超声多技术联合在良恶性甲状腺结节鉴别诊断中的应用价值

摘要 目的：分析超声剪切波弹性成像（SWE）、超声造影（CEUS）、声触诊组织成像及定量（VTIQ）、促甲状腺激素（TSH）多技术联合在甲状腺结节良恶性鉴别诊断中的应用价值。方法：选取宁德市医院甲状腺不确定性质结节患者120例，以病理结果为金标准将其分为良性组和恶性组，分析两组SWE、CEUS、VTIQ各影像参数及术前TSH水平差异，绘制受试者工作特征曲线（ROC）评估上述技术联合对甲状腺结节良恶性的鉴别诊断价值。结果：120例患者共检出128个结节，其中良性47个，恶性81个；恶性组SWE中弹性模量值（Emax、Emin、Emean）均大于良性组（P＜0.01）；恶性组、良性组在CEUS中强化差异有显著性（P＜0.05）；VTIQ中恶性组剪切波速度（SWV）最大值、最小值、平均值均大于良性组（P＜0.01）；恶性组患者术前TSH水平高于良性组（P＜0.01）；ROC曲线分析显示，SWE、CEUS、VTIQ、TSH联合检测诊断甲状腺结节良恶性的效能最高，其灵敏度、特异度、准确度、曲线下面积（AUC）分别为85.19%、89.36%、86.72%、0.873。结论：SWE、CEUS、VTIQ、TSH联合对区分甲状腺结节良恶性有较高价值。

Application Value of Ultrasound Multi-technology in the Differential Diagnosis of Benign and Malignant Thyroid Nodules

ABSTRACT Objective: To analyze the application value of ultrasound shear wave elastography (SWE), contrast enhanced ultrasound (CEUS), virtual touch tissue imaging quantification (VTIQ) combined with thyroid stimulating hormone (TSH) in the differential diagnosis of benign and malignant thyroid nodules. Methods: 120 patients with indeterminate thyroid nodules were selected from Ningde Hospital and divided into benign group and malignant group with pathological results as the golden standard. Differences between the two groups in SWE, CEUS, VTIQ imaging parameters and preoperative TSH levels were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the value of combined application of above-mentioned techniques in differential diagnosis of benign and malignant thyroid nodules. Results: A total of 128 nodules were detected in this study, including 47 benign and 81 malignant nodules. The elasticity modulus values (Emax, Emin, Emean) in SWE of the malignant group were larger than the benign group (P<0.01). There was a statistically significant difference in CEUS enhancement between the two groups (P<0.05). The maximum, minimum and average shear wave velocities (SWV) in VTIQ of the malignant group were higher than the benign group(P<0.01), and the preoperative TSH level was also higher than the benign group(P<0.01). ROC curve analysis showed that the efficiency of combined detection of SWE, CEUS, VTIQ and TSH was the highest in diagnoses of benign and malignant thyroid nodules. The sensitivity, specificity, accuracy and area under the curve (AUC) were 85.19%, 89.36%, 86.72% and 0.873. Conclusion: The combined application of SWE, CEUS, VTIQ and TSH is of high value in the diagnosis of benign and malignant thyroid nodules.