超声造影结合定量分析技术在鉴别诊断甲状腺良恶性结节中的应用价值
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摘要
目的探讨超声造影联合定量分析技术鉴别诊断甲状腺良恶性结节的临床价值。方法回顾性分析2016年8月至2017年9月于陆军军医大学第一附属医院超声造影检查的114例(共计175个结节)甲状腺结节患者,分析甲状腺良恶性结节超声造影(contrast-enhanced ultrasonography, CEUS)增强模式及时间-强度曲线(time-intensity curve, TIC)特点。所有患者均经手术证实,并与手术病理结果对照。结果 CEUS检测结果中显示良性结节为93个,恶性结节为82个,而病理结果显示良性结节为98个(其中腺瘤29个,结节性甲状腺肿69个),恶性结节(乳头状癌)为77个,CEUS检查对甲状腺恶性结节的诊断敏感性为85.7%,特异性为83.6%,准确率为84.5%。CEUS显示58.1%(57/98)的甲状腺腺瘤和结节性甲状腺肿呈均匀整体高增强或等增强,71.4%(55/77)的甲状腺恶性结节呈不均匀低增强。TIC显示,甲状腺腺瘤CEUS较结节周边的甲状腺组织进入更为迅速,且上升较快,其PI相对较高(P<0.05)。结节性甲状腺肿表现出同样迅速进入的特点,且上升较快,其PI与周围组织较相近。而甲状腺癌CEUS则缓慢进入,且上升较慢,其PI相对较低(P<0.05)。甲状腺癌的PI明显低于甲状腺良性结节(P<0.05),但二者在达峰时间和增强开始时间上差异均无统计学意义。结论甲状腺常见的良恶性结节CEUS具有不同的图像特征,其中甲状腺癌(乳头状癌)主要呈缓慢不均匀低增强,而甲状腺良性结节则以快速高增强或等增强为主。在常规超声检查的基础上,CEUS联合定量分析技术有助于提高甲状腺癌的诊断准确性。
Objective To investigate the clinical value of contrast-enhanced ultrasonography(CEUS) combined with time-intensity curve(TIC) analysis in differential diagnosis of benign and malignant thyroid nodules. Methods We conducted a retrospective study of 114 patients with 175 thyroid nodules detected by CEUS in our hospital between August, 2016 and September, 2017 and compared the enhancement patterns and TIC of CEUS between benign and malignant thyroid nodules. All the patients underwent surgical resection of the nodules and the findings of CEUS were compared with the results of surgical pathology. Results CEUS identified 93 benign nodules and 82 malignant nodules, while the pathological results confirmed 98 benign nodules(29 adenomas and 69 nodular goiters) and 77 malignant nodules(papillary carcinoma). CEUS had a diagnostic sensitivity of 85.7% for malignant thyroid nodules with a specificity of 83.6% and an accuracy of 84.5%. CEUS showed homogeneous hyperenhancement or isoenhancement in 58.1%(57/98) of thyroid adenomas and nodular goiters, and heterogeneous hypoenhancement in 71.4%(55/77) of malignant thyroid nodules. TIC analysis showed that compared with the surrounding thyroid tissue, thyroid adenomas showed a rapid entry in CEUS with a steep ascending branch and a higher peak intensity(P<0.05); nodular goiters also showed a rapid entry and a steep ascending branch but with a peak intensity consistent with that of the surrounding thyroid tissue. CEUS of thyroid carcinoma showed a slow entry, a relatively flat ascending branch, and a low peak intensity(P<0.05). The peak intensity of thyroid carcinomas was significantly lower than that of benign thyroid nodules(P<0.05), but the time to peak and arrival time were comparable between benign and malignant thyroid nodules(P>0.05). Conclusion Benign and malignant thyroid nodules commonly present with different characteristics in CEUS. Thyroid carcinomas(papillary carcinomas) are typically characterized by slow and heterogeneous hypoenhancement in CEUS, while benign thyroid nodules feature a rapid hyper-or isoenhancement. CEUS combined with quantitative analysis can improve the diagnostic accuracy for malignant thyroid nodules.
