摘要
目的 分析中国版甲状腺影像报告和数据系统(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS)分级结合超声剪切波弹性成像(shear wave elastography,SWE)、超微血管成像技术(super microvascular imaging,SMI)诊断甲状腺结节良恶性的应用价值.方法 回顾性分析汕头市中心医院超声医学科125例甲状腺结节手术患者的临床资料,男35例,女90例;病程(3.45±1.32)年,范围3个月～7年;年龄(55.45±3.31)岁,范围25～70岁;结节最大径(12.13±5.76)mm,范围5.0～42.9 mm.分析患者超声检查结节C-TIRADS分类、SWE、SMI及病理诊断结果,分析C-TIRADS分类、SWE、SMI及联合诊断恶性结节时的诊断效能,使用SPSS 21.0软件分析数据,计量资料符合正态分布,两组比较行独立t检验;计数资料以率(％)表示,采用x2检验.结果 本次共检出180个病灶,经病理诊断,良性结节114个,恶性结节66个.C-TIRADS 4B类结节中恶性百分率占比最高,达72.00％(36/50);恶性结节Emix、Emax、Emean分别为(15.98±6.56)kPa、(84.22±24.23)kPa、(63.29±15.89)kPa,显著高于良性结节的(13.56±4.68)kPa、(48.33±14.46)kPa、(37.32±12.63)kPa(t=2.49、8.76、9.07,P＜0.05).甲状腺结节SMI分型中IV型恶性占比最高,为78.95％;联合诊断的敏感性、特异性、准确率、阳性预测值、阴性预测值分别为94.64％、92.85％、94.64％、42.85％、90.16％,高于单一 C-TIRADS 分类(89.65％、75.00％、89.65％、37.50％、80.55％)、SMI(82.35％、55.56％、89.36％、32.60％、78.33％)、SWE诊断(81.08％、56.00％、90.22％、28.57％、77.22％),差异有统计学意义(P＜0.05).结论 相较于SWE、SMI与C-TIRADS分类单独检查诊断效能,三者联合使用对甲状腺良恶性结节诊断效能更高,可减少或避免侵入性操作的滥用.
Abstract
Objective To analyze the Chinese thyroid imaging reporting and data system(C-TIRADS)classification combined with ultrasonic shear wave elastography(SWE)and super microvascular imaging technolo-gy(SMI)in the diagnosis of benign and malignant thyroid nodules.Methods Clinical data of 125 patients under-going thyroid nodule surgery in the Department of Ultrasound Medicine,Shantou Central Hospital were retrospec-tively analyzed.There were 35 males and 90 females.The disease duration was(3.45±1.32)years,ranging from 3 months to 7 years;the age was(55.45±3.31)years old,ranging from 25 to 70 years old;the maximum diameter of the nodule is(12.13±5.76)mm,ranging from 5.0 to 42.9 mm.C-TIRADS classification,SWE,SMI and pathologi-cal diagnosis results of ultrasonic nodules in patients were analyzed.The diagnostic performance of C-TIRADS clas-sification,SWE,SMI and combined diagnosis of malignant nodules were analyzed.SPSS 21.0 software was used to analyze the data,and the measurement data were consistent with the normal Statistical distribution,independent t test was performed for comparison between two groups;count data were expressed as rate(％),and x2 test was used.Results A total of 180 lesions were detected this time.According to pathological diagnosis,there were 114 benign nodules and 66 malignant nodules;the malignant percentage of C-TIRADS 4B nodules was the highest,reaching 72.00％(36/50);Emix of malignant nodules,Emax and Emean were(15.98±6.56)kPa,(84.22±24.23)kPa and(63.29±15.89)kPa respectively,which were significantly higher than those of benign nodules(13.56±4.68)kPa,(48.33±14.46)kPa and(37.32±12.63kPa)(t=2.49,8.76,9.07,P＜0.05);Type Ⅳ malignancy account-ed for the highest proportion in SMI classification of thyroid nodules,which was 78.95％;the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of the joint diagnosis were 94.64％,92.85％,94.64％,42.85％,90.16％,higher than the single C-TIRADS classification(89.65％,75.00％,89.65％,37.50％,80.55％),SMI(82.35％,55.56％,89.36％,32.60％,78.33％),and SWE diagnosis(81.08％,56.00％,90.22％,28.57％,77.22％).The difference was statistically significant(P＜0.05).Conclusions Compared with the diag-nostic efficiency of SWE,SMI and C-TIRADS classification alone,the combined use of the three has higher diag-nostic efficiency for benign and malignant thyroid nodules.The abuse of invasive procedures can be reduced or avoided.
基金项目
汕头市科技计划医疗卫生类别项目(191221235263410)
NETL
NSTL
万方数据