| 摘要: |
| 目的：探讨中国甲状腺成像报告和数据系统（C-TIRADS）4类良恶性甲状腺结节的超声造影（CEUS）成像特征及其与丝/苏氨酸特异性激酶（BRAF）基因的相关性研究。方法：选取2020年1月至2022年1月于本院行CEUS检查并经手术病理证实的126例甲状腺结节患者，术后均行BRAF基因突变检测。根据C-TIRADS指南分为C-TIRADS 4A类（52例）、C-TIRADS 4B类（36例）和C-TIRADS 4C类（38例）。比较三类甲状腺结节的CEUS成像特征、BRAF 基因突变情况的差异，并绘制受试者工作特征曲线（ROC）评估CEUS成像特征、BRAF 基因突变单独及联合诊断C-TIRADS 4类恶性甲状腺结节的诊断效能。采用Spearman相关分析C-TIRADS 4类恶性甲状腺结节的CEUS成像特征与BRAF基因突变的相关性。结果：C-TIRADS 4A类甲状腺结节病理结果为甲状腺腺瘤（21例）、结节性甲状腺肿（31例）；C-TIRADS 4B/C类甲状腺结节病理结果均为甲状腺乳头状癌（36/38例）。C-TIRADS 4 B/C类甲状腺结节大部分表现为低增强（66.67%、73.68%）、不均匀增强（94.44%、89.47%）、向心性增强（97.22%、89.47%），且所占比例分别显著高于C-TIRADS 4A类（P<0.05）。126个甲状腺结节中58个发生BRAF基因突变，发生率为46.03%，其术后病理结果均为甲状腺乳头状癌。C-TIRADS 4 B/C类甲状腺结节BRAF基因突变所占比例显著高于C-TIRADS 4A类（P<0.05）。通过绘制ROC曲线发现，CEUS成像特征联合BRAF 基因突变诊断C-TIRADS 4类恶性甲状腺结节的AUC最高（0.973），且敏感度（100%）、特异度（94.60%）最高，且差异具有统计学意义（P<0.05）。C-TIRADS 4类恶性甲状腺结节的CEUS成像特征（低增强、不均匀增强、向心性增强）与BRAF基因突变呈显著正相关（P<0.05）。结论：CEUS成像特征联合BRAF 基因突变有助于提高对C-TIRADS 4类恶性甲状腺结节的鉴别诊断价值，而且CEUS成像特征与BRAF 基因突变具有显著的正相关，说明CEUS成像特征可在一定程度上可反映C-TIRADS 4类恶性甲状腺结节的生物学行为，有助于提高对其的鉴别诊断价值，进一步为临床医生的定性判断提供更加科学的影像学依据。 |
| 关键词: 中国甲状腺成像报告和数据系统 超声造影 BRAF基因 突变 相关性 |
| DOI： |
| 投稿时间：2022-05-16修订日期：2022-06-04 |
| 基金项目:河北省邯郸市科学技术研究与发展计划项目(19422083011ZC) |
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| Contrast-enhanced ultrasound imaging characteristics of C-TIRADS 4 benign and malignant thyroid nodules and their correlation with BRAF gene |
| Shao Jianbo,Hou Xiaoying,Shen Xianghui,Li Jia,Liu Xin,Shen Zhihua,Mao Yajuan,Liu Yanchao |
| (Department of Ultrasound Medicine,Handan Central Hospital of Hebei Province,Handan,Hebei) |
| Abstract: |
| Objective: To investigate the contrast-enhanced ultrasonography (CEUS) imaging features of Chinese Thyroid Imaging Reports and Data System (C-TIRADS) 4 types of benign and malignant thyroid nodules and their correlation with serine/threonine-specific kinase (BRAF) gene.Methods: A total of 126 patients with thyroid nodules who underwent CEUS examination in our hospital from January 2020 to January 2022 and were confirmed by surgery and pathology were selected, and BRAF gene mutation detection was performed after surgery. According to the C-TIRADS guidelines, it was divided into C-TIRADS 4A (52 cases), C-TIRADS 4B (36 cases) and C-TIRADS 4C (38 cases). The CEUS imaging features and BRAF gene mutation of three types of thyroid nodules were compared, and the receiver operating characteristic (ROC) curve was drawn to evaluate the CEUS imaging characteristics, BRAF gene mutation alone and combined diagnosis of C-TIRADS type 4 malignant thyroid nodules diagnostic performance. Spearman correlation was used to analyze the correlation between CEUS imaging features of C-TIRADS category 4 malignant thyroid nodules and BRAF gene mutation.Results: The pathological results of C-TIRADS 4A thyroid nodules were thyroid adenoma (21 cases) and nodular goiter (31 cases); the pathological results of C-TIRADS 4B/C thyroid nodules were all papillary thyroid carcinoma (36/ 38 cases). Most of C-TIRADS 4 B/C thyroid nodules showed low enhancement (66.67%, 73.68%), heterogeneous enhancement (94.44%, 89.47%), concentric enhancement (97.22%, 89.47%), and accounted for The proportions were significantly higher than those of C-TIRADS class 4A (P<0.05). BRAF gene mutation was found in 58 of 126 thyroid nodules, and the incidence rate was 46.03%. The postoperative pathological results were all papillary thyroid carcinoma. The proportion of BRAF gene mutation in C-TIRADS 4 B/C thyroid nodules was significantly higher than that in C-TIRADS 4A (P<0.05). By drawing the ROC curve, it was found that CEUS imaging features combined with BRAF gene mutation had the highest AUC (0.973), and the highest sensitivity (100%) and specificity (94.60%) in the diagnosis of C-TIRADS type 4 malignant thyroid nodules, and the difference was statistically significant Academic significance (P<0.05). CEUS imaging features of C-TIRADS class 4 malignant thyroid nodules (low enhancement, heterogeneous enhancement, and centripetal enhancement) were significantly positively correlated with BRAF gene mutation (P<0.05). Conclusion: CEUS imaging features combined with BRAF gene mutation can help improve the differential diagnosis value of C-TIRADS 4 malignant thyroid nodules, and CEUS imaging features have a significant positive correlation with BRAF gene mutation, indicating that CEUS imaging features can be used to a certain extent. Reflecting the biological behavior of C-TIRADS category 4 malignant thyroid nodules can help to improve its differential diagnosis value, and further provide a more scientific imaging basis for clinicians to make qualitative judgments. |
| Key words: China Thyroid Imaging Reporting and Data System Contrast-enhanced ultrasonography BRAF gene Mutation Correlation |
