TI-RADS分类联合CEUS对多发结节性甲状腺肿基础上实性低回声结节的鉴别诊断价值

发布时间：2018-02-14 00:43

本文关键词： 结节性甲状腺肿实性低回声结节 TI-RADS分类超声造影鉴别诊断　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨甲状腺影像学报告及数据系统(thyroid imaging reporting and data system,TI-RADS)联合超声造影(Contrast enhanced ultrasound,CEUS)对多发结节性甲状腺肿基础上实性低回声结节的鉴别诊断价值。方法:回顾性分析65例多发结节性甲状腺肿基础上的实性低回声结节(共70个),分别进行二维超声及CEUS检查,所有实性低回声结节依据二维超声特征进行TI-RADS分类,以手术病理结果为金标准,绘制TI-RADS分类、CEUS及二者联合诊断实性低回声结节的受试者工作特征(receiver operating characteristic,ROC)曲线。评价TI-RADS分类联合CEUS对多发结节性甲状腺肿基础上实性低回声结节的鉴别诊断价值。结果:将甲状腺实性低回声结节TI-RADS分类在4b及以上的结节诊断为恶性,其灵敏度、特异度及准确性分别为90.24%(37/41),58.62%(17/29),77.14%(54/70)。甲状腺恶性结节的CEUS增强模式主要为早期低增强、晚期低增强、不均匀增强和周边无环状增强,四种增强模式的灵敏度、特异度及准确性分别为87.70%(36/41),82.76%(24/29),85.71%(60/70);82.93%(34/41),79.31%(23/29),81.43%(57/70);90.24%(37/41),68.97%(20/29),81.43%(57/70);95.12%(39/41),20.69%(6/29),64.29%(45/70)。二者联合诊断恶性结节的灵敏度、特异度及准确性分别为95.12%(39/41),82.76%(24/29),90.00%(63/70)。TI-RADS分类联合CEUS诊断实性低回声结节的特异度和准确性均高于TI-RADS分类单独诊断(P0.05)。TI-RADS分类、CEUS及二者联合诊断甲状腺实性低回声结节的ROC曲线下面积分别为0.734、0.860、0.889,由此得出TI-RADS分类联合CEUS对实性低回声结节的诊断效能更高。结论:在甲状腺多发结节性甲状腺肿初次检出及随访过程中,TI-RADS分类可初步评估实性低回声结节的恶性风险,再结合CEUS进一步鉴别良恶性,二者联合可提高实性低回声结节的准确性,为指导临床治疗提供依据。
[Abstract]:Objective: to evaluate the diagnostic value of thyroid imaging reporting and data system TI-RADS combined with Contrast enhanced Ultrasound-CEUSin in the differential diagnosis of solid hypoechoic nodules based on multiple nodular goiter. Solid hypoechoic nodules on the basis of multiple nodular goiter (70 cases) were examined by two-dimensional ultrasound and CEUS respectively. All solid hypoechoic nodules were classified by TI-RADS according to the characteristics of two-dimensional ultrasound, and the results of surgery and pathology were taken as the gold standard. To evaluate the value of TI-RADS classification combined with CEUS in the differential diagnosis of solid hypoechoic nodules on the basis of multiple nodular goiter, the receiver operating characteristic roc curves were drawn for the diagnosis of solid hypoechoic nodules. Results: the solid hypoechoic thyroid nodules with TI-RADS classification of 4b and above were diagnosed as malignant. Its sensitivity, specificity and accuracy were 90.24 / 37 / 41 / 58.62 and 17 / 29 / 77.14 / 54 / 70 respectively. The CEUS enhancement patterns of malignant thyroid nodules were mainly early low enhancement, late low enhancement, uneven enhancement and peripheral non-annular enhancement. The specificity and the accuracy were 87.70 / 36 / 36 / 41 / 82.76 / 10 / 24 / 29 / 85.71a / R 82.9331 / 34 / 79.31 / I and 23 / 29 / 81.43 / 57 / 70 / 57 / 90.24 / 37 / 37 / 41 / 68.97 / 208.97 / 201.43 / 70 / 95.95 / 12 / 3941 / 20.69 / 2929 / 64.29 / 4570, and the sensitivity of the two groups was 64.29% 4570. Specificity and accuracy were 95.1212 / 41 / 82.76 and 24 / 29 / 90.003 / 70 / 70, respectively. The specificity and accuracy of TI-RADS combined with CEUS in the diagnosis of solid hypoechoic nodules were higher than those in TI-RADS alone and under the ROC curve for the diagnosis of solid hypoechoic nodules. The results showed that TI-RADS classification combined with CEUS was more effective in the diagnosis of solid hypoechoic nodules. Conclusion: TI-RADS classification can be used to evaluate solid hypoechoic nodules in the first detection and follow-up of multiple nodular goiter of thyroid. The malignant risk of nodules, The combination of CEUS and CEUS can improve the accuracy of solid hypoechoic nodules and provide evidence for clinical treatment.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R581

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