高频超声联合PSV、RI、Adler血流分级在甲状腺良恶性结节中的诊断价值

doi:10.7517/issn.1674-0475.200802

摘要/Abstract

摘要： 本研究探讨高频超声联合彩色多普勒超声参数在诊断甲状腺良恶性结节中的价值。选取40例甲状腺癌患者作为观察组，42例甲状腺良性结节患者作为对照组，比较两组、不同N和T分期患者高频超声联合彩色多普勒超声参数，并对数据进行统计分析。两组结节形态、边界、回声、钙化超声征象比较，差异具有统计学意义（P<0.05）。观察组A/T_C、A/T_L、TI-RADS分级评分、PSV、RI、Adler血流分级评分高于对照组（P<0.05）。各参数联合诊断恶性甲状腺结节的AUC为0.902，诊断N1分期的AUC为0.879，诊断Ⅲ+Ⅳ分期的AUC为0.915，均大于任一单一参数（P<0.05）。可见采用高频超声、彩色多普勒超声联合观测甲状腺结节征象与A/T_C、A/T_L、TI-RADS分级、PSV、RI、Adler分级，可诊断结节性质，并能评估恶性结节患者术前肿瘤分期，为临床治疗、决策提供量化参考。

关键词: 高频超声, PSV, RI, Adler血流分级, 甲状腺结节, 肿瘤分期

Abstract: The value of high-frequency ultrasound combined with color Doppler ultrasound parameters in the diagnosis of benign and malignant thyroid nodules was explored. Forty patients with thyroid cancer were selected as the observation group and 42 patients with benign thyroid nodules were selected as the control group.The parameters of high-frequency ultrasound combined with color Doppler ultrasound in patients with different N and T stages were compared between the two groups, and the data were statistically analyzed. The comparison of nodule morphology, boundary, echo and calcification ultrasound signs between the two groups was statistically significant (P<0.05). The A/T_C, A/T_L, TI-RADS classification scores, PSV, RI, and Adler blood flow classification scores of the observation group were higher than those of the control group (P<0.05). The AUC of each parameter combined diagnosis of malignant thyroid nodules was 0.902. The AUC of diagnosis N1 staging was 0.879, and the AUC of diagnosis Ⅲ+Ⅳ staging was 0.915. All of which were greater than any single parameter (P<0.05). It can be seen that the combination of high-frequency ultrasound and color Doppler ultrasound to observe the signs of thyroid nodules and A/T_C, A/T_L, TI-RADS grades, PSV, RI, and Adler grades can diagnose the nature of nodules. It can also assess the preoperative tumor stage of patients with malignant nodules, and provide a quantitative reference for clinical treatment and decision-making.

Key words: high frequency ultrasound, PSV, RI, Adler blood flow classification, thyroid nodules, tumor staging

宋海国, 陆燕飞, 苏庚, 罗强. 高频超声联合PSV、RI、Adler血流分级在甲状腺良恶性结节中的诊断价值[J]. 影像科学与光化学, 2021, 39(2): 190-196.

SONG Haiguo, LU Yanfei, SU Geng, LUO Qiang. Diagnostic Value of High-frequency Ultrasound Combined with PSV, RI and Adler Blood Flow Classification in Benign and Malignant Thyroid Nodules[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2021, 39(2): 190-196.

