【作者】 陈静；

【导师】 韩若凌；

【作者基本信息】 河北医科大学 ， 影像医学与核医学（专业学位）， 2018， 硕士

【摘要】 目的:探讨声触诊组织成像及定量(VTIQ)技术与甲状腺影像报告和数据系统(TI-RADS)在不同直径甲状腺结节定性诊断中的应用价值。方法:选取2017年3月至12月在我院超声科行常规甲状腺超声检查发现甲状腺结节并在我院耳鼻喉科行甲状腺结节手术的146名患者共166个结节为研究对象。所有结节术前均行常规超声和VTIQ检查,且以上患者均知情同意并主动配合弹性成像。所有结节按照最大直径分为:≥1.0cm和<1.0cm两组。通过将结节进行TI-RADS分类并测量VTIQ剪切波速度(SWV)进行定性诊断。以病理学诊断为金标准,获得TI-RADS、VTIQ及二者联合诊断对不同直径甲状腺癌诊断的灵敏度、特异度及准确性。结果:166个结节:良性23个,恶性143个。直径≥1.0cm的结节91个,直径<1.0cm的结节75个。直径≥1.0cm的结节通过TI-RADS、VTIQ及二者联合诊断甲状腺癌的灵敏度、特异度及准确性分别是82.05%、92.31%、83.52%;89.74%、100%、90.10%;96.15%、92.31%、95.60%。直径<1.0cm的结节通过TI-RADS、VTIQ及二者联合诊断甲状腺癌的灵敏度、特异度及准确性分别是:73.85%、60.00%、72.00%;75.38%、70.00%、74.67%;95.38%、60.00%、90.67%。对于直径≥1.0cm的结节,VTIQ联合TI-RADS较单独应用TI-RADS的灵敏度、准确性高,VTIQ联合TI-RADS与单独应用VTIQ的诊断价值无明显差异(P>0.05),单独应用VTIQ较单独应用TI-RADS的准确性高(P<0.05);对于直径<1.0cm的结节,VTIQ联合TI-RADS较单独应用VTIQ或TI-RADS的灵敏度、准确性高(P<0.05),单独应用VTIQ与单独应用TI-RADS的诊断价值无明显差异(P>0.05)。结论:对于直径≥1.0cm的结节,VTIQ联合TI-RADS较单独应用TI-RADS对甲状腺癌的鉴别诊断的价值更高。对于直径<1.0cm的结节,VTIQ联合TI-RADS对甲状腺癌鉴别诊断的价值较单独应用TI-RADS或VTIQ均高,对临床进一步处理有指导意义。更多还原

【Abstract】 Objective: To evaluate the application value of virtual touch tissue image and quantification(VTIQ)technique and thyroid imaging report and data system(TI-RADS)in qualitative diagnosis of thyroid nodules of different diameters.Methods: From March 2017 to December,146 patients with 166 nodules were detected by routine thyroid ultrasound in our hospital and operated on in otolaryngology.All the nodules were performed before operation.All patients were examined by conventional ultrasound and VTIQ,and the above patients were informed consent and actively cooperated with all exams.All the nodules were divided into two groups according to their maximum diameters: ≥ 1.0 cm and < 1.0 cm.The nodules were diagnosed qualitatively by TI-RADS classification and VTIQ shear wave velocity measurement.Gold standard based on pathological diagnosis,Obtain Sensitivity,specificity and accuracy of TI-RADS,VTIQ and their combination in the diagnosis of thyroid carcinoma with different diameters.Results: All of the 166 nodules,23 were benign and 143 were malignant.Larger than 1.0cm in diameter 91 nodules,75 nodules with diameter less than1.0cm.The sensitivity,specificity and accuracy of TI-RADS,VTIQ and their combination in the diagnosis of thyroid carcinoma with diameter ≥ 1.0 cm were as follows: 82.05%,92.31%,83.52%;89.74%,100%,90.10%;96.15%,92.31%,95.60%.For nodules less than 1.0 cm in diameter,the sensitivity,specificity and accuracy of TI-RADS,VTIQ and their combination in the diagnosis of thyroid carcinoma were as follows: 73.85%,60% and 72%,75.38%,70%,74.67%,95.38%,60%,90.67%,respectively.For nodules with diameter ≥ 1.0 cm,the sensitivity and accuracy of VTIQ combined with TI-RADS are higher than that of TI-RADS alone,the diagnostic value of VTIQcombined with TI-RADS was the same as that of VTIQ alone(P > 0.05),the accuracy of VTIQ alone is higher than that of TI-RADS alone(P < 0.05).For nodules less than 1.0 cm in diameter,VTIQ combined with TI-RADS is more sensitive and more accurate than VTIQ or TI-RADS alone.(P < 0.05),the diagnostic value of VTIQ alone was the same as that of TI-RADS alone(P >0.05).Conclusion: The value of VTIQ combined with TI-RADS in the diagnosis of thyroid carcinoma with diameter ≥ 1.0 cm is higher than that with TI-RADS alone,and the value of VTIQ combined with TI-RADS with diameter less than 1.0 cm is higher than that with TI-RADS or VTIQ alone.It is of guiding significance for further clinical treatment.更多还原