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

摘要：

目的　探讨二维超声（two dimensional ultrasound，2D-US）、超声造影（contrast-enhanced ultrasound，CEUS）及微血流成像（micro flow imaging，MFI）等多模态超声技术单独及联合诊断甲状腺结节的价值。方法　选取2024年1月至2025年1月于宝鸡市人民医院就诊的甲状腺单发良性结节和恶性结节患者各60例为研究对象，其中男42例，女78例，年龄21～72（45.64±3.19）岁。两组患者均行2D-US、CEUS及MFI检查。分析2D-US图像特征、CEUS增强模式、结节MFI血流Alder分级及血流分型情况。评价2D-US、CEUS及MFI诊断甲状腺结节良恶性的价值。以病理结果为金标准，绘制2D-US、CEUS、MFI单独及联合诊断的受试者操作特征曲线（receiver operating characteristic，ROC），比较诊断效能（采用DeLong检验）。采用t检验和χ²检验进行统计分析。结果　恶性结节组年龄、结节长径小于良性组，差异均有统计学意义（t=2.067、2.151，均P<0.05）。恶性结节组2D-US图像特征中结节内部构成（实性）、结节内部回声（低/极低回声）、结节生长方式（垂直位）、结节边缘（模糊）、结节内微钙化占比与良性结节组相比，差异均有统计学意义（均P<0.05）。恶性结节组CEUS特征中向心性增强、不均匀低增强、增强后边界不清、周边无环状增强、造影剂快速消退占比与良性结节组相比，差异均有统计学意义（均P<0.05）。恶性结节组Alder血流分级以Ⅲ级为主［66.67%（40/60）］，良性结节组以0～I级为主［65.00%（39/60）］，差异有统计学意义（χ²=43.064，P<0.05）。恶性结节截止血流分型以Ⅳ型为主［68.33%（41/60）］，良性结节以Ⅲ型为主［41.67%（25/60）］，差异有统计学意义（χ²=25.333，P<0.05）。CEUS的诊断灵敏度较高（85.00%），2D-US诊断的特异度较低（73.33%）。联合诊断的灵敏度（93.33%）、特异度（85.00%）、阳性预测值（87.50%）、阴性预测值（92.73%）及准确度（89.17%）均优于3种单独诊断方法。以病理结果为诊断依据，绘制2D-US、CEUS、MFI单独及联合诊断的ROC，联合诊断的曲线下面积（AUC）为0.870［95%CI（0.822～0.941）］，优于其他3种方法单独诊断。结论　2D-US、CEUS、MFI联合诊断可提高甲状腺结节的诊断效能，为临床判断结节性质提供更多有价值的信息。

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