中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2018, Vol. 40 ›› Issue (1): 59-66.doi: 10.3881/j.issn.1000-503X.2018.01.009

• 论著 • 上一篇    下一篇

超声弹性成像评估桥本甲状腺炎背景下甲状腺结节的价值

张晓燕, 张波, 姜玉新(), 杨筱, 赵瑞娜, 赖兴建   

  1. 中国医学科学院 北京协和医学院 北京协和医院超声诊断科,北京 100730
  • 收稿日期:2017-05-10 出版日期:2018-02-28 发布日期:2018-03-05
  • 基金资助:
    国家自然科学基金(81171354)和国家国际科技合作专项基金(2015DFA30440)

Diagnostic Value of Elastography for Thyroid Nodules in Hashimoto’s Thyroiditis

ZHANG Xiaoyan, ZHANG Bo, JIANG Yuxin(), YANG Xiao, ZHAO Ruina, LAI Xingjian   

  1. Department of Diagnostic Ultrasound,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2017-05-10 Online:2018-02-28 Published:2018-03-05
  • Supported by:
    Supported by the National Natural Sciences Foundation of China (81171354) and the International S&T Cooperation Program of China (2015DFA30440)

摘要:

目的 评估超声弹性成像对桥本甲状腺炎(HT)背景下甲状腺结节的诊断价值。方法 回顾性分析38例HT患者共43个甲状腺结节的超声特征及超声弹性评分(ES),评估ES与常规超声(CU)的诊断价值。结果 43个结节中,恶性结节29个(67.4%),良性结节14个(32.6%)。在HT背景下,恶性结节与良性结节在实性(96.6%比64.0%;OR:15.6,95%CI:1.6000~151.262,P=0.004)、形态不规则(90.0%比42.9%;OR:11.6,95%CI:2.341~57.032,P=0.001)、纵横比≥1(72.0%比21.4%;OR:9.6,95%CI:2.117~43.753,P=0.002)、微小钙化(69.0%比28.6%;OR:5.6,95%CI:1.368~22.556,P=0.012)和不规则血流(90.0%比28.6%;OR:17.3,95%CI:3.186~94.290,P=0.000)等方面差异均有统计学意义。ES与CU对HT背景下甲状腺结节诊断价值分别为:敏感性(86.2%比96.6%),特异性(71.4%比42.9%),阳性预测值(86.2%比77.8%),阴性预测值(71.4%比85.7%)和准确性(81.4比79.0%)。两者联合诊断的敏感性为93.1%,特异性为71.4%,阳性预测值为87.1%,阴性预测值为83.3%,准确性为86.0%。结论 超声弹性成像对HT背景下甲状腺结节性质的诊断特异性高于CU,敏感性低于CU,两者联合应用可提高诊断特异性和准确性。

关键词: 甲状腺结节, 超声, 弹性成像, 桥本甲状腺炎

Abstract:

Objective To evaluate the diagnostic performance of elastography in the diagnosis of thyroid nodules in the context of Hashimoto’s thyroiditis(HT). Methods The study evaluated 43 thyroid nodules by conventional ultrasound (CU) and elastography in 38 patients co-existed with HT who were referred for operation. The patients underwent CU and elastography before operation. The sensitivity,specificity,positive and negative predictive values,and accuracy for CU,elastography,and combination of these two techniques were assessed by using histopathological results as the gold standard. Results Among these 43 thyroid nodules,pathology confirmed 29 (67.4%) malignant nodules and 14 (32.6%) benign ones. There were statistically significant differences between malignant and benign groups in features such as solid shape (96.6% vs. 64.0%;OR:15.6,95%CI:1.600-151.262,P=0.004),irregularity (90.0% vs. 42.9%;OR:11.6,95%CI:2.341-57.032,P=0.001),taller than wide shape (72.0% vs. 21.4%;OR:9.6,95% CI:2.117-43.753,P=0.002),microcalcification (69% vs. 28.6%;OR:5.6,95% CI:1.368-22.556,P=0.012) and irregular blood flow (90.0% vs. 28.6%;OR:17.3,95%CI:3.186-94.290,P=0.000). The diagnostic performance of elastography and CU was as follows:sensitivity (86.2 % vs.96.6%),specificity (71.4% vs.42.9%),positive predictive value (86.2% vs.77.8%),negative predictive value (71.4% vs.85.7%),and accuracy (81.4% vs.79.0%). The combination of these two techniques had a sensitivity of 93.1%,a specificity of 71.4%,a positive predictive value of 87.1%,a negative predictive value of 83.3%,and an accuracy of 86.0%. Conclusions Elastography has a higher specificity in the diagnosis of thyroid nodules in HT,while its sensitivity is slightly lower than that of CU. Combination of these two techniques can increase the specificity and accuracy.

Key words: thyroid nodules, ultrasound, elastography, Hashimoto’s thyroiditis;

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