SMART 3D-SMI在甲状腺TI-RADS 4类结节良恶性鉴别诊断中的应用

doi:10.7517/issn.1674-0475.211204

摘要/Abstract

摘要： 探讨超微血管三维立体超声成像(SMART 3D-SMI)在甲状腺影像学报告及数据系统(TI-RADS)4类结节良恶性鉴别诊断。选取120例(128个结节)TI-RADS 4类结节患者,分析CDFI、2D-SMI、3D-SMI对TI-RADS 4类结节良恶性的诊断效能。病理确诊良性84个,恶性44个。TI-RADS 4a级87个,4b级30个,4c级11个,准确率为67.97%。与CDFI比,2D-SMI、3D-SMI的血流分级较高;与CDFI比,2D-SMI、3D-SMI检出3级血流较多;2D-SMI与3D-SMI的Adler分级比较,差异无统计意义(P＞0.05)。良性结节在CDFI、2D-SMI、3D-SMI的血流分布模式差异无统计意义(P＞0.05),与CDFI比,恶性结节在2D-SMI与3D-SMI模式下的Ⅲ型显示率较高(P＜0.05)。TI-RADS分别联合CDFI、2D-SMI、3D-SMI鉴别诊断甲状腺结节良恶性,三者比较,TI-RADS+3D-SMI的敏感性、准确度及阴性预测值更高(P＜0.05),诊断特异度、阳性预测值差异无统计意义(P＞0.05)。SMART 3D-SMI能准确评估甲状腺TI-RADS 4类结节的微血管空间分布和模式。

关键词: 甲状腺结节, 超微血管三维立体超声成像, 甲状腺影像学报告及数据系统, 鉴别诊断

Abstract: This study investigated the application value of 3-dimensional ultrasound imaging (smart 3D-SMI) in the differential diagnosis of benign and malignant in TI-RADS 4 thyroid nodules. 120 cases of patients (128 nodules) with TI-RADS type 4 nodules were selected and analyzed the diagnostic efficacy of CDFI, 2D-SMI and 3D-SMI for benign and malignant of TI-RADS type 4 nodules. Pathologically confirmed 84 cases benign and 44 cases malignant. TI-RADS had 87 grades 4a, 30 grades 4b and 11 grades 4c, with an accuracy rate of 67.97%. Compared with CDFI, 2D-SMI and 3D-SMI had higher blood flow grades, and detected more grade 3 blood flow. There was no statistically significant difference between 2D-SMI and 3D-SMI grades (P＞0.05). There was no significant difference in the blood flow distribution pattern of benign nodules in CDFI, 2D-SMI and 3D-SMI (P＞0.05). Compared with CDFI, malignant nodules showed more type Ⅲ in 2D-SMI and 3D-SMI modes (P＜0.05). TI-RADS combined with CDFI, 2D-SMI and 3D-SMI respectively in the differential diagnosis of benign and malignant thyroid nodules, compared of the three methods, TI-RADS +3D-SMI had higher sensitivity, accuracy and negative predictive value (P<0.05), and had no significant difference in diagnostic specificity and positive predictive value (P＜0.05). SMART 3D-SMI can accurately assess the microvascular spatial distribution and pattern of thyroid TI-RADS 4 nodules.

Key words: thyroid nodule, 3 dimensional ultrasound imaging of microvascular, thyroid imaging report and data system, differential diagnosis

李朝喜, 温德惠, 刘伟亮, 陆海永. SMART 3D-SMI在甲状腺TI-RADS 4类结节良恶性鉴别诊断中的应用[J]. 影像科学与光化学, 2022, 40(3): 510-514.

LI Chaoxi, WEN Dehui, LIU Weiliang, LU Haiyong. Application of SMART 3D-SMI in the Differential Diagnosis of Benign and Malignant in TI-RADS 4 Thyroid Nodules[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(3): 510-514.

参考文献

[1] Hoang J K, Middleton W D, Tessler F N. Update on ACR TI-RADS:Successes, challenges, and future directions, from the AJR special series on radiology reporting and data systems[J]. American Journal of Roentgenology, 2021,216(3):570-578.
[2] 庞土娣, 姜伟. 超声新技术在甲状腺微小癌中的研究现状[J]. 医学综述, 2019,25(1):144-148, 153.
[3] Adler D D, Carson P L, Rubin J M, et al. Doppler ultrasound color flow imaging in the study of breast cancer:Preliminary findings[J]. Ultrasound in Medicine & Biology, 1990,16(6):553-559.
[4] Kim J H, Baek J H, Lim H K, et al. 2017 Thyroid radiofrequency ablation guideline:korean society of thyroid radio-logy[J]. Korean Journal of Radiology, 2018,19(4):632-655.
[5] 吴晓安, 刘丽萍. 二维超声TI-RADS分类联合超声造影在诊断甲状腺癌中的应用[J]. 中国医学影像学杂志, 2019,27(2):131-134.
[6] 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.
[7] 程将, 葛晖. 超声新技术在甲状腺结节良恶性鉴别诊断中的研究进展[J]. 医学综述, 2017,23(23):4746-4751.
[8] 李伟伟, 周庆华, 吴迎, 等. 超微血管三维立体成像技术对乳腺肿块血流的评估价值[J]. 中国超声医学杂志, 2019,35(7):587-589.
[9] 李阳, 郭婕, 苏蕾, 等. 超微血管三维立体超声成像在甲状腺良恶性结节鉴别诊断中的应用价值[J]. 蚌埠医学院学报, 2020,45(4):507-510.
[10] 刘扬, 闫国珍, 何俊峰, 等. 联合应用二维超声、彩色多普勒血流成像、超声造影及超声弹性成像技术并参照TI-RADS标准对甲状腺结节诊断价值的研究[J]. 包头医学院学报, 2019,35(4):10-13.
[11] 陶玲玲, 詹维伟, 樊金芳, 等. 超微血管成像结合TI-RADS鉴别诊断甲状腺良恶性结节[J]. 中国医学影像技术, 2020,36(5):671-674.
[12] 赵永锋, 周平, 彭洪, 等. 超微血管成像及超声造影在甲状腺结节鉴别诊断中的应用[J]. 中南大学学报(医学版), 2019,44(6):649-656.
[13] Miyamoto M, Ohara A, Arai T, et al. Three-dimensional imaging of vocalizing larynx by ultra-high-resolution computed tomography[J]. European Archives of Oto-Rhino-Laryngology, 2019,276(11):3159-3164.
[14] 陆海永, 李朝喜, 温德惠, 等. 多模态超声在中、高度可疑恶性甲状腺结节鉴别中的诊断价值[J]. 天津医药, 2021,49(1):69-73.