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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2015, Vol. 12 ›› Issue (10) : 768 -772. doi: 10.3877/cma.j.issn.1672-6448.2015.10.006

所属专题： 文献；

浅表器官超声影像学

超声联合硬度评分系统在甲状腺微小结节诊断中的应用价值
朱隽1, 詹嘉1,†(), 刁雪红1, 万敏1, 王慧芳1, 陈悦1   
  1. 1. 200040　上海，复旦大学附属华东医院超声科
  • 收稿日期:2015-02-12 出版日期:2015-10-01
  • 通信作者: 詹嘉
  • 基金资助:
    上海市科委医学引导类科技项目(14411970400)

The value of combined stiffness score system for the diagnosis of thyroid micronodules

Jun Zhu1, Jia Zhan1,†(), Xuehong Diao1, Min Wan1, Huifang Wang1, Yue Chen1   

  1. 1. Department of Ultrasound, Huadong Hospital of Fudan University, Shanghai 200040, China
  • Received:2015-02-12 Published:2015-10-01
  • Corresponding author: Jia Zhan
  • About author:
    Corresponding author: Zhan Jia, Email:
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引用本文：

朱隽, 詹嘉, 刁雪红, 万敏, 王慧芳, 陈悦. 超声联合硬度评分系统在甲状腺微小结节诊断中的应用价值[J]. 中华医学超声杂志（电子版）, 2015, 12(10): 768-772.

Jun Zhu, Jia Zhan, Xuehong Diao, Min Wan, Huifang Wang, Yue Chen. The value of combined stiffness score system for the diagnosis of thyroid micronodules[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(10): 768-772.

目的

探讨超声联合硬度评定系统在甲状腺微小结节诊断中的应用价值。

方法

对30例行甲状腺切除手术患者的67个甲状腺微小结节，术前分别行实时弹性成像和声脉冲辐射力成像评定成像测定其硬度。在此基础上，以联合硬度评定系统对甲状腺结节硬度进行评定，以硬度为依据鉴别诊断甲状腺结节的良恶性，并以病理为标准，绘制ROC曲线。

结果

实时弹性成像鉴别诊断甲状腺良恶性的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为58.8%、96.9%、95.2%、69.6%、77.6%。声脉冲辐射力成像鉴别诊断甲状腺良恶性的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为76.4%、75.8%、76.4%、75.8%、76.1%。联合硬度评定系统鉴别诊断甲状腺良恶性的敏感度、特异度、阳性预测值、阴性预测值、准确性分别为91.2%、93.9%、93.9%、91.2%、92.5%。联合系统与实时弹性成像以及声脉冲辐射力成像相比，ROC曲线下面积分别为0.98，0.93和0.88（Z=8.72，P<0.05）。

结论

联合硬度评分系统有助于提高术前甲状腺微小结节良恶性鉴别诊断的准确性。

关键词: 联合硬度评分系统, 实时弹性成像, 声脉冲辐射力, 甲状腺微小结节
Objective

To assess the value of combined stiffness score system (CSSS) in differential diagnosis of thyroid micronodules.

Methods

30 patients with 67 thyroid nodules underwent real-time elastography (RTE) and acoustic radiation force impulse (ARFI) imaging before thyroidectomy , then CSSS were taken to re-evaluate the stiffness of the thyroid nodules. Compared with pathological findings, ROC curves were drawn to evaluate the diagnostic accuracy.

Result

The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of RTE for differential diagnosis were 58.8%, 96.9%, 95.2%, 69.6%, 77.6%, while for ARFI and CSSS they were 76.4%, 75.8%, 76.4%, 75.8%, 76.1%, and 91.2%, 93.9%, 93.9%, 91.2%, 92.5%. The areas under the ROC curve for CSSS, RTE and ARFI were 0.98, 0.93 and 0.88 respectively, there were significant differences (Z = 8.72, P<0.05).

Conclusion

CSSS was helpful in differential diagnosis of benign and malignant thyroid micronodules.

Key words: United stiffness score system, Real-time elastography, Acoustic radiation force impulse, Thyroid micronodules
表1 常规超声检查甲状腺微小结节结果与病理结果（个）
常规超声 病理结果 合计
恶性 良性
恶性 22 8 37
良性 12 25 30
合计 34 33 67
图1 乳腺微小结节联合硬度评分对实时弹性成像评分的校正。
表2 RTE检查甲状腺微小结节结果与病理结果（个）
RTE评分 病理结果 合计
恶性 良性
1~3 14 32 46
4~5 20 1 21
合计 34 33 67
表3 ARFI检查甲状腺微小结节结果与病理结果（个）
SWV 病理结果 合计
恶性 良性
<2.81 m/s 8 25 33
≥2.81 m/s 26 8 34
合计 34 33 67
表4 RTE和ARFI联合硬度评价甲状腺微小结节结果与病理结果（个）
联合评分 病理结果 合计
恶性 良性
0~2 30 2 32
3~4 3 32 35
合计 33 34 67
图2 乳腺微小结节联合硬度评分系统、实时弹性成像和声脉冲辐射力成像的ROC曲线下面积分别为0.98，0.88和0.93
图3 乳腺微小结节联合硬度评分对声脉冲辐射力成像评分的校正
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