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甲状腺结节内部血管的形态和分布是判断甲状腺结节良、恶性质的重要参考[1]。超微血流成像技术(two-dimensional superb microvascular imaging, 2D-SMI)对甲状腺结节内部血流的评估明显优于传统的彩色多普勒成像技术(color Doppler flow image,CDFI)[2]。研究[3]证实2D-SMI在甲状腺结节良恶性的鉴别诊断中有重要的临床价值。超微血管三维立体成像技术(smart three-dimensional superb microvascular imaging, SMART 3D-SMI)基于2D-SMI,可以更加全面、立体地评价结节内部细微血管的空间分布特点和形态特征。本研究旨在探讨SMART 3D-SMI技术在甲状腺良恶性结节鉴别诊断中的应用价值。现作报道。
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本研究共纳入甲状腺结节病人47例,其中男6例,女41例,年龄19~68岁;共检出甲状腺结节100个,其中良性结节55个,恶性结节45个。
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CDFI、2D-SMI及SMART 3D-SMI对甲状腺良性结节血流的分级差异无统计学意义(P>0.05),对恶性结节血流的分级差异有统计学意义(P < 0.01)(见表 1、图 1)。
方法 0级 Ⅰ级 Ⅱ级 Ⅲ级 χ2 P 良性结节 3.44 >0.05 CDFI 22(40.0) 26(47.3) 4(7.3) 3(5.5) 2D-SMI 16(29.1) 21(38.2) 12(21.8) 6(10.9) SMART 3D-SMI 10(18.2) 17(30.9) 17(30.9) 11(20.0) 恶性结节 70.40 < 0.01 CDFI 5(11.1) 10(22.2) 25(55.6) 5(11.1) 2D SMI 4(8.9) 7(15.6) 19(42.2) 15(33.3) SMART 3D-SMI 2(4.4) 5(11.1) 13(28.9) 25(55.6) 表 1 SMART 3D-SMI、2D-SMI及CDFI对甲状腺结节血流分级的比较[n;百分率(%)]
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灰阶超声联合CDFI、2D-SMI及SMART 3D-SMI对甲状腺良恶性结节鉴别诊断的结果见表 2。灰阶超声联合3种方法诊断甲状腺结节的敏感度、特异性、准确度、阳性预测值、阴性预测值见表 3。ROC曲线分析显示,灰阶超声联合CDFI、2D-SMI及SMART 3D-SMI诊断甲状腺结节的ROC曲线下面积分别为0.719、0.800及0.890,灰阶超声联合SMART 3D-SMI对甲状腺良、恶性结节的诊断效能高于CDFI和2D-SMI(见图 2)。
方法 病理结果 合计 恶性 良性 灰阶超声联合CDFI 恶性 32 15 47 良性 13 40 53 灰阶超声联合2D-SMI 恶性 36 11 47 良性 9 44 53 灰阶超声联合SMART3D-SMI 恶性 40 6 46 良性 5 49 54 表 2 CDFI、2D-SMI及SMART 3D-SMI联合灰阶超声对甲状腺结节鉴别诊断的结果(n)
敏感性 特异性 准确度 阳性
预测值阴性
预测值CDFI 71.1 72.7 72.0 68.1 75.5 2D-SMI 80.0 80.0 80.0 76.5 83.0 SMART 3D-SMI 88.9 89.1 89.0 87.0 90.7 表 3 灰阶超声联合CDFI、2D-SMI及SMART 3D-SMI对甲状腺良、恶性结节的诊断效能(%)
超微血管三维立体超声成像在甲状腺良恶性结节鉴别诊断中的应用价值
Application value of Smart 3D-SMI in differential diagnosis of thyroid nodules
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摘要:
目的探讨超微血管三维立体超声成像(SMART 3D-SMI)在甲状腺良恶性结节鉴别诊断中的应用价值。 方法应用彩色多普勒成像(CDFI)、超微血流成像(2D-SMI)以及SMART 3D-SMI观察和记录结节的血流的分布和形态特征,并比较3种方法联合灰阶超声鉴别良、恶性结节的诊断效能。 结果CDFI、2D-SMI及SMART 3D-SMI对甲状腺良性结节血流的分级差异无统计学意义(P>0.05),对恶性结节血流的分级差异有统计学意义(P < 0.01)。灰阶超声联合CDFI、2D-SMI及SMART 3D-SMI诊断甲状腺良恶性结节的敏感度分别为71.1% vs 80.0% vs 88.9%;特异度分别为72.7% vs 80.0% vs 89.1%;准确度分别为72.0% vs 80.0% vs 89.0%;阳性预测值分别为68.1% vs 76.5% vs 87.0%;阴性预测值分别为75.5% vs 83.0% vs 90.7%;ROC曲线下面积分别为0.719 vs 0.800 vs 0.890。 结论SMART 3D-SMI可以较好地评价甲状腺结节微血管的空间分布和形态特点。联合应用SMART 3D-SMI和灰阶超声鉴别诊断甲状腺结节具有较大的临床价值。 -
