Abstract:

Objective　To investigate the value of contrast-enhanced ultrasound (CEUS), diffusion-weighted imaging (DWI), and serum melanoma-associated antigen A3 (MAGEA3) and melanoma-associated antigen A4 (MAGEA4) in the diagnosis of papillary thyroid carcinoma (PTC). Methods　This was a retrospective study. Eighty patients pathologically confirmed with PTC treated at Imaging Center, Ankang Hospital of Traditional Chinese Medicine between January 2022 and March 2024 were selected as a PTC group, including 32 males and 48 females who were (45.84±8.51) years old. Eighty patients with benign thyroid tumors were set as a control group, including 35 males and 45 females who were (44.62±7.50) years old. The serum levels of MAGEA3 and MAGEA4, CEUS characteristics, and apparent diffusion coefficient (ADC) values were compared between the two groups. The consistency of serum MAGEA3 and MAGEA4, CEUS, and DWI with pathological diagnosis was evaluated. t and χ² tests were used for the statistical analysis. Results　The serum levels of MAGEA3 and MAGEA4 in the PTC group were higher than those in the control group [(43.68±10.24) ng/L vs. (31.40±6.85) ng/L and (33.57±8.94) ng/L vs. (28.56±6.20) ng/L], with statistical differences (t=8.92 and 4.12; both P<0.05). The proportions of the patients with lymph node enlargement, calcification, heterogeneous echogenicity, unclear boundaries, and irregular shapes in the PTC group were higher than those in the control group [20.00% (16/80) vs. 3.75% (3/80), 60.00% (48/80) vs. 21.25% (17/80), 58.75% (47/80) vs. 35.00% (28/80), 47.50% (38/80) vs. 18.75% (15/80), and 72.50% (58/80) vs. 28.75% (23/80)], with statistical differences (χ²=10.09, 24.90, 9.06, 14.93, and 30.63; all P<0.05). Blood flow grading in the PTC group was mainly Ⅱ-Ⅲ, and that in the control group was mainly I-Ⅱ, with a statistical difference between the two groups (Z=44.91; P<0.05). The ADC value in the PTC group was significantly lower than that in the control group [(1.26±0.33)×10^-3mm²/s vs. (1.93±0.64)×10^-3mm²/s], with a statistical difference (t=8.32; P<0.05). The results of the receiver operating characteristic curve analysis showed that the sensitivities of CEUS, ADC, MAGEA3, and MAGEA4 in the diagnosis of PTC were 83.8%, 93.8%, 68.8%, and 53.7%, respectively; the specificities were 90.0%, 66.2%, 91.2%, and 85.0%, respectively; the areas under the curves (AUC) were 0.937, 0.819, 0.839, and 0.690, respectively. These findings demonstrate the high diagnostic accuracy of these indicators for PTC. When CEUS, ADC, MAGEA3, and MAGEA4 were combined, the sensitivity, specificity, AUC were 96.3%, 93.8%, and 0.990, respectively. Conclusions　Serum levels of MAGEA3 and MAGEA4 are elevated in patients with PTC. The combination of CEUS, DWI, and serum MAGEA3 and MAGEA4 has high clinical application value in the diagnosis of PTC and can improve diagnostic accuracy.

Key words:

Contrast-enhanced ultrasound, Diffusion-weighted imaging, Melanoma-associated antigen A3, Melanoma-associated antigen A4,  , Papillary thyroid carcinoma, Diagnostic value

摘要：

目的　探讨超声造影（CEUS）、弥散加权成像（DWI）和血清黑色素瘤抗原A3（MAGEA3）、黑色素瘤抗原A4（MAGEA4）对甲状腺乳头状癌（PTC）的诊断价值。方法　采用回顾性研究，收集安康市中医医院影像中心2022年1月至2024年3月经病理证实为PTC的80例患者为PTC组［男32例、女48例，年龄（45.84±8.51）岁］，80例甲状腺良性肿瘤患者作为对照组［男35例、女45例，年龄（44.62±7.50）岁］。比较两组的血清MAGEA3、MAGEA4水平和CEUS特征、表观扩散系数（ADC）值，评估血清MAGEA3、MAGEA4、CEUS及DWI单项及联合诊断与病理诊断结果的一致性，并分析这些指标对PTC的诊断价值。采用t检验、χ²检验进行统计分析。结果　PTC组血清MAGEA3、MAGEA4水平均高于对照组［（43.68±10.24）ng/L比（31.40±6.85）ng/L、（33.57±8.94）ng/L比（28.56±6.20）ng/L］，差异均有统计学意义（t=8.92、4.12，均P<0.05）；PTC组淋巴结肿大、钙化、回声不均匀、边界不清和形态不规则比例均高于对照组［20.00%（16/80）比3.75%（3/80）、60.00%（48/80）比21.25%（17/80）、58.75%（47/80）比35.00%（28/80）、47.50%（38/80）比18.75%（15/80）、72.50%（58/80）比28.75%（23/80）］，差异均有统计学意义（χ²=10.09、24.90、9.06、14.93、30.63，均P<0.05）；PTC组血流分级主要为Ⅱ、Ⅲ级，对照组主要为Ⅰ、Ⅱ级，两组血流分级比较，差异有统计学意义（Z=44.91，P<0.05）；PTC组ADC值低于对照组［（1.26±0.33）×10^-3mm²/s比（1.93±0.64）×10^-3mm²/s］，差异有统计学意义（t=8.32，P<0.05）。受试者操作特征曲线（ROC）结果表明，CEUS、ADC值、MAGEA3和MAGEA4在PTC诊断中的灵敏度分别为83.8%、93.8%、68.8%和53.7%，特异度分别为90.0%、66.2%、91.2%和85.0%，曲线下面积（AUC）分别为0.937、0.819、0.839和0.690。四者联合预测时，灵敏度和特异度分别为96.3%和93.8%，AUC为0.990。结论　PTC患者血清MAGEA3、MAGEA4水平升高，CEUS、DWI联合血清MAGEA3、MAGEA4在PTC诊断中具有较高的临床应用价值，可以提高诊断准确率。

关键词:

超声造影, 弥散加权成像, 黑色素瘤抗原A3, 黑色素瘤抗原A4, 甲状腺乳头状癌, 诊断价值