超声弹性应变率比值在TI-RADS（4-6）类合并钙化的甲状腺结节中的价值

摘要

Objective To explore the application value of ultrasound elastic strain ratio in differential diagnosing calcified thyroid nodules of TI‐RADS(4‐6) categories .Methods Conventional ultrasound was applied to 324 thyroid nodules (from 303 patients) to observe their sizes ,margins ,echoes ,presence of calcification ,aspect ratio and interior and ambitus bloodstream .The thyroid nodules were classified into groups according to the thyroid imaging reporting and data system (TI‐RADS) ,then underwent ultrasonic elastography and the strain ratios of them were recorded .A receiver‐operating characteristic curve (ROC) was drawn to identify the cut‐off point in the differential diagnosis of thyroid nodules .The 137 thyroid nodules(from 137 patients) of TI‐RADS 4‐6 categories were classified into two groups :groupⅠ (calcification group) and groupⅡ (no calcification group) .Calcification group was classified into micro‐calcification group and coarse calcification group according to the size of calcification (≤2 mm) .Pathologic results were taken as the gold standard .A ROC curve was drawn to evaluate the application value of strain ratio in group Ⅰ and group Ⅱ .Results The boundary values or strain ratio was 0 .55 .The sensitivity ,specificity ,accuracy and positive predictive value in micro‐calcification and group Ⅱ were 88 .9% ,71 .4% ,86 .5% ,95 .2% and 82 .4% ,78 .9% ,81 .1% ,87 .5% respectively .The area under the curve (AUC) in micro‐calcification group ,coarse calcification group and group Ⅱ were 0 .808 ,0 .655 and 0 .831 respec‐tively .Conclusion The joint application of TI‐RADS and strain ratio can improve the sensitivity ,accuracy and specificity of strain ratio in the differential diagnosis of thyroid nodules in group Ⅱ and the micro‐calcification group ,and provide guidance in treating calcified thyroid nodules ,which is helpful in achieving the goal of early diagnosis and early treatment .%目的：探讨超声弹性应变率比值在鉴别诊断甲状腺 T I‐RADS （4‐6）类合并钙化结节中的应用价值。方法常规超声观察303例患者（共324个结节）甲状腺结节的边界、内部回声、是否合并钙化、纵横比、内部及周边血流情况等，依据甲状腺影像数据评分与报告系统（T I‐RADS ）对相应的甲状腺结节进行分类，同时进行超声弹性成像记录弹性应变率比值，绘制ROC曲线，获得弹性应变率比值鉴别诊断甲状腺良恶性结节的最佳界值。其中 T I‐RADS 4‐6类患者137例（137个结节）分钙化组（Ⅰ组）和无钙化组（Ⅱ组），钙化组又以钙化大小分为微钙化组（≤2mm ）和粗钙化组。以病理结果为金标准，绘制ROC曲线，评价弹性应变率比值在Ⅰ、Ⅱ组病变中的应用价值。结果弹性应变率界值为0．55。微钙化组和Ⅱ组的敏感性、特异性、准确性、阳性预测值分别为88．9％、71．4％、86．5％、95．2％和82．4％、78．9％、81．1％、87.5％，ROC曲线下面积（AUC）分别为0．808、0．831；粗钙化组ROC曲线AUC为0．655。结论应用TI‐RADS分类标准联合弹性应变率比值可提高鉴别诊断Ⅱ组和微钙化组甲状腺结节良恶性的敏感性、特异性和准确性，指导临床对甲状腺合并钙化结节采取正确的处理，达到早期诊断，早期治疗的效果。