关键词:

二维超声, 超声造影, 微血流成像, 甲状腺结节, 诊断价值

Abstract:

Objective　To evaluate the values of two dimensional ultrasonography (2D-US), contrast-enhanced ultrasound (CEUS), and microflow imaging (MFI), as well as their combination, in the diagnosis of thyroid nodules. Methods　From January 2024 to January 2025, 120 patients with single thyroid nodules (60 benign nodules and 60 malignant nodules) treated at Baoji People's Hospital were selected selected as the study objects, including 42 males and 78 females. They were 21-72 (45.64±3.19) years old. 2D-US, CEUS, and MFI examinations were performed in both groups. The 2D-US image features, CEUS enhancement patterns, MFI blood flow Alder grading, and blood flow classification of the nodules were analyzed, so as to evaluate the diagnostic values of 2D-US, CEUS, and MFI for benign and malignant thyroid nodules. The pathological results were set as the gold standard. The receiver operating characteristic curves (ROC) of 2D-US, CEUS, MFI, and their combination were drawn, and the diagnostic efficacies were compared by the DeLong test. t and χ² tests were used for the statistical analysis. Results　The age and maximum nodule diameter in the malignant group were smaller than those in the benign group, with statistical differences (t=2.067 and 2.151; both P<0.05). There were statistical differences in the proportions of the patients with solid nodule internal composition, low/very low nodule internal echo, vertical nodule growth pattern, blurred nodule edge, and nodule microcalcification in 2D-US between the two groups (all P<0.05). There were statistical differences in the proportions of the patients with centripetal enhancement, uneven low enhancement, blurred border after enhancement, peripheral no-ring enhancement, and rapid regression of contrast media in CEUS between the two groups (all P<0.05). The Alder blood flow grading of thyroid malignant nodules was mainly grade Ⅲ [66.67% (40/60)], and that of benign nodules grade 0-I [65.00% (39/60)], with a statistical difference (χ²=43.064; P<0.05). The cut-off blood flow type of thyroid malignant nodules was mainly type Ⅳ [68.33% (41/60)], and that of benign nodules type Ⅲ [41.67% (25/60)], with a statistical difference (χ²=25.333; P<0.05). The diagnostic sensitivity of CEUS was higher (85.00%), while the specificity of 2D-US diagnosis was lower (73.33%). The sensitivity (93.33%), specificity (85.00%), positive prediction value (87.50%), negative prediction value (92.73%), and accuracy (89.17%) of the combination were higher those of any method of the three. Based on the pathological results, the ROC's of 2D-US, CEUS, and MFI and their combination were drawn, and the area under the curve (AUC) of the combination was 0.870 (95%CI 0.822-0.941), which was higher than that of any method. Conclusion　The combination of 2D-US, CEUS, and MFI can improve the diagnostic efficacy for thyroid nodules, and provide more valuable information for clinical judgment of nodule nature.

Key words:

Two-dimensional ultrasound, Contrast-enhanced ultrasound, Microflow imaging, Thyroid nodules, Diagnostic value