目的：探讨声脉冲辐射力成像（ARFI）和超声造影（CEUS）及两者联合应用对实性低回声甲状腺结节的鉴别诊断价值。方法：观察47例甲状腺实性低回声结节患者共62个病灶的术前常规超声、ARFI和CEUS成像特征，以手术后病理结果为标准，评价ARFI、CEUS和两者联合应用对甲状腺实性低回声结节良恶性鉴别诊断的效果。结果：以SWV值≥2.86 m/s作为鉴别甲状腺结节良恶性的诊断界值，诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为82.4％、82.1％、84.8%、79.3%、82.3%。CEUS以弱增强作为诊断甲状腺结节恶性的标准，诊断的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为88.2％、78.6％、83.3%、84.6%、83.9%。ARFI和CEUS联合应用时敏感性94.1%、特异性96.4%、阳性预测值97.0%、阴性预测值93.1%、准确率95.2%，诊断准确率明显高于单独应用（P<0.05）。结论：ARFI和CEUS对甲状腺实性低回声结节具有较高的诊断价值，两种技术的联合应用有助于提高诊断准确性。
Abstract
Objective: To assess the value of acoustic radiation force impulse(ARFI), contrast-enhanced US(CEUS) and their combined application in differential diagnosis of solid hypo-echoic thyroid nodules． Methods: ARFI and CEUS were performed in 47 patients with 62 thyroid nodules. The results of ARFI, CEUS and their combined application, which were classified as benign or malignant ones, were compared with pathological findings. The diagnostic results of ARFI, CEUS and ARFI+CEUS were evaluated and compared． Result: The sensitivity, specificity, PPV, NPV and accuracy of the ARFI for differential diagnosis were 82.4％, 82.1％, 84.8%, 79.3%, and 82.3%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the CEUS for differential diagnosis were 88.2％, 78.6％, 83.3%, 84.6% and 83.9%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the ARFI+CEUS for differential diagnosis were 94.1%, 96.4%, 97.0%, 93.1% and 95.2%, respectively. Conclusions: ARFI and CEUS have high value in differential diagnosis of solid hypo-echoic thyroid nodules, the combined application of two methods can be helpful to improve the diagnostic accuracy．
关键词
甲状腺结节；超声检查 /
多普勒 /
彩色
Key words
Thyroid nodule /
Ultrasonography, Doppler, color
中图分类号：
Ｒ736.1
Ｒ581
R445.1
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Frates MC, Benson CB, Charboneau JW, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement[J]. Ultrasound Q, 2006, 22(4): 231-238.
[2]王兴田，王荣，张星荣. 声触诊组织成像鉴别甲状腺实性小结节的应用价值[J]. 中华超声影像学杂志，2013，22（2）：133-136.
[3]Ma JJ, Ding H, Xu BH, et al. Diagnostic performances of various gray-scale, color Doppler, and contrast-enhanced ultrasonography findings in predicting malignant thyroid nodules[J]. Thyroid, 2014, 24(2): 355-363.
[4]周琦，姜珏，杜晓鹏，等． 超声造影在甲状腺乳头状癌中的诊断价值[J]. 中国超声医学杂志，2011，27（7）：595-597．
[5]Gul K, Ersoy R, Dirikoc A, et al. Ultrasonographic evaluation of thyroidnodules: Comparison of ultrasonographic, cytological, and histopathological findings[J]. Endocrine, 2009, 36(3): 464-472.
[6]Zhan J, Diao XH, Chai QL, et al. Comparative study of acoustic radiation force impulse imaging(ARFI) with real-time elastography(RTE) in differential diagnosis of thyroid nodules[J]. Ultrasound Med Biol, 2013, 39(12): 2217-2225.
[7]Gu J, Du LF, Bai M, et al. Preliminary study on the diagnostic value of acoustic radiation force impulse technology for differentiating between benign and malignant thyroid nodules[J]. J Ultrasound Med, 2012, 31(5): 763-771.
[8]Xu JM, Xu HX, Xu XH, et al. Solid hypo-echoic thyroid nodules on ultrasound: the diagnostic value of acoustic radiation force impulse elastography[J]. Ultrasound Med Biol, 2014, 40(9): 2020-2030.
[9]陈立斌，蒋天安，王菁，等. 超声造影及定量分析技术鉴别甲状腺实性肿块良恶性的价值[J]. 中华超声影像学杂志，2012，21（12）：1035-1039.
[10]Zhang B, Jiang YX, Liu JB, et al. Utility of contrast enhanced ultrasound for evaluation of thyroid nodules[J]. Thyroid, 2010, 20(1): 51-57.
[11]Nemec U, Nemec SF, Novotny C, et al. Quantitative evaluation of contrast-enhanced ultrasound after intravenous administration of a microbubble contrast agent for differentiation of benign and malignant thyroid nodules: assessment of diagnostic accuracy[J]. Eur Radiol, 2012, 22(6): 1357-1365.
[12]Hornung M, Jung EM, Georgieva M, et al. Detection of microvascularization of thyroid carcinomas using linear high resolution contrast-enhanced ultrasonography(CEUS). Clin Hemorheol Microcirc, 2012, 52(2-4): 197-203.
基金
上海市科委医学引导类科技项目（14411970400）。
