本文關(guān)鍵詞： 結(jié)節(jié)性甲狀腺腫 實性低回聲結(jié)節(jié) TI-RADS分類 超聲造影 鑒別診斷　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討甲狀腺影像學(xué)報告及數(shù)據(jù)系統(tǒng)(thyroid imaging reporting and data system,TI-RADS)聯(lián)合超聲造影(Contrast enhanced ultrasound,CEUS)對多發(fā)結(jié)節(jié)性甲狀腺腫基礎(chǔ)上實性低回聲結(jié)節(jié)的鑒別診斷價值。方法:回顧性分析65例多發(fā)結(jié)節(jié)性甲狀腺腫基礎(chǔ)上的實性低回聲結(jié)節(jié)(共70個),分別進(jìn)行二維超聲及CEUS檢查,所有實性低回聲結(jié)節(jié)依據(jù)二維超聲特征進(jìn)行TI-RADS分類,以手術(shù)病理結(jié)果為金標(biāo)準(zhǔn),繪制TI-RADS分類、CEUS及二者聯(lián)合診斷實性低回聲結(jié)節(jié)的受試者工作特征(receiver operating characteristic,ROC)曲線。評價TI-RADS分類聯(lián)合CEUS對多發(fā)結(jié)節(jié)性甲狀腺腫基礎(chǔ)上實性低回聲結(jié)節(jié)的鑒別診斷價值。結(jié)果:將甲狀腺實性低回聲結(jié)節(jié)TI-RADS分類在4b及以上的結(jié)節(jié)診斷為惡性,其靈敏度、特異度及準(zhǔn)確性分別為90.24%(37/41),58.62%(17/29),77.14%(54/70)。甲狀腺惡性結(jié)節(jié)的CEUS增強(qiáng)模式主要為早期低增強(qiáng)、晚期低增強(qiáng)、不均勻增強(qiáng)和周邊無環(huán)狀增強(qiáng),四種增強(qiáng)模式的靈敏度、特異度及準(zhǔn)確性分別為87.70%(36/41),82.76%(24/29),85.71%(60/70);82.93%(34/41),79.31%(23/29),81.43%(57/70);90.24%(37/41),68.97%(20/29),81.43%(57/70);95.12%(39/41),20.69%(6/29),64.29%(45/70)。二者聯(lián)合診斷惡性結(jié)節(jié)的靈敏度、特異度及準(zhǔn)確性分別為95.12%(39/41),82.76%(24/29),90.00%(63/70)。TI-RADS分類聯(lián)合CEUS診斷實性低回聲結(jié)節(jié)的特異度和準(zhǔn)確性均高于TI-RADS分類單獨診斷(P0.05)。TI-RADS分類、CEUS及二者聯(lián)合診斷甲狀腺實性低回聲結(jié)節(jié)的ROC曲線下面積分別為0.734、0.860、0.889,由此得出TI-RADS分類聯(lián)合CEUS對實性低回聲結(jié)節(jié)的診斷效能更高。結(jié)論:在甲狀腺多發(fā)結(jié)節(jié)性甲狀腺腫初次檢出及隨訪過程中,TI-RADS分類可初步評估實性低回聲結(jié)節(jié)的惡性風(fēng)險,再結(jié)合CEUS進(jìn)一步鑒別良惡性,二者聯(lián)合可提高實性低回聲結(jié)節(jié)的準(zhǔn)確性,為指導(dǎo)臨床治療提供依據(jù)。
[Abstract]:Objective: to evaluate the diagnostic value of thyroid imaging reporting and data system TI-RADS combined with Contrast enhanced Ultrasound-CEUSin in the differential diagnosis of solid hypoechoic nodules based on multiple nodular goiter. Solid hypoechoic nodules on the basis of multiple nodular goiter (70 cases) were examined by two-dimensional ultrasound and CEUS respectively. All solid hypoechoic nodules were classified by TI-RADS according to the characteristics of two-dimensional ultrasound, and the results of surgery and pathology were taken as the gold standard. To evaluate the value of TI-RADS classification combined with CEUS in the differential diagnosis of solid hypoechoic nodules on the basis of multiple nodular goiter, the receiver operating characteristic roc curves were drawn for the diagnosis of solid hypoechoic nodules. Results: the solid hypoechoic thyroid nodules with TI-RADS classification of 4b and above were diagnosed as malignant. Its sensitivity, specificity and accuracy were 90.24 / 37 / 41 / 58.62 and 17 / 29 / 77.14 / 54 / 70 respectively. The CEUS enhancement patterns of malignant thyroid nodules were mainly early low enhancement, late low enhancement, uneven enhancement and peripheral non-annular enhancement. The specificity and the accuracy were 87.70 / 36 / 36 / 41 / 82.76 / 10 / 24 / 29 / 85.71a / R 82.9331 / 34 / 79.31 / I and 23 / 29 / 81.43 / 57 / 70 / 57 / 90.24 / 37 / 37 / 41 / 68.97 / 208.97 / 201.43 / 70 / 95.95 / 12 / 3941 / 20.69 / 2929 / 64.29 / 4570, and the sensitivity of the two groups was 64.29% 4570. Specificity and accuracy were 95.1212 / 41 / 82.76 and 24 / 29 / 90.003 / 70 / 70, respectively. The specificity and accuracy of TI-RADS combined with CEUS in the diagnosis of solid hypoechoic nodules were higher than those in TI-RADS alone and under the ROC curve for the diagnosis of solid hypoechoic nodules. The results showed that TI-RADS classification combined with CEUS was more effective in the diagnosis of solid hypoechoic nodules. Conclusion: TI-RADS classification can be used to evaluate solid hypoechoic nodules in the first detection and follow-up of multiple nodular goiter of thyroid. The malignant risk of nodules, The combination of CEUS and CEUS can improve the accuracy of solid hypoechoic nodules and provide evidence for clinical treatment.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.1;R581

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