| 摘要: |
| ［摘要］ 目的 探讨常规超声联合超声造影（CEUS）诊断甲状腺结节的价值，分析联合诊断中误诊结节的特征及原因。方法 选择广西壮族自治区人民医院2019年1月至2021年6月收治的甲状腺结节患者481例（共522个结节），均先接受常规超声检查，后再行常规超声联合CEUS检查。其中男130例，女351例，年龄19～71（37.2±15.3）岁，病灶最大径0.5～3.9（1.8±0.7）cm。比较常规超声及联合CEUS对甲状腺良恶性结节的诊断效能，分析联合诊断误诊结节的特征。结果 522个结节中，经病理检查证实为恶性结节203个，良性结节319个。常规超声联合CEUS检查共修改59例结节的TI-RADS分类和诊断，错误修改6例。联合检查共误诊53例结节，其中41例良性结节误诊为恶性，12例恶性结节误诊为良性。良性误诊为恶性的结节均包含≥2个以下常规超声特征：低回声、纵横比≥1、边界不清、形态不规则、包膜侵犯、微钙化等。恶性误诊为良性的结节表现出等增强、高增强、环状增强等CEUS特征。Kappa一致性分析检验显示，常规超声和常规超声联合CEUS检查结果与病理检查结果具有一致性（P<0.05），但常规超声联合CEUS鉴别诊断甲状腺良恶性结节的特异度、灵敏度、准确率均高于常规超声（87.15% vs 81.19%；94.09% vs 84.73%；89.85% vs 82.57%）。结论 常规超声联合CEUS可提高对甲状腺结节的诊断价值，但良恶性结节在常规超声及CEUS特征上均有一定程度的交叉重叠，可导致误诊。 |
| 关键词: 甲状腺结节 常规超声 超声造影 误诊 |
| DOI：10.3969/j.issn.1674-3806.2022.11.11 |
| 分类号:R 445.1 |
| 基金项目:广西卫生健康委科研课题项目（编号：Z20180744，Z20210677） |
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| Diagnostic value and misdiagnosis analysis of conventional ultrasound combined with contrast-enhanced ultrasound in thyroid nodules |
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WEI Liu, LING Bing, ZHENG Hong-yu, et al.
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Department of Ultrasound, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To investigate the value of conventional ultrasound combined with contrast-enhanced ultrasound(CEUS) in the diagnosis of thyroid nodules, and to analyze the characteristics and causes of misdiagnosed nodules in the combined diagnosis. Methods Four hundred and eighty-one patients with thyroid nodules(522 nodules in total) who were admitted to the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2019 to June 2021 were selected. All the patients received conventional ultrasound examination first, and then received conventional ultrasound combined with CEUS examination. Among the 481 patients, there were 130 males and 351 females, aged from 19 to 71 years, with an average of (37.2±15.3)years, and the largest diameter of the lesions was 0.5-3.9(1.8±0.7)cm. The diagnostic efficacy of conventional ultrasound and combined CEUS in benign and malignant thyroid nodules was compared, and the characteristics of the combined diagnosis in the misdiagnosis of thyroid nodules were analyzed. Results Of the 522 nodules, 203 were confirmed as malignant nodules and 319 as benign nodules by pathological examination. A total of 59 cases of TI-RADS classification and diagnosis of the nodules were revised by conventional ultrasound combined with CEUS, and 6 cases were incorrectly revised. Fifty-three nodules were misdiagnosed by the combined examination, among which 41 benign nodules were misdiagnosed as malignant nodules, and 12 malignant nodules were misdiagnosed as benign nodules. The benign nodules misdiagnosed as malignant nodules all contained two or more than two of the following conventional ultrasound features: hypoechoic, aspect ratio ≥1, ill-defined borders, irregular shape, capsular invasion and microcalcifications. The malignant nodules misdiagnosed as benign nodules showed CEUS features such as isoenhancement, hyperenhancement and ring enhancement. The Kappa consistency analysis test showed that the results of the conventional ultrasound and the conventional ultrasound combined with CEUS were consistent with the results of pathological examinations(P<0.05). However, the specificity, sensitivity and accuracy of the conventional ultrasound combined with CEUS in the differential diagnosis of benign and malignant thyroid nodules were higher than those of the conventional ultrasound(87.15% vs 81.19%; 94.09% vs 84.73%; 89.85% vs 82.57%). Conclusion Conventional ultrasound combined with CEUS can improve the diagnostic value of thyroid nodules, but benign and malignant nodules have a certain degree of overlap in conventional ultrasound and CEUS features, which may lead to misdiagnosis. |
| Key words: Thyroid nodule Conventional ultrasound Contrast-enhanced ultrasound(CEUS) Misdiagnosis |
