甲状腺结节的超声多模态诊断路径探讨
英语听力训练
摘要
目的
评估多模态超声成像技术对TI-RADS4类甲状腺结节的超声诊断效能，以期提高超声诊断的准确性和促进临床管理路径。
方法
前瞻性收集2018年10月至2019年10月于延安大学附属医院行常规超声检查、超声造影及剪切波弹性成像三种超声成像技术诊断为TI-RADS4类的甲状腺结节患者62例。经纳入排除标准、图像质量筛选并且经组织病理学证实共纳入68个病灶。男性12例，女性50例，年龄26~72岁（平均年龄45.8±10.8）。所有常规超声、CEUS及弹性成像检查均由两名经验丰富的超声医师在未知病理结果的情况下独立完成。定性分析甲状腺TI-RADS4类结节的增强时间、增强程度、增强形态以及弹性成像杨氏模量等参数。以穿刺或手术病理为金标准，构建ROC曲线，比较常规超声，超声造影及弹性成像三种不同超声诊断路径对甲状腺良恶性结节的诊断效能。结果
68个TI-RADS4类病变中，病理诊断良性45例(66.2%)，恶性23例(33.8%)。在常规超声中，以TI-RADS4c为诊断标准，良恶性结节间差异有统计学意义（P<0.05）。在超声造影中，甲状腺良恶性结节之间存在统计学差异的增强特征有：增强程度、增强形态、增强速度（P<0.05）；良恶性结节在廓清时间上不存在统计学差异（p=0.963）。其中慢进、不均匀、低增强是超声造影鉴别良恶性结节主要超声造影增强特征。良性结节中慢进、不均匀、低增强占比分分别为74.41%（32/43）、62.79%（27/43）、55.81%（24/43），恶性结节中慢进、不均匀、低增强占比分别为56%（14/25）、72%（18/25）、88%（22/25）。在剪切波弹性成像中，甲状腺良恶性结节之间存在统计学差异的杨氏模量值有最大值、均值、最小值（p＜0.05）。恶性甲状腺结节的所有杨氏模量值均明显高于良性结节，良性结节最大、平均、最
小杨氏模量值分别为（38.00±12.45）kPa、（23.69±7.49）kPa、（13.61±3.75）
北京留学机构
kPa，恶性结节最大、平均、最小杨氏模量值分别为(59.74±26.52)kPa、（34.37±21.09）kPa、（19.51±15.80）kPa。SWE单独用于甲状腺结节良恶性的诊断，杨氏
attention的用法模量最大值、均值、最小值的曲线下面积分别为0.806、0.720、0.554（P<0.05），
ishoot
Emax用于鉴别甲状腺良恶性结节时其最佳截断值为44.8kPa。2、单独使用高分辨
率超声、超声造影、剪切波弹性成像时，诊断甲状腺结节良恶性的灵敏度、特异度、准确率、PPV、NPV分别为61.5%、96.6%、68.4%、96%、65.1%；66.7%、96.9%、
80.8%、96%、72%；78.6%、92.5%、86.8%、88%、86%；HRUS与CEUS、HRUS
与SWE、CEUS与SWE联合诊断时，判断甲状腺结节的良恶性的灵敏度、特异度、准确度、PPV、NPV分别为79.3%、94.9%、88.2%、92%、86.1%；88%、93%、91.2%、
88%、93.2%；78.6%、92.5%、86.8%、88%、86.1%；并联时对甲状腺结节良恶性
诊断的灵敏度、特异度、准确度、PPV、NPV为91.7%、93.2%、92.6%、88%、95.3%。对比发现，多模态超声技术联合时定性诊断TI-RADS4类结节的价值更高，ROC 曲线下面积为0.899，均大于单独检查（常规超声0.791、超声造影0.815、弹性成像0.850）。
结论
多模态超声技术可提高TI-RADS4类结节诊断的敏感度和准确度，减少不必要的穿刺活检，在临床诊疗和管理中具有重要的指导意义。
国际音标辅音表关键词：甲状腺结节；常规超声；超声造影；剪切波弹性成像；TI-RADS4类
Study on Ultrasonographic Multimodality Diagnosis Pathway
例子的英文of Thyroid Nodules
Abstract
hat是什么意思
Objective
To evaluate the ultrasonic diagnostic efficiency of multimodal ultrasound imaging technology for TI-RADS type4nodules in order to improve the accuracy of ultrasound diagnosis and promote clinical management.
