摘要
目的探讨甲状腺影像学报告和数据系统(TI-RADS)、超声剪切波弹性成像(SWE)、超微血管成像技术(SMI)联合应用对甲状腺良恶性结节的鉴别诊断价值。方法将晋中市中医院2015年1月至2017年7月收治的104例甲状腺结节患者纳入研究,所有患者均行SWE、SMI检查及TI-RADS评分分级,以联合评分法重新调整TI-RADS量化分级,以手术病理学检查结果为金标准,绘制受试者工作特征曲线(ROC),比较曲线下面积(AUC)及诊断甲状腺良恶性结节的敏感度、特异度。结果104例患者中共有157个甲状腺结节,其中良性结节107个,恶性结节50个;TI-RADS分级诊断恶性甲状腺结节的准确率为90.00%(45/50),当AUC为0.930(95%CI 0.896~0.964)时,TI-RADS分级鉴别诊断甲状腺良恶性结节的敏感度为89.61%,特异度为93.10%;良性结节的SWE杨氏模量值为(23.15±10.69)kPa,高于恶性结节的(59.75±21.19)kPa,差异有统计学意义(t=15.951,P<0.001);当AUC为0.930(95%CI 0.889~0.973)时,取40.10 kPa为诊断临界值,SWE诊断甲状腺良恶性结节的敏感度为86.09%,特异度为83.91%;当AUC为0.876(95%CI 0.865~0.887)时,SMI检查诊断甲状腺良恶性结节的敏感度为82.49%,特异度为94.41%,其敏感度、特异度高于SWE检查(χ2=7.437,P<0.001);当AUC为0.960(95%CI 0.940~0.980)时,联合评分诊断甲状腺良恶性结节敏感度、特异度最高,分别为95.00%、94.19%,其敏感度、特异度高于单纯TI-RADS评分法(χ2=13.613,P<0.001)。结论TI-RADS、SWE与SMI三种方式联合检查可显著提高甲状腺良恶性结节诊断的敏感度、特异度,值得临床推广。
Objective To investigate the value of thyroid imaging-reporting and data system (TI-RADS) combined with shear wave elastography (SWE) and superb microvascular imaging (SMI) in the differentiation of benign and malignant thyroid nodules. Methods A total of 104 patients with thyroid nodules admitted to Jinzhong Hospital of Traditional Chinese Medicine from January 2015 to July 2017 were selected. All the nodules underwent SWE, SMI and TI-RADS grading. The quantitative score was gotten by the TI-RADS system and the results were confirmed by the pathology examination. According to the readjusted TI-RADS system and pathologic results, the receiver operating characteristic curve (ROC) was drawn to evaluate the sensitivity and specificity of benign and malignant thyroid nodules by the area under curve (AUC). Results There were 157 pathologically proven thyroid nodules (104 patients) including 107 benign lesions and 50 malignant lesions. When the AUC was 0.930 (95%CI: 0.896-0.964), the sensitivity and specificity of TI-RADS were 89.61% and 93.10%, respectively. The SWE Young’s modulus value of benign nodules was (23.15±10.69)kPa, which was significantly higher than (59.75±21.19)kPa of malignant nodules (t=15.951, P<0.001). When the AUC was 0.930 (95%CI: 0.889-0.973), the value of 40.10 kPa was considered as the critical value for diagnosis, and the sensitivity and specificity of SWE were 86.09% and 83.91% respectively. When the AUC was 0.876 (95%CI: 0.865-0.857), the sensitivity and specificity of SMI were the highest (82.49%, 94.41%), which were higher than those of the SME (χ2=7.437, P<0.001). When the AUC was 0.960 (95%CI: 0.940-0.980), the sensitivity and specificity of the comined grading diagnosis were the highest (95.00%, 94.19%), which were higher than those of the TI-RADS (χ2=13.613, P<0.001). Conclusions Combined examination of TI-RADS, SWE and SMI can significantly improve the sensitivity and specificity of diagnosis of benign and malignant thyroid nodules and it is worthy of clinical promotion.
作者
李永红
Li Yong hong(Functional Department, Jinzhong Hospital of Traditional Chinese Medicine, Jinzhong 030600, China)
出处
《中国实用医刊》
2019年第1期47-50,共4页
Chinese Journal of Practical Medicine
作者简介
通信作者:李永红,Email:z58d5t@163.com.