Objective To investigate the clinical value of contrast-enhanced ultrasonography(CEUS) combined with time-intensity curve(TIC) analysis in differential diagnosis of benign and malignant thyroid nodules. Methods We conducted a retrospective study of 114 patients with 175 thyroid nodules detected by CEUS in our hospital between August, 2016 and September, 2017 and compared the enhancement patterns and TIC of CEUS between benign and malignant thyroid nodules. All the patients underwent surgical resection of the nodules and the findings of CEUS were compared with the results of surgical pathology. Results CEUS identified 93 benign nodules and 82 malignant nodules, while the pathological results confirmed 98 benign nodules(29 adenomas and 69 nodular goiters) and 77 malignant nodules(papillary carcinoma). CEUS had a diagnostic sensitivity of 85.7% for malignant thyroid nodules with a specificity of 83.6% and an accuracy of 84.5%. CEUS showed homogeneous hyperenhancement or isoenhancement in 58.1%(57/98) of thyroid adenomas and nodular goiters, and heterogeneous hypoenhancement in 71.4%(55/77) of malignant thyroid nodules. TIC analysis showed that compared with the surrounding thyroid tissue, thyroid adenomas showed a rapid entry in CEUS with a steep ascending branch and a higher peak intensity(P<0.05); nodular goiters also showed a rapid entry and a steep ascending branch but with a peak intensity consistent with that of the surrounding thyroid tissue. CEUS of thyroid carcinoma showed a slow entry, a relatively flat ascending branch, and a low peak intensity(P<0.05). The peak intensity of thyroid carcinomas was significantly lower than that of benign thyroid nodules(P<0.05), but the time to peak and arrival time were comparable between benign and malignant thyroid nodules(P>0.05). Conclusion Benign and malignant thyroid nodules commonly present with different characteristics in CEUS. Thyroid carcinomas(papillary carcinomas) are typically characterized by slow and heterogeneous hypoenhancement in CEUS, while benign thyroid nodules feature a rapid hyper-or isoenhancement. CEUS combined with quantitative analysis can improve the diagnostic accuracy for malignant thyroid nodules.
引文
[1] 马文琦, 周茹, 姜珏, 等. 甲状腺结节三维能量多普勒定量分析与病理微血管密度的相关性研究[J].中国超声医学杂志, 2018, 34(5): 385-388. MA W Q, ZHOU R, JIANG J, et al. Correlation between Three-dimensional color power angiography quantification and pathological microvessel density in thyroid nodules[J].Chin J Ultrasound Med, 2018, 34(5): 385-388.
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[7] 杨萌, 苏娜, 王亮, 等.甲状腺乳头状癌微血管灌注模式的量化评估及其病理学基础[J].中华医学超声杂志(电子版), 2017, 14(4): 269-273. DOI: 10.3877/cma.j.issn.1672-6448.2017.04.007. YANG M, SU N, WANG L, et al. The contrast enhanced perfusion pattern and pathological changes of papillary thyroid cancer [J].Chin J Med Ultrasound(Electr Ed), 2017, 14(4): 269-273. DOI: 10.3877/cma.j.issn.1672-6448.2017.04.007.
[8] SCHLEDER S, JANKE M, AGHA A, et al. Preoperative differentiation of thyroid adenomas and thyroid carcinomas using high resolution contrast-enhanced ultrasound (CEUS)[J]. Clin Hemorheol Microcirc, 2015, 61(1): 13-22. DOI: 10.3233/CH-141848.
[9] LI F, WANG Y, BAI B, et al. Advantages of routine ultrasound combined with contrast-enhanced ultrasound in diagnosing papillary thyroid carcinoma[J]. Ultrasound Q, 2017, 33(3): 213-218. DOI: 10.1097/RUQ.0000000000000309.
[10] WIESINGER I, KROISS E, ZAUSIG N, et al. Analysis of arterial dynamic micro-vascularization with contrast-enhanced ultrasound (CEUS) in thyroid lesions using external perfusion software: First results[J]. Clin Hemorheol Microcirc, 2016, 64(4): 747-755. DOI: 10.3233/CH-168044.
[11] ZHOU Q, JIANG J, SHANG X, et al. Correlation of contrast-enhanced ultrasonographic features with microvessel density in papillary thyroid carcinomas[J]. Asian Pac J Cancer Prev, 2014, 15(17): 7449-7452. DOI: 10.7314/ apjcp.2014.15.17.7449.
[12] WEI X, LI Y, ZHANG S, et al. Evaluation of thyroid cancer in Chinese females with breast cancer by vascular endothelial growth factor (VEGF), microvessel density, and contrast-enhanced ultrasound (CEUS)[J]. Tumour Biol, 2014, 35(7): 6521-6529. DOI: 10.1007/s13277-014-1868-2.
