2024 年第 5 期 第 0 卷

超微血管成像联合超声造影对甲状腺微小癌的诊断价值

The diagnostic value of superb microvascular imaging combined with contrast-enhanced ultrasound in thyroid micropapillary carcinoma

作者：濮恬宁 郑超 张依然 赵青

英文作者：Pu Tianning Zheng Chao Zhang Yiran Zhao Qing

单位：首都医科大学附属北京安贞医院综合超声科，北京100029

英文单位：Department of General Ultrasound Beijing Anzhen Hospital Capital Medical University， Beijing 100029 China

关键词：甲状腺微小癌；超声造影；超微血管成像

英文关键词：Thyroidmicropapillarycarcinoma;Contrast-enhancedultrasound;Superbmicrovascularimaging

• 摘要：

• 目的  探讨超微血管成像（SMI）、超声造影及二者联合对甲状腺微小癌（TMC）的诊断价值。方法  选取2017年7月至2023年9月于首都医科大学附属北京安贞医院行甲状腺超声、SMI及超声造影检查的45例疑似TMC患者。患者同期行外科手术切除并取得病理结果，以病理诊断为金标准，对比分析SMI、超声造影及二者联合对TMC的诊断价值。结果  45例患者共检出甲状腺结节55个。SMI共检出44个甲状腺恶性结节、11个甲状腺良性结节，SMI诊断TMC的符合率为89.1%、敏感度为100.0%、特异度为45.5%、误诊率为54.5%、漏诊率为0、阳性预测值为88%、阴性预测值为100%，Kappa值为0.571。超声造影共检出49个甲状腺恶性结节、6个甲状腺良性结节，超声造影诊断TMC的符合率为94.5%、敏感度为98.0%、特异度为66.7%、误诊率为33.3%、漏诊率为2.0%、阳性预测值为96%、阴性预测值为80%，Kappa值为0.697。SMI联合超声造影共检出48个甲状腺恶性结节，7个甲状腺良性结节，二者联合诊断TMC的符合率为96.4%、敏感度为100%、特异度为71.4%、误诊率为28.6%、漏诊率为0、阳性预测值为96%、阴性预测值为100%,Kappa值为0.814。结论  SMI联合超声造影诊断TMC的符合率高于二者单一检查，SMI能够辅助超声造影，可作为TMC的初筛手段。

• Objective  To evaluate the diagnostic value of superb microvascular imaging (SMI), contrast-enhanced ultrasound (CEUS) and both combination in thyroid micropapillary carcinoma (TMC). Methods  Totally 45 patients with suspected TMC were examined by ultrasound, SMI and CEUS, and then underwent surgical resection in Beijing Anzhen Hospital, Capital Medical University from July 2017 to September 2023. The pathological results were obtained. Pathological diagnosis was used as a golden indicator, and the diagnostic value of SMI, CEUS and SMI combined with CEUS in TMC was compared. Results  Among 45 patients, 55 thyroid nodules were detected. SMI found 44 malignant thyroid nodules and 11 benign thyroid nodules, and the SMI diagnosis of TMC had a conformity rate of 89.1%, sensitivity of 100%, specificity of 45.5%, misdiagnosis rate of 54.5%, missed diagnosis rate of 0, positive predictive value of 88%, negative predictive value of 100%, and Kappa value of 0.571. CEUS found 49 malignant nodules and 6 benign nodules, and the CEUS diagnosis of TMC had a coincidence rate of 94.5%, sensitivity of 98.0%, specificity of 66.7%, misdiagnosis rate of 33.3%, missed diagnosis rate of 2.0%, positive predictive value of 96%, negative predictive value of 80%，and Kappa value of 0.697. SMI combined with CEUS found 48 malignant thyroid nodules and 7 benign thyroid nodules, and SMI combined with CEUS diagnosis of TMC had a coincidence rate of 96.4%, sensitivity of 100%, specificity of 71.4%, misdiagnosis rate of 28.6%, missed diagnosis rate of 0, positive predictive value of 96%, negative predictive value of 100%，and Kappa value of 0.814. Conclusion  The diagnostic coincidence rate of SMI combined with CEUS is higher than that of single SMI and CEUS. SMI can be used as a preliminary screening method for TMC patients.