参考文献

[1] Bailey S,Wallwork B.Differentiating between benign and malignant thyroid nodules:an evidence-based approach in general practice[J].Australian Journal of General Practice,2018,47(11):770-774.
[2] Pan X,Wang L.Comparison of diagnostic values between ultrasound elastography and ultrasound-guided thyroid nodular puncture in thyroid nodules[J].Oncology Letters,2018,16(4):5209-5213.
[3] Zhao X,Han Q,Zhang Z B,et al.Value of coarse needle biopsy in thyroid nodules as first-line diagnostic tool[J].Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2019,33(10):932-936.
[4] Slough C M,Kamani D,Randolph G W.In-office ultrasonographic evaluation of neck masses/thyroid nodules[J].Otolaryngologic Clinics of North America,2019,52(3):559-575.
[5] Liang J,Huang X,Hu H,et al.Predicting malignancy in thyroid nodules:radiomics score versus 2017 american college of radiology thyroid imaging, reporting and data system[J].Thyroid,2018,28(8):1024-1033.
[6] 夏丛燕,卢延嘉,韩煜东,等.甲状腺结节的彩色多普勒血流Adler分级对超声引导下细针穿刺细胞学结果的影响[J].临床与病理杂志,2018,38(10):57-63.
[7] Wang J,Wei W,Guo R.Ultrasonic elastography and conventional ultrasound in the diagnosis of thyroid micro-nodules[J].Pakistan Journal of Medical Sciences,2019,35(6):1526-1531.
[8] Zheng Y,Xu S,Zheng Z,et al.Ultrasonic classification of multicategory thyroid nodules based on Logistic regression[J].Ultrasound Quarterly,2020,36(2):146-157.
[9] Tang J J,Zhang B. Application of ultrasonography in the diagnosis of medullary thyroid cancer[J].Acta Academiae Medi-cinae Sinicae,2019,41(5):690-695.
[10] Ren J,Baek J H,Chung S R, et al. Degenerating thyroid nodules:ultrasound diagnosis, clinical significance, and management[J]. Korean Journal of Radiology,2019,20(6):947-955.
[11] Huang K,Gao N,Zhai Q,et al.The anteroposterior diameter of nodules in the risk assessment of papillary thyroid microcarcinoma[J].Medicine (Baltimore),2018,97(10):e9712.
[12] Jiao W P,Zhang L. Using ultrasonography to evaluate the relationship between capsular invasion or extracapsular extension and lymph node metastasis in papillary thyroid carcinomas[J].Chinese Medical Sciences Journal,2017,130(11):1309-1313.
[13] Lei Z K,Li M K,Luo D C,et al. The clinical significance of ultrasound grayscale ratio in differentiating markedly hypoechoic and anechoic minimal thyroid nodules[J].Journal of Cancer Research and Therapeutics,2018,14(7):1567-1571.
[14] Chen X,Gao M,Hu L,et al.The diagnostic value of the ultrasound gray scale ratio for different sizes of thyroid nodules[J]. Cancer Medicine,2019,8(18):7644-7649.
[15] Yin L, Zhang W, Bai W,et al. Relationship between morphologic characteristics of ultrasonic calcification in thyroid nodules and thyroid carcinoma[J].Ultrasound in Medicine and Biology,2020,46(1):20-25.
[16] Tian Y, Lu Y, Zhao Y Z,et al. Characteristics of high-resolution ultrasound in the assessment of microcalcification of papillary thyroid carcinoma[J].Acta Academiae Medicinae Sinicae,2018,40(3):378-384.
[17] Kobayashi K,Fujimoto T,Ota H,et al.Calcifications in thyroid tumors on ultrasonography:calcification types and relationship with histopathological type[J].Ultrasound International Open,2018,4(2):E45-E51.
[18] 肖春莹,周剑宇,杨朝晖,等.超声微血流成像技术与常规彩色多普勒超声评价甲状腺微小癌供应血管及其对甲状腺微小癌预测价值的比较研究[J].中国超声医学杂志,2018,34(12):1073-1076.
[19] 王晶,鹿皎,王荣,等.甲状腺乳头状癌常规超声图像特征及声触诊组织成像预测颈部淋巴结转移的价值研究[J].中国临床医学影像杂志,2020,31(1):11-14.
[20] 姚春,陈林丽,李艳萍,等.超声影像学检查在肉芽肿性乳腺炎和浸润性导管癌鉴别诊断中的价值[J].中华肿瘤杂志,2018,40(3):222-226.
[21] 孔晶,杨薇,金金,等.超微血管显像,能量多普勒及彩色多普勒血流显像对甲状腺结节的诊断价值比较[J].中华超声影像学杂志,2018,27(7):595-598.
[22] 李小娟,温德惠,张利英,等.TI-RADS联合SMI技术对甲状腺良恶性结节的鉴别诊断价值[J].山西医科大学学报,2018,49(6):85-88.
[23] Kalantari S. The diagnostic value of color Doppler ultrasonography in predicting thyroid nodules malignancy[J].International Tinnitus Journal,2018,22(1):35-39.
[24] 王小兵,马笑,付超,等.微细血管模式背景下造影对甲状腺良性结节血流的评估[J].中国超声医学杂志,2019,35(3):32-35.
[25] 吕秀芳,王延海,孙丹立,等.甲状腺良恶性结节的超声特征及血流情况分析[J].临床超声医学杂志,2019,21(6):435-438.
[26] Gannon A W, Langer J E, Bellah R, et al. Diagnostic accuracy of ultrasound with color flow Doppler in children with thyroid nodules[J].Journal of clinical Endocrinology & Metabolism,2018,103(5):1958-1965.
[27] Yang G C H, Fried K O. Most thyroid cancers detected by sonography lack intranodular vascularity on color Doppler imaging:review of the literature and sonographic-pathologic correlations for 698 thyroid neoplasms[J]. Journal of Ultrasound in Medicine,2017,36(1):89-94.