摘要
目的弹性成像技术存在敏感度差等不利因素,因此限制了该技术在甲状腺结节诊断中的应用,本研究以弹性应变率比值(SR)法为基础,针对不同大小的甲状腺结节采用不同的SR计算方法,以探讨不同SR计算方法在甲状腺结节良恶性鉴别中的应用价值。资料与方法回顾性分析行甲状腺弹性超声检查、超声引导下甲状腺细针穿刺的336例患者共340个结节,以细胞病理结合随访为标准,分析固定面积法和实际面积法在不同大小甲状腺结节良恶性鉴别中的差异。结果超声诊断340个结节中,小结节91例,大结节249例。病理诊断91例小结节中恶性36例,良性55例;249例大结节中恶性104例,良性145例。对于纵、横径均≤8 mm的小结节,实际面积法判断恶性肿瘤与病理的一致性更优(χ2=20.89,P<0.01);对于纵径/横径>8 mm的大结节,固定面积法更优(χ2=57.08,P<0.01)。实际面积法诊断恶性结节的敏感度为57.10%,特异度为83.00%,符合率为72.30%(Kappa=0.413);固定面积法的诊断敏感度为73.60%,特异度为85.00%,符合率为80.30%(Kappa=0.590);根据结节大小选择性使用两种方法诊断的敏感度为85.00%,特异度为85.50%,符合率为85.30%(Kappa=0.699)。根据结节大小选择性使用两种方法诊断的敏感度最高,与病理诊断的一致性检验较单一方法更高(Kappa=0.699,P<0.01)。结论根据甲状腺结节大小选择性使用固定面积法和实际面积法可以明显提高弹性成像诊断恶性甲状腺结节的敏感性。
Purpose The restriction of strain ratio（SR） in the diagnosis of thyroid malignant tumor are caused mainly because of disadvantages including low sensitivity,in this research the authors used different calculation methods of strain ratio based on the size of tumors,to explore the clinical application value of them on the differentiation of benign and malignant thyroid nodules. Materials and Methods Data of 336 patients with thyroid nodule（340 nodules） who underwent elasticity imaging and ultrasound-guided fine-needle aspiration were retrospective analyzed,with the pathology combined follow up acted as golden standards,fixed surface area assay and true surface area assay of strain ratio were compared on the differential diagnosis of benign and malignant thyroid nodules with various size. Results Among 340 thyroid nodules,there were 91 small nodules and 249 big nodules. Pathological results showed that 36 of 91 small nodules and 104 of 249 big nodules were malignant,while the others were benign. The true surface area assay was significantly better for the diagnosis of smaller thyroid nodules with longitudinal diameter and transverse diameter8 mm with higher consistency with pathology（χ^2=20.89,P〈0.01）,and fixed surface area assay is more suitable of thyroid nodules with longitudinal diameter and transverse diameter8mm（χ^2=57.08,P〈0.01）. The sensitivity,specificity and consistency for the diagnosis of malignant nodules of true surface area assay were 57.10%,83.00% and 72.30%（Kappa=0.413）,which were 73.60%,85.00% and 72.30%（Kappa=0.590） in the fixed surface area assay,and 85.00%,85.50% and 85.30%（Kappa=0.699） in the selective usage of two methods according to the tumor size,respectively. Conclusion The sensitivity is highest when using the two methods selectively according to the nodule size,with a better consistence rate with pathological results as well.
出处
《中国医学影像学杂志》
CSCD
北大核心
2015年第9期663-666,共4页
Chinese Journal of Medical Imaging
基金
南京市医学科技发展项目(YKK13084)
关键词
甲状腺结节
甲状腺肿瘤
超声检查
多普勒
彩色
弹性成像技术
病理学
临床
诊断
鉴别
Thyroid nodule
Thyroid neoplasms
Ultrasonography
Doppler
color
Elasticity imaging techniques
Pathology
clinical
Diagnosis
differential
