摘要
目的:探究多模态超声弹性成像参数在甲状腺弥漫性病变患者的甲状腺结节鉴别诊断中的应用。方法:选取2023年1月至2024年1月在西安医学院附属宝鸡医院接受治疗的103例甲状腺弥漫性病变患者103例,经细针穿刺活检或手术病理学证实存在甲状腺结节,并根据结节的良恶性将良性结节患者56例纳入良性组,其他47例患者纳入恶性组。所有患者均接受常规超声及多模态超声弹性成像检查,记录相关参数情况,比较组间差异,并探究各指标对其甲状腺结节良恶性诊断的价值。结果:恶性组和良性组患者在性别、结节长径、结节部位、甲状腺功能异常、射线接触史、有无声晕方面比较差异均无统计学意义(P>0.05);恶性组患者的年龄低于良性组,差异有统计学意义(t=-3.121,P<0.05),结节有血流占比(14.89%)、纵横比<1占比(74.47%)、以及边界清晰占比(27.66%)均低于良性组,两组比较差异均有统计学意义(χ^(2)=25.634、5.112、12.465,P<0.05);恶性组患者淋巴转移(27.66%)、钙化占比(65.96%)高于良性组,差异均有统计学意义(χ^(2)=11.917、9.350,P<0.05);恶性组患者的向心性增强占比(76.60%)、不均匀增强占比(68.09%)、低/等增强占比(87.23%)、早期快退明显占比(63.83%)、增强后边界不清晰占比(91.49%)、快退占比(59.57%)均高于良性组,差异有统计学意义(χ^(2)=33.409、26.695、9.079、12.853、17.798、12.649,P<0.05);恶性组患者达峰强度低于良性组、达峰时间长于良性组,差异有统计学意义(t=-12.381、4.958,P<0.05)。两组的平均通过时间比较,差异无统计学意义(P>0.05);恶性组患者的杨氏模量最大值、杨氏模量最小值、杨氏模量平均值、纵断面最大值、纵断面平均值、横断面最大值、横断面平均值均高于良性组,差异有统计学意义(t=13.997、9.100、12.191、7.616、6.310、4.679、5.355,P<0.05)。经受试者工作特征(ROC)曲线分析,超声造影参数及剪切波弹性成像(SWE)参数均对患者的甲状腺结节良恶性具有较高的诊断价值,达峰强度、达峰时间、杨氏模量最大值、杨氏模量最小值、杨氏模量平均值、纵断面最大值、纵断面平均值、横断面最大值、横断面平均值的ROC曲线下面积(AUC)值分别为0.976、0.759、0.974、0.837、0.989、0.872、0.805、0.732、0.749。结论:多模态超声弹性成像参数在甲状腺弥漫性病变患者的甲状腺结节鉴别诊断中具有显著应用价值,其中杨氏模量的最大值、平均值、达峰强度和达峰时间对患者恶性甲状腺结节的诊断AUC值较高,具有较高的诊断效能,能有效帮助临床医生在甲状腺弥漫性病变患者中准确鉴别结节的良恶性。
Objective:To investigate the application of the parameters of multimodal ultrasound elastography in differential diagnosis for thyroid nodules of patients with diffuse thyroid lesions.Methods:A total of 103 patients with diffuse thyroid lesions who underwent treatment at Affiliated Baoji Hospital of Xi′an Medical University from January 2023 to January 2024 were retrospectively selected,whose thyroid nodules were confirmed by fine needle aspiration biopsy or surgical pathology.They were grouped according to the benign or malignant nodules.56 patients with benign nodules were included in the benign nodule group,while the other 47 patients were included in the malignant nodule group.All patients were examined by conventional ultrasound and multimodal ultrasound elastography,and the relevant parameters were recorded to compare the differences between the two groups.The value of each indicator in diagnosing benign and malignant thyroid nodules was investigated.Results:There were no statistically significant differences between the benign and malignant nodule groups in terms of gender,length diameter of nodule,nodule location,functional abnormalities of thyroid,exposure history of radiation,and the presence of acoustic halos(P>0.05),the age of patients in the malignant nodule group was lower than that of the benign nodule group(t=-3.121,P<0.05),and the percentage of nodules with blood flow(14.89%),the percentage of aspect ratio<1(74.47%),and the percentage of nodules with clear boundary(27.66%)in the malignant nodule group were all lower than those of the benign nodule group,with statistically significant differences(χ^(2)=25.634,5.112,12.465,P<0.05).The ratio of lymphatic metastasis(27.66%)and that of calcification(65.96%)in the malignant nodule group were lower than those in the benign nodule group,and the differences were all statistically significant(χ^(2)=11.917,9.350,P<0.05).The ratios of centripetal enhancement(76.60%),inhomogeneous enhancement(68.09%),low/equal enhancement(87.23%),early obvious discharge(63.83%),unclear boundary after enhancement(91.49%),and fast discharge(59.57%)in the malignant nodule group were higher than that of the benign nodule group,and the differences were statistically significant(χ^(2)=33.409,26.695,9.079,12.853,17.798,12.649,P<0.05),respectively.The intensity and time to peak of the malignant nodule group were respectively lower and long than these of the benign nodule group,and the differences were statistically significant(t=-12.381,4.958,P<0.05).However,the mean passage time of the two groups was not statistically significant(P>0.05).The maximum value,minimum value and mean value of Young's modulus,the maximum value of vertical section,mean value of vertical section,maximum value of cross section,mean value of cross section in the malignant nodule group were all higher than those in the benign nodule group,and the differences were statistically significant(t=13.997,9.100,12.191,7.616,6.310,4.679,5.355,P<0.05).The result of receiver operating characteristic(ROC)curve analysis indicated that both ultrasonography parameters and shear wave elastography(SWE)parameters had higher diagnostic value for the benign and malignant nature of thyroid nodules in patients.The area under curve(AUC)values of intensity to peak,time to peak,and the maximum value,minimum value and mean value of Young's modulus,and the maximum value of vertical section,mean value of vertical section,maximum value of cross section,mean value of cross section were respectively 0.976,0.759,0.974,0.837,0.989,0.872,0.805,0.732 and 0.749.Conclusion:Multimodal ultrasound elastography parameters has significant application value in differential diagnosis for thyroid nodules in patients with diffuse thyroid lesions.In these parameters,the diagnostic AUC values of intensity to peak,time to peak,and the maximum value and mean value of Young's modulus are higher for malignant thyroid nodules of patients,which have higher diagnostic efficiency.It can effectively help clinical doctor to accurately identify the benign and malignant nodules for patients with diffuse thyroid lesions.
作者
刘静
薛驰
刘虹
赵君智
Liu Jing;Xue Chi;Liu Hong;Zhao Junzhi(Department of Ultrasound Medicine,Affiliated Baoji Hospital of Xi′an Medical University,Baoji 721006,China)
出处
《中国医学装备》
2025年第4期58-63,共6页
China Medical Equipment
基金
陕西省重点研发计划(2023-YBSF-011)。
关键词
多模态超声弹性成像参数
甲状腺
弥漫性病变
结节
诊断
Parameters of multimodal ultrasound elastography
Thyroid
Diffuse lesion
Nodule
Diagnosis
