分析评估323个中、高度可疑恶性甲状腺结节，其中中度237个（73.4%）、高度86个（26.6%）。依据受试者工作特征（ROC）曲线，对照手术病理结果，评估SMI、SWE、US，以及联合SMI、SWE和US对中、高度可疑恶性甲状腺结节良恶性的诊断效能。结果　323个甲状腺结节经手术病理学检查确定良性结节205个（63.5%）、恶性结节118个（36.5%）。甲状腺恶性结节的血管分布模式主要以穿支血管为主；良性结节的剪切波速度最大值和平均值均低于恶性结节（均P＜0.05）；联合SMI、SWE和US的多模态超声鉴别中、高度甲状腺结节的敏感度、特异度、准确性、阳性预测值、阴性预测值和Youden指数分别为95.7%、92.7%、93.8%、91.9%、95.0%和0.884，均显著高于单一超声模式。中、高度可疑恶性甲状腺结节多模态超声的不必要细针穿刺活检（FNA）率分别为24.1%和3.5%。结论　多模态超声可以提供全面的甲状腺结节信息，有助于提高对甲状腺中、高度可疑恶性结节的诊断价值。

关键词: 甲状腺结节, 甲状腺肿瘤, 超声检查, 内镜超声引导细针穿刺, 超微血管显像技术, 剪切波弹性成像技术

Abstract: Abstract: Objective To explore the diagnostic value of multimodal ultrasound imaging in evaluating the moderate and highly suspected malignant thyroid nodules. Methods Multimodal ultrasound imaging, including two-dimensional ultrasound (US), superb microvascular imaging (SMI) and shear wave elastography (SWE), were performed in 323 moderate and highly suspected malignant thyroid nodules according to the 2015 American Thyroid Association (ATA) guideline. The diagnostic effects of SMI, SWE, US, and SMI combined with SWE and US were calculated using the ROC curve on the basis of the results of pathological results. Results The vascular distribution pattern of malignant thyroid nodules was mainly perforator vessel, the numbers of benign and malignant nodules determined by surgical pathology were 205 (63.5%) and 118 (36.5%). The vascular distribution pattern of malignant thyroid nodules was mainly perforating vessels, and the SWV values of benign nodules were less than those of malignant nodules (P＜0.05). The sensitivity, specificity, accuracy positive predictive value, negative predictive value and Youden index of SMI combined with SWE and US were 95.7%, 92.7%, 93.8%, 91.9%, 95.0% and 0.884, which were significantly higher than those of the single diagnostic modes, and the necessary FNA rates of multimodal ultrasound imaging were 24.1% and 3.5%. Conclusion Multimodal ultrasound imaging could provide comprehensive information regarding the thyroid nodule, which is helpful to improve the diagnostic value of the moderate and highly suspected malignant thyroid nodules.

Key words: thyroid nodule, thyroid neoplasms, ultrasonography, endoscopic ultrasound-guided fine needle aspiration, superb microvascular imaging, shear wave elastography