探讨超声造影及弹性成像对细胞学不能明确诊断的TI-RADS 4类甲状腺结节的诊断价值。

选取2014年1月至2016年12月在浙江大学医学院附属第二医院对140例患者共151个细胞学不能明确诊断的甲状腺影像报告与数据系统（TI-RADS 4）类结节，按结节最大径分成A组（≤1.0 cm）和B组（>1.0 cm），行超声造影（CEUS）及弹性成像评估，最后与手术结果对比，以手术病理结果为"金标准"，通过四格表分别计算超声弹性、CEUS及两者联合诊断的敏感度、特异度及准确性，CEUS、弹性成像以及联合诊断的敏感度、特异度及准确性比较，采用多组间χ²检验，有统计学意义的采用两两比较，A组与B组间三种诊断方法的敏感度、特异度及准确性比较采用两两比较的χ²检验。

A组中CEUS与弹性成像联合诊断的敏感度为98.0%、特异度为89.0%、准确性为93.7%。B组中CEUS、弹性成像联合诊断的敏感度为96.8%、特异度为88.0%、准确性为92.9%。A组中敏感度及准确性比较，差异均有统计学意义（χ²=17.344、16.315，P均<0.001）。两两比较，联合诊断的敏感度及准确性高于CEUS，差异均有统计学意义（χ²=17.344、16.173，P均<0.001），联合诊断的敏感度及准确性均高于弹性成像，差异均有统计学意义（χ²=7.111、5.141，P均<0.05）。B组中敏感度及准确性比较，差异均有统计学意义（χ²=15.123、15.485，P均<0.01）。两两比较，联合诊断的敏感度及准确性高于CEUS，差异均有统计学意义（χ²=5.167、3.903，P均<0.05），联合诊断的敏感度及准确性也高于弹性成像，差异均有统计学意义（χ²=14.862、14.882，P均<0.001）。CEUS的准确性高于弹性成像，差异有统计学意义（χ²=4.375，P=0.036）。弹性成像在A组的敏感度及准确性高于B组，差异均有统计学意义（χ²=6.943、8.127，P均<0.01）。

CEUS与弹性成像联合应用可以更准确评估细胞学未定性的甲状腺结节的性质，为该类结节的诊疗提供一定依据。且弹性成像在结节最大径≤1.0 cm中的诊断价值高于>1.0 cm。

To ivestigate the clinical value of ultrasound elastography in combination with contrast-enhanced ultrasound in nondiagonostic thyroid nodules with suspicous ultrasound features.

A total of 140 patients with 151 thyroid nodules (TIRADS 4) were examined by elastography and contrast-enhanced ultrasound (CEUS) in this study. The results were compared with surgical pathology. According to the maximal diameter of thyroid nodules, they were divided into group A (≤1.0 cm) and group B (>1.0 cm). Surgical pathologic results as the ″gold standard″, through four tables calculated the sensitivity, specificity and accuracy of the elastography, CEUS and combining both diagnosis. The sensitivity, specificity and accuracy were analyzed by chi-square test.

The sensitivity, specificity, accuracy of CEUS combined with elastography were 98.0%, 89.0%, 93.7% in group A, while in group B, they were 96.8%, 88.0%, 92.9%. In group A, the differeces in sensitivity and accuracy were statistically significant (χ²=17.344, 16.315, all P<0.001); the sensitivity and accuracy of combined were higher than those of CEUS (χ²=17.344, 16.173, P<0.001); The sensitivity and accuracy of combined were higher than those of elastography (χ²=7.111, 5.141, P均<0.05). In group B, the differeces in sensitivity and accuracy were statistically significant (χ²=15.123, 15.485, all P<0.01) the sensitivity and accuracy of combined were higher than those of CEUS (χ²=5.167, 3.903, P均<0.05); The sensitivity and accuracy of combined were higher than those of elastography (χ²=14.862, 14.882, P<0.001). The accuracy of CEUS is higher than elastography in group B (χ²=4.375, P=0.036). The sensitivity and accuracy of elastography in group A were higher those in group B (χ²=6.943, 8.127, P均<0.01). The above differences were statistically significant (all P<0.05).

Combination of CEUS with ultrasound elastography have good application value in diagnosis of thyroid nodules with indeterminate cytology. And elastography has a higher diagnostic value for thyroid nodules in group A than in group B.