基于多模态超声成像对TI-RADS 4级甲状腺结节良恶性的鉴别诊断价值研究

Research on the Differential Diagnostic Value of TI-RADS Grade 4 Thyroid Nodules between Benign and Malignant Based on Multimodal Ultrasound Imaging

摘要: 目的：探讨基于多模态超声成像对TI-RADS 4级甲状腺结节良恶性的鉴别诊断价值。方法：2022年1月到2024年12月在本院诊治的80例TI-RADS 4级甲状腺结节患者，均行彩色多普勒超声(CDU)、超声弹性成像(UE)、超声造影(CEUS)检查，比较CDU、UE、CEUS单项以及三项联合检查对TI-RADS 4级甲状腺结节良恶性的检出率，以手术病理诊断结果为准，比较CDU、UE、CEUS单项以及三项联合检查的鉴别诊断价值。绘制受试者工作特征(ROC)曲线，分析CDU、UE、CEUS单项检查以及三项联合检查对甲状腺恶性结节的诊断价值。结果：80例患者，经手术病理诊断为恶性结节62例(77.50%)，良性结节18例(22.50%)。三项联合检查对TI-RADS 4级甲状腺结节良恶性的检出率均高于CDU、UE单项检查(P < 0.05)；略高于CEUS检查(P > 0.05)。三项联合检查鉴别诊断的准确率、敏感度、特异度均高于CDU、UE单项检查(P < 0.05)，准确率、敏感度均高于CEUS单项检查(P < 0.05)，特异度略高于CEUS检查(P > 0.05)。三项联合检查对甲状腺恶性结节诊断的曲线下面积(AUC)、灵敏度、特异度高于CDU、UE、CEUS单项检查。结论：基于多模态超声成像对TI-RADS 4级甲状腺结节的鉴别诊断价值高，可提供可靠参考依据，值得推行。

Abstract: Objective: To explore the differential diagnostic value of TI-RADS grade 4 thyroid nodules between benign and malignant based on multimodal ultrasound imaging. Method: 80 patients with TI-RADS grade 4 thyroid nodules treated in our hospital from January 2022 to December 2024 were selected and underwent color Doppler ultrasound (CDU), elastography (UE), and contrast-enhanced ultrasound (CEUS) examinations. The detection rates of benign and malignant TI-RADS grade 4 thyroid nodules by CDU, UE, CEUS single and three combined examinations were compared, and the differential diagnostic value of CDU, UE, CEUS single and three combined examinations was compared based on surgical pathological diagnosis results. Draw the receiver operating characteristic (ROC) curve to analyze the diagnostic value of CDU, UE, CEUS alone and their combination in thyroid malignant nodules. Result: Among the 80 patients, 62 (77.50%) were diagnosed as malignant nodules and 18 (22.50%) as benign nodules through surgical pathology. The detection rate of benign and malignant TI-RADS grade 4 thyroid nodules by three combined examinations was higher than that of CDU and UE single examinations (P < 0.05); slightly higher than CEUS examination (P > 0.05). The accuracy, sensitivity, and specificity of the three combined examinations for differential diagnosis were higher than those of CDU and UE single examinations (P < 0.05), and the accuracy and sensitivity were higher than those of CEUS single examination (P < 0.05), with slightly higher specificity than CEUS examination (P > 0.05). The area under the curve (AUC), sensitivity and specificity of the three combined examinations in the diagnosis of thyroid malignant nodules are higher than those of CDU, UE and CEUS alone. Conclusion: Multimodal ultrasound imaging has high value in the differential diagnosis of TI-RADS category 4 thyroid nodules, which can provide a reliable reference and is worthy of promotion.