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目的探讨超声造影对甲状腺TI-RADS 4a类结节的鉴别诊断价值。方法对术前215个TI-RADS 4a类甲状腺结节的患者行超声造影检查,以病理结果为金标准,观察良恶性组间超声造影特征,并应用Sono Liver CAP软件获得时间-强度曲线(TIC)各参数值,与术后病理结果进行对照(良性172个、恶性43个)。结果 TI-RADS 4a类甲状腺结节恶性组的超声造影增强模式:≥1 cm结节早期快速不均匀高增强伴灌注缺损区,<1 cm结节呈不均匀低增强;良性组增强模式表现为病灶早期快速均匀高或等增强,周边可见环状高增强,两者比较差异有统计学意义(P<0.05);增强水平、增强后边界、消退特点、定量参数MTT、PI、AI均具有统计学意义(P<0.05),而定量参数AT、PT在良恶性组间均无明显差异(P>0.05)。超声造影对TI-RADS 4a类甲状腺结节恶性病灶诊断敏感性为55.81%,特异性为88.95%,准确性为82.32%、阳性预测值为55.81%、阴性预测值为88.95%。结论对于TI-RADS 4a类甲状腺结节在常规超声基础上实施超声造影可进一步鉴别甲状腺结节的良恶性。
Objective To investigate the differential diagnosis of TI-RADS 4a class nodules by contrast-enhanced ultrasound. Methods Twenty-five TI-RADS patients with type 4a thyroid nodules underwent preoperative contrast-enhanced ultrasonography. The pathological results were taken as the gold standard. Contrast-enhanced ultrasonography was performed. Sono Liver CAP software was used to obtain the time-intensity curve (TIC) ) Values of each parameter, and postoperative pathological results were compared (172 benign, 43 malignant). Results Ultrasound enhancement of TI-RADS type 4a thyroid nodules in malignant group: ≥1 cm in early nodules with rapid non-uniform enhancement and perfusion defect area, <1 cm nodules showed uneven low enhancement; benign group enhanced mode was The lesions were characterized by rapid or even rapid increase in early stage and high level of annular enhancement in the periphery, with significant difference between the two groups (P <0.05). The level of enhancement, the enhancement of posterior border and extinction were found. The MTT, PI and AI (P <0.05), while the quantitative parameters AT, PT in benign and malignant groups showed no significant difference (P> 0.05). The sensitivity, specificity and accuracy of CEUS in diagnosing TI-RADS 4a thyroid nodules were 55.81%, 88.95%, 82.32%, 55.81%, and 88.95%, respectively. Conclusion TI-RADS type 4a thyroid nodules on conventional ultrasound based on the implementation of ultrasound contrast can further identify the benign and malignant thyroid nodules.