| 摘要: |
| 摘 要 目的 探讨常规超声联合超声造影在TI-RADS 3类和4类甲状腺微小结节中的诊断价值。方法 选取经病理和临床证实的TI-RADS 3类和4类甲状腺孤立性微小结节患者88例，回顾性分析其常规超声（结节大小、纵横比（A/T）、边界、回声、微钙化、血流信号、颈部周围淋巴结）和超声造影表现（结节增强时间、增强均匀程度、增强方式、增强强度、增强后结节大小变化、增强后结节边界、有无环状增强）。并对这些指标进行了t检验（方差齐性）、χ2检验、Logistic 回归分析、ROC曲线分析以及一致性检验统计学分析。结果 多因素分析表明，常规超声表现中微钙化和颈部异常淋巴结诊断甲状腺微小结节的恶性相关性最高，其诊断甲状腺微小结节的准确率、敏感性、特异性分别为85.2%、80.0%、89.6%；超声造影表现中结节增强时间和有无环状增强诊断甲状腺微小结节的恶性相关性最高，其诊断甲状腺微小结节的准确率、敏感性、特异性分别为87.5%、87.5%、87.5%；常规超声联合超声造影的特征性指标有微钙化、颈部异常淋巴结、结节增强时间和环状增强，其诊断甲状腺微小结节的准确率、敏感性、特异性分别为97.7%、97.5%、97.9%。常规超声、超声造影及两者联合诊断甲状腺微小结节的曲线下面积分别为90.0%、90.7%、99.0%。两者联合诊断甲状腺微小结节与病理诊断结果的一致性较高（Kappa=0.813，P=0.000）。结论 常规超声联合超声造影在诊断甲状腺微小结节的良恶性时具有更高的准确率和敏感性，具有一定的临床价值，值得推广应用。 |
| 关键词: 超声造影 TI-RADS 甲状腺微小结节 |
| DOI： |
| 投稿时间：2017-11-11修订日期：2018-09-21 |
| 基金项目: |
|
| Evaluation of TI-RADS 3 or 4 in Thyroid Micronodules by Contrast-enhanced Ultrasound |
| Yingxian Liu,Qin Chen |
| (Department of Ultrasound,China Meitan General Hospital) |
| Abstract: |
| ABSTRACT Objective To investigate the diagnostic value of TI-RADS 3 or 4 in Small thyroid nodules by conventionaland contrast-enhanced ultrasound（CEUS）.Methods For 88 cases of TI-RADS 3 or 4 in Small thyroid nodules retrospective analysis of the characteristics of ultrasound（nodule size, aspect ratio (A/T), boundary, echo, microcalcification, blood flow signal, lymph nodes around the neck） and CEUS(nodular enhancement time, enhancement uniformity, enhancement mode, enhancement intensity, variation of nodular size after enhancement, boundary of nodular enhancement after enhancement, and presence of ring enhancement)，and T test (homogeneity of variance), χ2 test, Logistic regression analysis, ROC curve analysis and consistency test statistical analysis were performed for these indicators.Results Logistic regression analysis of conventional US showed that microcalcification，and suspicious lymph glands are risk factors for malignant thyroid micronodules，while logistic regression analysis of CEUS showed that slow enhancement time and absence of rim-like enhancement are risk factors for malignant thyroid micronodules.Logistic regression analysis of conventional US combined with CEUS demonstrated that microcalcification，suspicious lymph gland，slow enhancement time，and absence with rim-like enhancement are risk factors.The ROC curve for conventional US，CEUS，and conventional US combined with CEUS were 90.0%，90.7%，99.0%，respectively.The correlation between the diagnosis of thyroid micronodules and pathological diagnosis was higher（Kappa=0.813，P=0.000）.Conclusion Our results show that conventional US combined with CEUS had superior diagnostic performance for TI-RADS 3 and 4 thyroid micronodules compared with conventional US and CEUS alone. |
| Key words: Contrast-enhanced ultrasound (CEUS) Thyroid imaging reporting and data system(TI-RADS) Micronodule of thyroid |