[13] WEI X, LI Y, ZHANG S, et al. Evaluation of primary thyroid lymphoma by ultrasonography combined with contrast-enhanced ultrasonography: A pilot study[J]. Indian J Cancer, 2015, 52(4): 546-550. DOI: 10.4103/0019- 509X.178419.
[14] PANG T, HUANG L, DENG Y, et al. Logistic regression analysis of conventional ultrasonography, strain elastosonography, and contrast-enhanced ultrasound characteristics for the differentiation of benign and malignant thyroid nodules[J]. PLoS ONE, 2017, 12(12): e0188987. DOI: 10.1371/journal.pone.0188987.
[15] CHALHOUB M, HARRIS K. The use of endobronchial ultrasonography with transbronchial needle aspiration to sample a solitary substernal thyroid nodule[J]. Chest, 2010, 137(6): 1435-1436. DOI: 10.1378/chest.09-2840.
[16] 马步云, 金亚, SUNDAR P S, 等. 甲状腺乳头状癌的超声造影表现及其病理基础[J]. 四川大学学报(医学版), 2014, 45(6): 997-1000. MA B Y, JIN Y, SUNDAR P S, et al. Contrast-enhanced ultrasonography findings for papillary thyroid carcinoma and its pathological base[J]. J Sichuan Univ(Med Sci Edi), 2014,45(6): 997-1000.
[17] MOLINARI F, MANTOVANI A, DEANDREA M, et al. Characterization of single thyroid nodules by contrast-enhanced 3-D ultrasound[J]. Ultrasound Med Biol, 2010, 36(10): 1616-1625. DOI: 10.1016/j.ultrasmedbio.2010.07.011.
[18] MA X, ZHANG B, LING W, et al. Contrast-enhanced sonography for the identification of benign and malignant thyroid nodules: systematic review and meta-analysis[J]. J Clin Ultrasound, 2016, 44(4): 199-209. DOI: 10.1002/jcu.22311.
[19] JIA Z, HONG D.Application of contrast-enhanced ultrasound for evaluation of thyroid nodules[J].Ultrasonography, 2018, 37(4): 288-297. DOI: 10.14366/usg.18019.
[20] GU F, HAN L, YANG X, et al. Value of time-intensity curve analysis of contrast-enhanced ultrasound in the differential diagnosis of thyroid nodules[J]. Eur J Radiol, 2018, 105: 182-187. DOI: 10.1016/j.ejrad.2018.05.013.
[2] 赵瑞娜, 张波, 杨筱, 等.超声造影对桥本甲状腺炎合并甲状腺结节的诊断价值[J].中国医学科学院学报, 2015, 37(1): 66-70. DOI: 10.3881/j.issn.1000-503X.2015.01.012. ZHAO R N, ZHANG B, YANG X, et al. Diagnostic value of contrast-enhanced ultrasound of thyroid nodules coexisting with Hashimoto’s thyroiditis[J].ACTA Academiae Medicinae Sinicae, 2015, 37(1): 66-70. DOI: 10.3881/j.issn.1000-503X.2015.01.012.
[3] ZHANG Y Z, XU T, GONG H Y, et al. Application of high-resolution ultrasound, real-time elastography, and contrast-enhanced ultrasound in differentiating solid thyroid nodules[J]. Medicine(Baltimore), 2016, 95(45): e5329. DOI: 10.1097/MD.0000000000005329.
[4] YUAN Z, QUAN J, YUNXIAO Z, et al. Contrast-enhanced ultrasound in the diagnosis of solitary thyroid nodules[J]. J Cancer Res Ther, 2015, 11(1): 41-45. DOI: 10.4103/0973-1482.147382.
[5] LIU Y, ZHOU H, YANG P, et al. Contrast-enhanced ultrasonography features of papillary thyroid carcinoma for predicting cervical lymph node metastasis[J]. Exp Ther Med, 2017, 14(5): 4321-4327. DOI: 10.3892/etm.2017.5087.
[6] JIANG J, SHANG X, WANG H, et al. Diagnostic value of contrast-enhanced ultrasound in thyroid nodules with calcification[J]. Kaohsiung J Med Sci, 2015, 31(3): 138-144. DOI: 10.1016/j.kjms.2014.12.001.
