弹性成像结合TI-RADS分类对甲状腺结节的诊断价值

发布时间：2018-02-20 22:00

  本文关键词： 弹性成像技术 TI-RADS分类 甲状腺结节 鉴别诊断　出处：《广州中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨超声弹性成像(ultrasonic elastography, U E)弹性评分及应变率比值(strain ratio, SR)结合TI-RADS分类对甲状腺结节良恶性的鉴别诊断价值,早期发现癌,早期治疗,为临床提供可靠的参考价值。方法：选取了254例甲状腺结节患者,共309个结节(其中良性结节205个,恶性结节104个),以结节的最大直径10mm为界分为两组,行常规超声及超声弹性成像UE检查。并且所有的结节均按照TI-RADS分类标准进行分类。所有的病例均经手术病理证实,以病理检查结果为金标准,建立受试者的工作特征的曲线(即ROC曲线),比较TI-RADS分类与弹性成像技术(UE)的弹性评分及应变率比值SR对甲状腺良恶性结节的鉴别诊断价值。结果：甲状腺恶性结节组别的弹性应变率比值SR明显高于甲状腺良性结节组别,二者的比较差异具有统计学意义(t=7.69,P0.05)。弹性成像UE的弹性评分及应变率比值SR对甲状腺结节良恶性诊断的敏感度、特异度及准确度分别为85.67%、89.85%、86.70%及87.41%、91.21%、90.01%,TI—RADS标准分类的敏感度、特异度及准确度分别为70.56%、83.49%和80.08%。弹性成像UE对甲状腺良恶性结节鉴别诊断的敏感度、特异度及准确度是高于TI—RADS分类的,差异有统计学意义(P0.05)；弹性成像和TI—RADS分类两种方法结合后,其敏感度、特异度及准确度为90.44%、93.21%和92.46%,均高于单一检查方法。UE的应变率比值法与TI-RADS分类法的曲线下面积分别为0.82和0.76,差异有统计学意义(P0.01)；两种方法结合后曲线下面积为0.86,诊断效能高于单一方法(P0.01)。在结节直径≤1Omm组中,UE的应变率比值法诊断准确度高于TI-RADS分类法(P0.05),而在结节直径l0mm组中,TI-RADS分类法的诊断准确度高于UE应变率比值法(P0.05)。甲状腺良恶性结节的形态、边界、边缘、后方回声、生长方式、微钙化、血流分布及淋巴结有无异常等情况的差异具有统计学意义(P0.01)。结论：弹性成像UE对甲状腺良恶性结节的诊断准确率高于TI-RADS分类法,对于不同大小的结节,两种方法可以起到相互补充的作用,两者结合能够提高甲状腺结节良恶性的诊断效能。边缘模糊、边界不清,形态不规则、纵横比1、后方回声衰减、结节内微钙化、血流紊乱等可作为甲状腺恶性结节的征象。其中,在结节最大径≤10mm的结节中,纵横比可作为预测恶性肿瘤的主要指标；在结节最大径10mm的结节中,形态不规则、边界不清、边缘模糊、结节内微钙化、后方回声衰减、血流紊乱、伴淋巴结形态不良等可作为预测恶性肿瘤的主要指标。
[Abstract]:Objective: to evaluate the value of ultrasound elastography (U E) score and strain rate ratio strain ratio (SRS) combined with TI-RADS classification in the differential diagnosis of benign and malignant thyroid nodules, early detection and early treatment of thyroid nodules. Methods: a total of 309 thyroid nodules (205 benign and 104 malignant) were selected from 254 patients with thyroid nodules. All nodules were classified according to TI-RADS classification criteria. All cases were confirmed by surgery and pathology, and the results of pathological examination were taken as gold standard. The value of elastic score and strain rate ratio SR in differential diagnosis of benign and malignant thyroid nodules by comparing TI-RADS classification with elastic imaging technique was compared with that of ROC curve (i.e. ROC curve). Results: thyroid nodule. The elastic strain rate ratio SR in nodal group was significantly higher than that in benign thyroid nodule group. The difference was statistically significant (P 0.05). The sensitivity, specificity and accuracy of elastography UE and strain rate ratio SR in the diagnosis of benign and malignant thyroid nodules were 85.67 ~ 89.85% and 87.41% respectively, and the sensitivity of TI-RADS standard classification was 91.21%. The specificity and accuracy of UE were 70.56% and 80.08%, respectively. The sensitivity, specificity and accuracy of UE in differential diagnosis of benign and malignant thyroid nodules were higher than those of TI-RADS classification (P 0.05). Its sensitivity, The specificity and accuracy were 90.444.93.21% and 92.46% respectively, which were higher than those of single test method. UE strain rate ratio method and TI-RADS classification method were 0.82 and 0.76, respectively, the difference was statistically significant (P 0.01), the area under the curve was 0.86 after the combination of the two methods. The diagnostic accuracy of the strain rate ratio method in the group with nodule diameter 鈮，

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