【摘要】 目的探讨二维超声、超声造影及超声引导下细针穿刺(US-FNA)针感赋值评分在甲状腺影像报告和数据系统(TI-RADS)3~4级甲状腺微小结节鉴别诊断中的应用价值。方法选取我院经病理证实的TI-RADS 3~4级甲状腺微小结节患者149例(共计149个结节),其中良性结节87个,恶性结节62个。比较良恶性结节的二维超声特征、超声造影特征及US-FNA针感情况;ROC曲线分析单独及联合赋值评分诊断恶性结节的相应截断值,并计算其诊断效能。结果良、恶性微小结节的二维超声征象即形态不规则、极低回声及低回声、微钙化及粗钙化、纵横比、声晕、声衰减比较差异均有统计学意义(均P<0.05);良、恶性微小结节的超声造影特征即增强模式、增强类型及增强速度比较差异均有统计学意义(均P<0.05);良、恶性微小结节的US-FNA针感比较差异有统计学意义(P<0.05)。二维超声、超声造影及USFNA针感两两联合赋值评分对甲状腺恶性微小结节的诊断准确率均可达80%以上,三者联合赋值评分诊断甲状腺恶性微小结节的敏感性最高(90.3%),其中超声造影、US-FNA联合赋值评分诊断的敏感性、特异性及准确率均可达80%以上(分别为80.6%、83.9%及82.3%)。结论对二维超声、超声造影及US-FNA相关指标进行联合赋值评分,可以提高TIRADS 3~4级甲状腺微小结节的诊断水平。更多还原

【Abstract】 Objective To investigate the application value of two-dimensional ultrasound,contrast-enhanced ultrasound and ultrasound-guided fine needle aspiration(US-FNA)feeling and assigning score in differential diagnosis of thyroid micronodules of TI-RADS grade 3 ~4. Methods One hundred and forty-nine cases of TI-RADS 3 ~4 thyroid micronodules confirmed by pathology were selected,of which 87 were benign and 62 were malignant. The characteristics of two-dimensional ultrasonography,the contrast and the US-FNA feeling of benign and malignant nodules were compared. The ROC curve analysis was used to diagnose the corresponding truncated values of malignant nodules,and to calculate their diagnostic efficiency.Results The two dimensional signs of thyroid micronodules included irregular shape,extremely low echo and hypoechoic,micro calcification and coarse calcification,halo,aspect ratio and acoustic attenuation. The differences of these signs were statistically significant between benign and malignant micronodules(all P < 0. 05). The contrast-enhanced ultrasound features including enhancement pattern,enhancement type and enhancement speed were statistically significant(all P < 0. 05). And the FNA feeling between benign and malignant micronodules was statistically significant(P<0.05).The diagnostic accuracy of two of the three ways combined was more than 80%,the diagnostic sensitivity of the three combined was the highest(90.3%). The sensitivity,specificity and diagnostic accuracy of contrast-enhanced ultrasound and US-FNA combined were all more than 80%(80.6%,83.9% and 82.3%). Conclusion The diagnostic level of thyroid micronodules of TI-RADS 3 ~4 could be improved by combined evaluation of two dimensional signs,contrast-enhanced ultrasound and US-FNA related indexes.更多还原