[7] 杨萌, 苏娜, 王亮, 等.甲状腺乳头状癌微血管灌注模式的量化评估及其病理学基础[J].中华医学超声杂志(电子版), 2017, 14(4): 269-273. DOI: 10.3877/cma.j.issn.1672-6448.2017.04.007. YANG M, SU N, WANG L, et al. The contrast enhanced perfusion pattern and pathological changes of papillary thyroid cancer [J].Chin J Med Ultrasound(Electr Ed), 2017, 14(4): 269-273. DOI: 10.3877/cma.j.issn.1672-6448.2017.04.007.
[8] SCHLEDER S, JANKE M, AGHA A, et al. Preoperative differentiation of thyroid adenomas and thyroid carcinomas using high resolution contrast-enhanced ultrasound (CEUS)[J]. Clin Hemorheol Microcirc, 2015, 61(1): 13-22. DOI: 10.3233/CH-141848.
[9] LI F, WANG Y, BAI B, et al. Advantages of routine ultrasound combined with contrast-enhanced ultrasound in diagnosing papillary thyroid carcinoma[J]. Ultrasound Q, 2017, 33(3): 213-218. DOI: 10.1097/RUQ.0000000000000309.
[10] WIESINGER I, KROISS E, ZAUSIG N, et al. Analysis of arterial dynamic micro-vascularization with contrast-enhanced ultrasound (CEUS) in thyroid lesions using external perfusion software: First results[J]. Clin Hemorheol Microcirc, 2016, 64(4): 747-755. DOI: 10.3233/CH-168044.
[11] ZHOU Q, JIANG J, SHANG X, et al. Correlation of contrast-enhanced ultrasonographic features with microvessel density in papillary thyroid carcinomas[J]. Asian Pac J Cancer Prev, 2014, 15(17): 7449-7452. DOI: 10.7314/ apjcp.2014.15.17.7449.
[12] WEI X, LI Y, ZHANG S, et al. Evaluation of thyroid cancer in Chinese females with breast cancer by vascular endothelial growth factor (VEGF), microvessel density, and contrast-enhanced ultrasound (CEUS)[J]. Tumour Biol, 2014, 35(7): 6521-6529. DOI: 10.1007/s13277-014-1868-2.
[13] WEI X, LI Y, ZHANG S, et al. Evaluation of primary thyroid lymphoma by ultrasonography combined with contrast-enhanced ultrasonography: A pilot study[J]. Indian J Cancer, 2015, 52(4): 546-550. DOI: 10.4103/0019- 509X.178419.
[14] PANG T, HUANG L, DENG Y, et al. Logistic regression analysis of conventional ultrasonography, strain elastosonography, and contrast-enhanced ultrasound characteristics for the differentiation of benign and malignant thyroid nodules[J]. PLoS ONE, 2017, 12(12): e0188987. DOI: 10.1371/journal.pone.0188987.
[15] CHALHOUB M, HARRIS K. The use of endobronchial ultrasonography with transbronchial needle aspiration to sample a solitary substernal thyroid nodule[J]. Chest, 2010, 137(6): 1435-1436. DOI: 10.1378/chest.09-2840.
[16] 马步云, 金亚, SUNDAR P S, 等. 甲状腺乳头状癌的超声造影表现及其病理基础[J]. 四川大学学报(医学版), 2014, 45(6): 997-1000. MA B Y, JIN Y, SUNDAR P S, et al. Contrast-enhanced ultrasonography findings for papillary thyroid carcinoma and its pathological base[J]. J Sichuan Univ(Med Sci Edi), 2014,45(6): 997-1000.
[17] MOLINARI F, MANTOVANI A, DEANDREA M, et al. Characterization of single thyroid nodules by contrast-enhanced 3-D ultrasound[J]. Ultrasound Med Biol, 2010, 36(10): 1616-1625. DOI: 10.1016/j.ultrasmedbio.2010.07.011.
[18] MA X, ZHANG B, LING W, et al. Contrast-enhanced sonography for the identification of benign and malignant thyroid nodules: systematic review and meta-analysis[J]. J Clin Ultrasound, 2016, 44(4): 199-209. DOI: 10.1002/jcu.22311.
[19] JIA Z, HONG D.Application of contrast-enhanced ultrasound for evaluation of thyroid nodules[J].Ultrasonography, 2018, 37(4): 288-297. DOI: 10.14366/usg.18019.
[20] GU F, HAN L, YANG X, et al. Value of time-intensity curve analysis of contrast-enhanced ultrasound in the differential diagnosis of thyroid nodules[J]. Eur J Radiol, 2018, 105: 182-187. DOI: 10.1016/j.ejrad.2018.05.013.