标题：超声造影与超声弹性成像鉴别诊断甲状腺富血供实性结节良恶性的价值

      作者：赵蕊新，杨金君，宇文国琳    咸阳市第一人民医院超声医学科，陕西 咸阳 712000

      卷次： 2024年35卷4期

      【摘要】 目的 探讨超声造影(CEUS)与超声弹性成像(UE)在甲状腺富血供实性结节良恶性鉴别诊断中的价值。方法 回顾性分析2020年3月至2023年2月咸阳市第一人民医院收治的110例甲状腺富血供实性结节患者的病例资料，所有患者均行CEUS与UE检查，并以穿刺病理学活检结果为“金标准”。比较良恶性结节间CEUS指标[最大灌注强度(SImax)、达峰时间(TTP)、峰值强度(PEAK)、平均通过时间(MTT)]、UE指标(图像蓝色面积占比、弹性评分、弹性应变比值)的差异，比较CEUS、UE检查及两者联合检查在鉴别诊断甲状腺富血供实性结节良恶性的准确度。结果 病理结果显示110例甲状腺富血供实性结节患者中共121个结节，其中恶性结节48个(39.67%)，良性结节73个(60.33%)。CEUS检查诊断恶性甲状腺富血供实性结节的准确度为89.26% (108/121)，Kappa值为0.771；UE检查诊断恶性甲状腺富血供实性结节的准确度为87.60% (106/121)，Kappa值为0.734；CEUS检查与UE检查诊断准确度比较差异无统计学意义(P>0.05)。CEUS联合UE诊断恶性甲状腺富血供实性结节的准确度为 96.69%(117/121)，Kappa值为0.932。准确度明确高于CEUS检查和UE检查，差异均有统计学意义(P<0.05)。结论 CEUS与UE检查在甲状腺富血供实性结节良恶性鉴别诊断中均具有较高诊断价值，且两者联合检查可显著提高诊断准确性。
      【关键词】 超声造影；超声弹性成像；甲状腺；富血供实性结节；良恶性；鉴别诊断
      【中图分类号】 R445.1 【文献标识码】 A 【文章编号】 1003—6350（2024）04—0553—06

Value of contrast-enhanced ultrasound and ultrasound elastography in the differential diagnosis of benign andmalignant thyroid hypervascular solid nodules.
ZHAO Rui-xin, YANG Jin-jun, YUWEN Guo-lin. Department ofUltrasound Medicine, the First People' s Hospital of Xianyang City, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To explore the value of contrast-enhanced ultrasound (CEUS) and ultrasound elastogra-phy (UE) in the differential diagnosis of benign and malignant thyroid hypervascular solid nodules.Methods The clini-cal data of 110 patients with benign and malignant thyroid hypervascular solid nodules admitted to the First People's Hos-pital of Xianyang City from March 2020 to February 2023 were retrospectively analyzed. All patients underwent CEUSand UE, and the pathological results (puncture biopsy) were taken as the "gold standard". The differences in CEUS indi-cators [maximum perfusion intensity (SImax), time to peak (TTP), peak intensity (PEAK), mean transit time (MTT)] andUE indicators (blue area ratio, elasticity score, elastic strain ratio) were compared between benign and malignant nod-ules. The accuracy of CEUS, UE, and their combination in the differential diagnosis of benign and malignant thyroid hy-pervascular solid nodules were compared. Results Pathological results showed 121 nodules among 110 patients withthyroid hypervascular solid nodules, including 48 malignant nodules (39.67%) and 73 benign nodules (60.33%). The ac-curacy of CEUS in the diagnosis of malignant thyroid hypervascular solid nodules was 89.26% (108/121), and the Kap-pa value was 0.771. The accuracy of UE examination in the diagnosis of malignant thyroid hypervascular solid noduleswas 87.60% (106/121), and the Kappa value was 0.734. There was no statistically significant difference in diagnostic ac-curacy between CEUS and UE (P>0.05). The accuracy and Kappa value of CEUS combined with UE in the diagnosis ofmalignant thyroid hypervascular solid nodules were 96.69% (117/121) and 0.932, which was significantly higher thanthat of CEUS and UE, and the differences were statistically significant (P<0.05). Conclusion Both CEUS and UE havehigh diagnostic value in the differential diagnosis of benign and malignant thyroid hypervascular solid nodules, and thecombined use of both can significantly improve diagnostic accuracy.
      【Key words】 Contrast-enhanced ultrasound; Ultrasound elastography; Thyroid; Hypervascular solid nodules; Be-nign and malignant; Differential diagnosis