摘要目的：探讨超声造影（CEUS）联合声辐射力脉冲成像（ARFI）技术在甲状腺微小乳头状癌（PTMC）诊断中的应用价值。方法：对496例患者共564个可疑甲状腺癌的微小结节进行常规超声、CEUS及ARFI检查，以手术病理结果为金标准进行比对。评估常规超声、CEUS及ARFI对PTMC的诊断效能，并应用受试者工作特征（ROC）曲线下面积（AUC）分析剪切波传导速度（SWV）对PTMC的诊断价值。结果：564个病灶中，良性病灶306个，恶性病灶258个。PTMC CEUS多表现为向心性、不均匀低增强。PTMC结节内部SWV值及SWV比值明显高于甲状腺良性结节（（5.92±3.25） m/s vs （2.02±0.93） m/s，2.82±1.44 vs 1.05±0.46，均P<0.05）。CEUS和ARFI诊断PTMC的敏感度和特异度均优于常规超声，两者联合检查对PTMC的诊断效能较好，其诊断敏感度、特异度、阳性预测值及阴性预测值分别为97.3%、94.1%、93.3%、97.6%，准确性可达95.6%。ROC曲线显示，SWV诊断PTMC的AUC及95%CI为0.894（0.836～0.958），其最佳阈值为3.65 m/s，诊断PTMC的敏感度、特异度、阳性预测值及阴性预测值分别为87.3%、90.6%、92.3%和85.7%。结论：CEUS和ARFI技术对PTMC的诊断均有重要价值，两者联合检查可提高其诊断准确率。
Abstract：Objective: To evaluate the value of contrast-enhanced ultrasound(CEUS) combined with acoustic radiation force pulse-imaging(ARFI) in the diagnosis of papillary thyroid microcarcinoma(PTMC). Methods: Conventional ultrasonography, CEUS and ARFI were performed in 496 patients with 564 suspicious thyroid nodules, and the results were compared with the gold standard after operation pathology. To evaluate the diagnostic efficacy of conventional ultrasound, CEUS and ARFI in PTMC, and to analyze the diagnostic value of shear wave conduction velocity(SWV) for PTMC by receiver operating characteristic(ROC) of curve area(AUC). Results: Of the 564 lesions, 306 were benign and 258 were malignant. PTMC ultrasound contrast showed concentric, inhomogeneous and low enhancement. The SWV and SWV ratios in the PTMC nodules were significantly higher than those in the thyroid nodules((5.92±3.25) m/s vs (2.02±0.93) m/s, 2.82±1.44 vs 1.05±0.46, all P<0.05). The sensitivity and specificity of CEUS and ARFI were better than that of conventional ultrasound in the diagnosis of PTMC, the combination of two methods for the diagnosis of PTMC was better, and the diagnostic sensitivity, specificity, positive predictive value and negative predictive value were 97.3%, 94.1%, 93.3%, 97.6%, respectively, and the accuracy could reach 95.6%. The ROC curve showed that the AUC and 95%CI of SWV in the diagnosis of PTMC was 0.894(0.836~0.958), the optimal threshold was 3.65 m/s, and the sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of PTMC were 87.3%, 90.6%, 92.3% and 85.7%, respectively. Conclusion: CEUS and ARFI are of great value in the diagnosis of PTMC, and the combination of two methods can improve the diagnostic accuracy.
何燕莲，余岳芬，徐小兰，舒 婷，符春荣，李梅芬. 超声造影联合声辐射力脉冲成像技术在甲状腺微小乳头状癌诊断中的研究[J]. 中国临床医学影像杂志, 2018, 29(4): 250-253.
HE Yan-lian, YU Yue-fen, XU Xiao-lan, SHU Ting, FU Chun-rong, LI Mei-fen. Study of contrast-enhanced ultrasound combined with acoustic radiation force impulse-imaging in the diagnosis of papillary thyroid micro-carcinoma. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(4): 250-253.
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