Methods
Prospective collection of62patients with thyroid nodules diagnod as TI-RADS type4 by conventional ultrasound examination,ultrasound contrast and shear wave elastography at the affiliated hospital of Yan'an University from October2018to October 2019.A total of68lesions were included by inclusion exclusion criteria,image quality screening,and confirmed by histopathology.There were12males and50females,aged 26-72years(mean age45.80±10.76).All routine ultrasound,CEUS,and elastography examinations were performed independently by two exp
erienced sonographers without knowledge of pathological findings.Qualitative analysis of parameters such as enhancement time,enhancement degree,enhancement morphology,and Young's modulus of TI-RADS type4nodules.Using the puncture or surgical pathology as the gold standard,construct ROC curves and compare the diagnostic efficacy of three different ultrasound diagnostic methods of conventional ultrasound,ultrasound contrast and elastography for benign and malignant thyroid nodules.
Results
Among the68TI-RADS type4lesions,45cas were diagnod as benign(66.2%)and 23cas were malignant(33.8%).In conventional ultrasound,with TI-RADS4c as the diagnostic criterion,the difference between benign and malignant nodules was statistically significant(P<0.05).In ultrasound contrast,there are statistically significant enhancement features between benign and malignant thyroid nodules:degree of enhancement,enhanced morphology,and enhancement speed(P<0.05);benign and malignant nodules have no statistical difference in clearance time(p==0.963).Among
them,slow progression,non-uniformity and low enhancement are the main features of ultrasound con
trast enhancement in the identification of benign and malignant nodules. The proportions of slow progression,unevenness and low enhancement in benign nodules were74.41%(32/43),62.79%(27/43),55.81%(24/43),slow progression, uneven,malignant nodules The proportion of low enhancement was56%(14/25),72% (18/25),and88%(22/25).In shear wave elastography,there are statistically significant Young's modulus values between benign and malignant thyroid nodules:maximum, average,and minimum(p<0.05).All Young's modulus values of malignant thyroid nodules are significantly higher than benign nodules.The maximum,average,and minimum Young's modulus values of benign nodules are(38.00±12.45)kPa,(23.69±7.49)kPa,(13.61± 3.75)kPa,the maximum,average and minimum Young's modulus values of malignant nodules are(59.74±26.52)kPa,(34.37±21.09)kPa, (19.51±15.80)kPa.Shear wave elastography is ud alone to diagno benign and malignant thyroid nodules.The area under the curve of the Young's modulus maximum, mean,and minimum values are0.806,0.720,and0.554,respectively(P<0.05).Emax is ud to identify benign and thyroid nodules.The best cutoff value for malignant nodules is44.8kPa.2.The nsitivity,specificity,accuracy,PPV and NPV of diagnosing benign and malignant thyroid nodules are61.5%,96.6%,68.4%,96%when using high-resolution ultrasound,ultrasound contrast,and shear wave elastography alone., 65.1%;66.7%,96.9%,80.8%,96%,72%;78.6%,92.5%,86.8%,88%,86%;HRUS and CEUS,HRUS and
SWE,CEUS and SWE combined diagnosis,judgment The nsitivity, specificity,accuracy,PPV and NPV of benign and malignant thyroid nodules were79.3%, 94.9%,88.2%,92%and86.1%;88%,93%,91.2%,88%and93.2%;78.6%,92.5%, 86.8%,88%,86.1%;the nsitivity,specificity,accuracy,PPV,NPV of91.7%,93.2%, 92.6%,88%,95.3for the diagnosis of benign and malignant thyroid nodules when connected in parallel%.The comparison found that the multimodal ultrasound technology combined with qualitative diagnosis of TI-RADS type4nodules is more valuable,and the area under the ROC curve is0.899,which is larger than the single examination(conventional ultrasound0.791,ultrasound contrast0.815,elastography 0.850).
Conclusion
Multimodal ultrasound can improve the nsitivity and accuracy of the diagnosis of
武汉成人学校有哪些TI-RADS type4nodules,reduce unnecessary biopsy,and has guiding significance in clinical diagnosis and management.
red eyeGraduate:Zhang Ting(Medical Image and Nuclear Medicine)
南京环球雅思Directed by:Prof.Wang Shengli Keywords:Thyroid nodules;Conventional ultrasound;Contrast-enhanced ultrasound; shear wave elastography;TI-RADS4
