探讨超声造影定性分析鉴别诊断甲状腺良恶性结节的价值。

选择2015年5月至2016年1月南京大学医学院附属金陵医院（南京军区南京总医院）收治的行甲状腺超声造影的110例患者共132个甲状腺结节。所有结节均经甲状腺细针穿刺细胞学病理证实，其中113个经手术病理证实。对甲状腺结节超声造影特征进行评分。采用χ²检验比较甲状腺良恶性结节超声造影特征差异。绘制甲状腺结节超声造影评分鉴别诊断甲状腺良恶性结节的操作者工作特征（ROC）曲线。

本组甲状腺良性结节56个，甲状腺恶性结节76个。甲状腺良恶性结节超声造影增强水平、增强方式、增强均匀性、环状增强、增强后结节形状、增强后结节边界、增强后结节大小等差异均有统计学意义（χ²=23.85，P<0.001；χ²=7.43，P=0.04；χ²=34.54，P<0.001；χ²=25.7，P<0.001；χ²=53.10，P<0.001；χ²=22.78，P<0.001；χ²=30.90，P<0.001）；甲状腺良恶性结节超声造影增强是否完全差异无统计学意义。甲状腺恶性结节典型超声造影征象为低增强（71.1%）、向心性增强（79.5%）、不均匀增强（89.0%）、增强后结节边界不清晰（64.4%）、增强后结节形状不规则（79.5%）、增强后结节增大（63.0%）；甲状腺良性结节典型超声造影征象为环状高增强（34.7%）。ROC曲线显示，超声造影评分鉴别诊断甲状腺良恶性结节最佳阈值为3.5分，超声造影评分>3.5分诊断甲状腺恶性结节的敏感度、特异度、准确性分别为80.8%、79.6%、80.3%，曲线下面积为0.862（95%可信区间0.797~0.927）。

超声造影定性分析有助于甲状腺良恶性结节的鉴别诊断。

To explore the qualitative evaluation of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant thyroid nodules (TNs).

Totally 110 outpatients with 132 TNs underwent CEUS were enrolled in this study in Jinling Hospitall Medical School of Nanjing University (Nanjing General Hospital of Nanjing Military). Nanjing General Hospital of Nanjing Military All the nodules underwent ultrasound guided fine needle aspiration biopsy (FNAB). 113 TNs were histologically diagnosed. the characteristics of enhancement for each noudle were scored. The characteristics of enhancement between benign and malignant TNs were compared by chi-square test. The receiver operating characteristic (ROC) curve analysis were conducted to determine the diagnostic values of thyroid CEUS.

Contrast-enhanced patterns were significantly different between benign and malignant TNs in the degree, homogeneity of enhancement, enhanced ring and boundary, shape and size of the enhanced lesions (χ²=23.85, P<0.001; χ²=7.43, P=0.04; χ²=34.54, P<0.001; χ²=25.7, P<0.001; χ²=53.10, P<0.001; χ²=22.78, P<0.001; χ²=30.90, P<0.001). Contrast-enhanced patterns were not significantly different between benign and malignant TNs in the process and completeness of enhancement. Malignant lesions had concentric (79.5%), inhomogeneous (89.0%) and low (71.1%) enhanced with irregular (79.5%) and unclear (64.4%) boundary and bigger size (63.0%). The typical CEUS feature of benign nodules was peripheral ring hyperenhancement (34.7%). According to ROC curve, the cut off value was 3.5 points. The area under the ROC curve (AUC) for CEUS was 0.862 (95%CI: 0.797-0.927).The sensitivity, specificity and accuracy for CEUS were 80.8%, 79.6%, 80.3% respectively.

The pattern of CEUS may assist in differential diagnosis of benign and malignant TNs.