摘要
目的评价多模态超声成像诊断甲状腺影像报告和数据系统(TI-RADS)高分类的意义不明确的细胞非典型病变(AUS)甲状腺结节的价值。方法对88例患者共90个TI-RADS 3~5类AUS甲状腺结节同时采用常规超声、超声弹性成像、超微血管成像、多模态超声成像检查,以甲状腺细针抽吸活检(FNAB)病理检查结果为金标准,比较不同超声方法诊断甲状腺结节的敏感度、特异度、准确率、假阳性率、假阴性率及受试者工作特征(ROC)曲线下面积(AUC)。结果良恶性甲状腺结节患者性别构成、年龄构成、位置差异均无统计学意义(P均>0.05),但恶性结节中≤1 cm的甲状腺结节比例显著高于良性结节(χ^(2)=9.610,P=0.002)。恶性甲状腺结节中结节呈低回声/极低回声比例、边界模糊结节比例、结节纵横比>1比例及结节呈微小钙化/无钙化特征比例显著多于良性结节(P均<0.05),超声弹性成像评分为≥3分及超微血管成像分型为III型血流模式提示恶性结节可能性更高(P均<0.001)。多因素logistic回归分析结果显示,甲状腺结节大小、回声、边界、纵横比及超微血管成像分型均与甲状腺结节良恶性无统计学意义(P均>0.05),而微小钙化/无钙化和超声弹性成像评分≥3分是AUS甲状腺恶性结节的独立危险因素(P均<0.05)。常规超声诊断AUS甲状腺结节良恶性的敏感度、特异度、准确度、假阳性率、假阴性率分别为91.30%、71.40%、62.70%、28.60%和8.70%,超声弹性成像分别为85.50%、66.70%、52.20%、33.30%和14.50%,超微血管成像分别为66.70%、76.20%、42.90%、23.80%和33.30%,多模态超声成像分别为75.20%、92.50%、67.70%、24.80%和7.50%。常规超声、超声弹性成像、超微血管成像、多模态超声成像诊断AUS甲状腺结节良恶性的AUC值分别为0.866、0.745、0.774和0.918。结论多模态超声成像可提高常规超声、超声弹性成像、超声血管成像用于诊断TIRADS 3~5类AUS甲
Objective To assess the value of multimodal ultrasonography for diagnosing thyroid nodules—atypia of undetermined significance(AUS)of thyroid imaging reporting and data system(TI-RADS)categories 3 to 5.Methods A total of 90 AUS thyroid nodules in TI-RADS 3-5 categories from 88 patients underwent conventional ultrasonography,ultrasound elastography,superb microvascular imaging,and multimodal ultrasonography at the same time.With fine needle aspiration biopsy results as the gold standard,the methods were compared in terms of the sensitivity,specificity,accuracy,false positive rate(FPR),false negative rate(FNR),and area under the receiver operating characteristic curve(AUC)for diagnosing thyroid nodules.Results There were no significant differences between patients with benign and those with malignant thyroid nodules in terms of sex,age,and nodule locations(all P>0.05),but the proportion of thyroid nodules≤1 cm in diameter was significantly higher for malignant thyroid nodules than for benign thyroid nodules(χ^(2)=9.610,P=0.002).Compared with benign nodules,malignant nodules were significantly more frequent to have low-level echoes or very lowlevel echoes,a blurred margin,a vertical diameter/horizontal diameter ratio of>1,and microcalcifications or no calcifications(all P<0.05).An ultrasound elastography score of≥3 and type III vascularity on superb microvascular imaging indicated a higher possibility of malignant thyroid nodules(both P<0.001).The multivariable logistic regression analysis showed that the size,echogenicity,margin,and vertical diameter/horizontal diameter ratio,and superb microvascular imaging type of thyroid nodules were not significant markers for benign or malignant thyroid nodules(all P>0.05),while microcalcifications/no calcifications and an ultrasound elastography score of≥3 were independent risk factors for malignant AUS nodules(both P<0.05).The diagnostic sensitivity,specificity,accuracy,FPR,and FNR of conventional ultrasonography for AUS nodules were 91.30%,71.40%,62.70%,28.60%,and
作者
黄瑞娟
丛淑珍
林振意
梁艳艳
雷嘉加
HUANG Ruijuan;CONG Shuzhen;LIN Zhenyi;LIANG Yanyan;LEI Jiajia(Department of Ultrasound,Guangdong Provincial People’s Hospital Affiliated to Southern Medical University(Guangdong Academy of Medical Sciences),Guangzhou 510080 China;Department of Ultrasound,Yangjiang Municipal People’s Hospital,Yangjiang 529500 China;The First Department of Cardiology,Yangjiang Municipal People’s Hospital,Yangjiang 529500 China)
出处
《中国辐射卫生》
2024年第3期346-352,共7页
Chinese Journal of Radiological Health
基金
国家自然科学基金项目(8190070543)
广东省广州市科技计划项目(202002030235)。
关键词
甲状腺结节
多模态超声成像
超声弹性成像
超微血管成像
诊断价值
Thyroid nodule
Multimodal ultrasonography
Ultrasound elastography
Superb microvascular imaging
Diagnostic value
