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超声造影结合定量分析技术在鉴别诊断甲状腺良恶性结节中的应用价值
Contrast-enhanced ultrasonography and time-intensity curve analysis for differential diagnosis of benign and malignant thyroid nodules
- 第三军医大学学报 2019年41卷第6期 页码：587-593
- 作者机构：
1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：超声科
2.400038 重庆，陆军军医大学(第三军医大学)第一附属医院：病理科
- 作者简介：
[ 郭燕丽，E-mail：guoyanli71@aliyun.com GUO Yanli, E-mail: guoyanli71@aliyun.com
- 基金信息：国家自然科学基金面上项目(81272688)
DOI：10.16016/j.1000-5404.201811024
中图分类号： R447;R730.41;R736.1收稿：2018-11-05，
修回：2019-01-06，
纸质出版：2019-03-30
- 稿件说明：
移动端阅览
陈萍, 朱连华, 方可敬, 等. 超声造影结合定量分析技术在鉴别诊断甲状腺良恶性结节中的应用价值[J]. 第三军医大学学报, 2019,41(6):587-593.
Ping CHEN, Lianhua ZHU, Kejing FANG, et al. Contrast-enhanced ultrasonography and time-intensity curve analysis for differential diagnosis of benign and malignant thyroid nodules[J]. Journal of Third Military Medical University, 2019, 41(6): 587-593.
陈萍, 朱连华, 方可敬, 等. 超声造影结合定量分析技术在鉴别诊断甲状腺良恶性结节中的应用价值[J]. 第三军医大学学报, 2019,41(6):587-593. DOI： 10.16016/j.1000-5404.201811024.
Ping CHEN, Lianhua ZHU, Kejing FANG, et al. Contrast-enhanced ultrasonography and time-intensity curve analysis for differential diagnosis of benign and malignant thyroid nodules[J]. Journal of Third Military Medical University, 2019, 41(6): 587-593. DOI： 10.16016/j.1000-5404.201811024.
摘要
目的
2
探讨超声造影联合定量分析技术鉴别诊断甲状腺良恶性结节的临床价值。
方法
2
回顾性分析2016年8月至2017年9月于陆军军医大学第一附属医院超声造影检查的114例(共计175个结节)甲状腺结节患者，分析甲状腺良恶性结节超声造影(contrast-enhanced ultrasonography
CEUS)增强模式及时间-强度曲线(time-intensity curve
TIC)特点。所有患者均经手术证实，并与手术病理结果对照。
结果
2
CEUS检测结果中显示良性结节为93个，恶性结节为82个，而病理结果显示良性结节为98个(其中腺瘤29个，结节性甲状腺肿69个)，恶性结节(乳头状癌)为77个，CEUS检查对甲状腺恶性结节的诊断敏感性为85.7%，特异性为83.6%，准确率为84.5%。CEUS显示58.1%(57/98)的甲状腺腺瘤和结节性甲状腺肿呈均匀整
体高增强或等增强，71.4%(55/77)的甲状腺恶性结节呈不均匀低增强。TIC显示，甲状腺腺瘤CEUS较结节周边的甲状腺组织进入更为迅速，且上升较快，其PI相对较高(
P
<
0.05)。结节性甲状腺肿表现出同样迅速进入的特点，且上升较快，其PI与周围组织较相近。而甲状腺癌CEUS则缓慢进入，且上升较慢，其PI相对较低(
P
<
0.05)。甲状腺癌的PI明显低于甲状腺良性结节(
P
<
0.05)，但二者在达峰时间和增强开始时间上差异均无统计学意义。
结论
2
甲状腺常见的良恶性结节CEUS具有不同的图像特征，其中甲状腺癌(乳头状癌)主要呈缓慢不均匀低增强，而甲状腺良性结节则以快速高增强或等增强为主。在常规超声检查的基础上，CEUS联合定量分析技术有助于提高甲状腺癌的诊断准确性。
Abstract
Objective
2
To investigate the clinical value of contrast-enhanced ultrasonography (CEUS) combined with time-intensity curve (TIC) analysis in differential diagnosis of benign and malignant thyroid nodules.
Methods
2
We conducted a retrospective study of 114 patients with 175 thyroid nodules detected by CEUS in our hospital between August
2016 and September
2017 and compared the enhancement patterns and TIC of CEUS between benign and malignant thyroid nodules. All the patients underwent surgical resection of the nodules and the findings of CEUS were compared with the results of surgical pathology.
Results
2
CEUS identified 93 benign nodules and 82 malignant nodules
while the pathological results confirmed 98 benign nodules (29 adenomas and 69 nodular goiters) and 77 malignant nodules (papillary carcinoma). CEUS had a diagnostic sensitivity of 85.7% for malignant thyroid nodules with a specificity of 83.6% and an accuracy of 84.5%. CEUS showed homogeneous hyperenhancement or isoenhancement in 58.1% (57/98) of thyroid adenomas and nodular goiters
and heterogeneous hypoenhancement in 71.4% (55/77) of malignant thyroid nodules. TIC analysis showed that compared with the surrounding thyroid tissue
thyroid adenomas showed a rapid entry in CEUS with a steep ascending branch and a higher peak intensity (
P
<
0.05); nodular goiters also showed a rapid entry and a steep ascending branch but with a peak intens
ity consistent with that of the surrounding thyroid tissue. CEUS of thyroid carcinoma showed a slow entry
a relatively flat ascending branch
and a low peak intensity (
P
<
0.05). The peak intensity of thyroid carcinomas was significantly lower than that of benign thyroid nodules (
P
<
0.05)
but the time to peak and arrival time were comparable between benign and malignant thyroid nodules (
P
>
0.05).
Conclusion
2
Benign and malignant thyroid nodules commonly present with different characteristics in CEUS. Thyroid carcinomas (papillary carcinomas) are typically characterized by slow and heterogeneous hypoenhancement in CEUS
while benign thyroid nodules feature a rapid hyper- or isoenhancement. CEUS combined with quantitative analysis can improve the diagnostic accuracy for malignant thyroid nodules.
关键词
Keywords
references
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