关键词:
- 超微血管三维立体成像 /
- 灰阶超声 /
- 彩色多普勒成像 /
- 超微血流成像 /
- 甲状腺结节
Abstract:ObjectiveTo investigate of the application value of smart three-dimensional superb microvascular imaging(SMART 3D-SMI) in the differential diagnosis of thyroid nodules. MethodsThe blood flow distribution and morphological characteristics of nodules were detected using color Doppler flow image(CDFI), two-dimensional superb microvascular imaging(2D-SMI) and SMART 3D-SMI, respectively.The diagnostic efficacy among three methods combined with gray-scale ultrasound in differentiating benign and malignant nodules was compared. ResultsAmong the detection of CDFI, 2D-SMI and SMART 3D-SMI, the differences of the grading of blood flow in benign nodules and malignant nodules were not and were statistically significant, respectively(P>0.05 and P < 0.01).The sensitivities, specificities, accuracy rating, positive predictive values, negative predictive values and areas under curve of CDFI, 2D-SMI, and SMART 3D-SMI combined with gray-scale ultrasound in the diagnosis of benign and malignant thyroid nodules were 71.1% vs 80.0% vs 88.9%, 72.7% vs 80.0% vs 89.1%, 72.0% vs 80.0% vs 89.0%, 68.1% vs 76.5% vs 87.0%, 75.5% vs 83.0% vs 90.7%, and 0.719 vs 0.800 vs 0.890, respectively. ConclusionSMART 3D-SMI can better evaluate the spatial distribution and morphological characteristics of the microvessels of thyroid nodules.The clinical value of SMART 3D-SMI combined with gray-scale ultrasound in the differential diagnosis of thyroid nodules is great. -
表 1 SMART 3D-SMI、2D-SMI及CDFI对甲状腺结节血流分级的比较[n;百分率(%)]
方法 0级 Ⅰ级 Ⅱ级 Ⅲ级 χ2 P 良性结节 3.44 >0.05 CDFI 22(40.0) 26(47.3) 4(7.3) 3(5.5) 2D-SMI 16(29.1) 21(38.2) 12(21.8) 6(10.9) SMART 3D-SMI 10(18.2) 17(30.9) 17(30.9) 11(20.0) 恶性结节 70.40 < 0.01 CDFI 5(11.1) 10(22.2) 25(55.6) 5(11.1) 2D SMI 4(8.9) 7(15.6) 19(42.2) 15(33.3) SMART 3D-SMI 2(4.4) 5(11.1) 13(28.9) 25(55.6) 表 2 CDFI、2D-SMI及SMART 3D-SMI联合灰阶超声对甲状腺结节鉴别诊断的结果(n)
方法 病理结果 合计 恶性 良性 灰阶超声联合CDFI 恶性 32 15 47 良性 13 40 53 灰阶超声联合2D-SMI 恶性 36 11 47 良性 9 44 53 灰阶超声联合SMART3D-SMI 恶性 40 6 46 良性 5 49 54 表 3 灰阶超声联合CDFI、2D-SMI及SMART 3D-SMI对甲状腺良、恶性结节的诊断效能(%)
敏感性 特异性 准确度 阳性
预测值阴性
预测值CDFI 71.1 72.7 72.0 68.1 75.5 2D-SMI 80.0 80.0 80.0 76.5 83.0 SMART 3D-SMI 88.9 89.1 89.0 87.0 90.7 -
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