目的：利用高频超声作为检测手段，探讨超声弹性成像联合血流分级在甲状腺结节良恶性鉴别诊断中的价值。方法：回顾性分析68个甲状腺结节的血流分级及弹性成像特点，和术后病理结果对照，通过受试者工作特征（ ROC）曲线下面积的比较，对二者单独及联合应用鉴别甲状腺结节的效果分别进行评估。结果：血流分级诊断甲状腺恶性结节的灵敏性、特异性、和准确性分别为75.0％、80.0％、77.9％，超声弹性成像诊断甲状腺恶性结节的灵敏性、特异性和准确性分别为78.6％、90.0％、85.3％，二者联合诊断甲状腺恶性结节的灵敏性、特异性、准确性为92.9％、92.5％、92.6％。ROC曲线下面积二者联合应用（0.936）大于单独使用血流分级（0.831）（Z＝2.59，P﹤0.01）或单独使用超声弹性成像（0.859）（Z＝2.22，P﹤0.05）。结论：超声弹性成像联合血流分级可以有效提高甲状腺恶性结节的诊断符合率。%Objective To explore the value of ultrasonic elastography combined with grades of blood in differential diagnosis between benign and malignant thyroid nodules by the detection of high frequency ultrasound. Method Retrospecting the 68 thy-roid nodules'grades of blood and elastograph,and compared with the postoperative pathological results. The areas under the re-ceiver operating characteristic( ROC)curves were compared to estimate the diagnostic effects in differentiating thyroid nodules by grades of blood,Elastograph and their combination respectively. Results The sensitivity,specificity and accuracy of grades of blood in the diagnosis of malignant thyroid nodules were 75. 0% ,80. 0% and 77. 9%,respectively,the sensitivity,specificity and accuracy of ultrasonic elastography in diagnosis of malignant thyroid nodules were 78. 6%,90. 0% and 85. 3%,respective-ly,and the sensitivity,specificity and accuracy of joint detection of grades of blood and ultrasonic elastography in diagnosis of malignant thyroid nodules were 92. 9% ,92. 5% and 92. 6%,respectively. The areas under the ROC curve of the combined ap-plication of grades of blood and Elastograph(0. 936)were greater than those of single grades of blood(0. 831)(Z=2. 59,P﹤0. 01)or single elastography(0. 859)(Z=2. 22,P﹤0. 05). Conclusion Combined application of grades of blood and Elasto-graph can improve the diagnostic coincidence rate of malignant thyroid nodules effectively.
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