摘要
目的探讨声触诊组织成像（VTI）硬度分级法和面积比值法鉴别不同大小甲状腺结节良、恶性的应用价值。方法采用VTI技术获取304例患者310个甲状腺结节的VTI图像，按病灶最长径（L）分成3组：L≤1cm组（98个结节）、1cm〈L≤2cm组（139个结节）和L〉2cm组（73个结节）。每组分别通过硬度分级法（根据结节VTI图像的黑白比例分为Ⅰ～Ⅵ级）和面积比值法判断结节的良、恶性。VTI硬度分级法中图像灰度≥Ⅳ级的结节认定为恶性，〈Ⅳ级的为良性。以病理结果为金标准，构建2种诊断方法的受试者操作特性（ROC）曲线，确定3组面积比值的最佳截点，采用Z检验分析曲线下面积，比较2种方法对不同大小甲状腺结节定性诊断的效能。结果310个结节中良性结节205个，恶性结节105个。面积比值法中3组结节的面积比值分别以1．32、1．11和1．09为诊断临界值。硬度分级法诊断甲状腺结节良、恶性的ROC曲线下面积分别为0．908（L≤1cm组）、0．910（1cm〈L≤2cm组）和0．895（L〉2cm组），面积比值法鉴别甲状腺结节良、恶性的ROC曲线下面积分别为0．937（L≤1cm组）、0．851（1cm〈L≤2cm组）和0．727（L〉2cm组），均大于0．7，说明2种方法在区分甲状腺结节良、恶性方面均具有较高的准确性。通过ROC曲线下面积比较得出：VTI硬度分级法和面积比值法鉴别L≤1cm组和1cm〈L≤2cm组结节良、恶性的差异均无统计学意义（L≤1cm组：Z=0．815，P=0．4148；1cm〈L≤2cm组：Z=1．615，P=0．1063）；在L〉2cm组中，2种诊断方法的差异有统计学意义（Z=2．350，P=0．0188）。结论VTI硬度分级法和面积比值法在甲状腺良、恶性结节鉴别方面均具有较高的诊断价值。在较大的结节中硬度分级法的诊断效能高于面积比佰法，VTI技术对于甲状腺结节的定性诊断具有重要的临床意义。
Objective To explore the value of image grade system and area ratio measurement of virtual touch tissue imaging（VTI） in the differential diagnosis of benign and malignant thyroid nodules in different size.Methods VTI was used to obtain the images of 310 thyroid nodules.All of the nodules were divided into three groups according to the lesions length（group 1,L≤1 cm,98 nodules;group 2,1 〈cm L ≤ 2 cm,139 nodules;group 3,L 〉2 cm,73 nodules）.All of the nodules were examined by image grade system and area ratio measurement to distinguish benign and malignant diseases.VTI-gradeⅣ or higher was used as diagnostic criteria of malignant lesions in the image grade system.The results were compared with pathologic diagnosis.The receiver operating characteristic（ROC） curve of the two means in the three groups was performed respectively.We confirmed the best cutoff point of the area ratio measure diagnosis in thyroid nodules and evaluated the diagnostic efficacy of the two methods by assessing the areas under ROC curves（AUC） with Z text.Results Among the 310 nodules,there were 205 benign nodules and 105 malignant ones.The cutoff value was defined as 1.32,1.11 and 1.09 for the nodules＇ qualitative diagnosis in area ratio measurement respectively.The AUC of image grade system were 0.908（group 1）,0.910（group 2） and 0.895（group 3）,the AUC of area ratio measure were 0.937（group 1）,0.851（group 2） and 0.727（group 3）.Both of the two methods were accurate for the diagnosis of thyroid disease because the areas of ROC curves were all more than 0.7.Compared with the areas of ROC curves,for the group 1 and group 2,there were no significant differences in the diagnosis performance between image grade system and area ratio measure（group 1：Z=0.815,P=0.4148;group 2：Z=1.615,P=0.1063）.For the group 3,the diagnostic value of image grade system was better than area ratio measurement（Z=2.350,P=0.0188）.Conclusions Image grade system and area ratio measurement are both valuable for differentiating benign and malignant thyroid nodules,and image grade system is more applicable in diagnosing big nodules.Virtual touch tissue imaging has an important clinical application value for the differential diagnosis of thyroid benign and malignant nodules.
出处
《中华医学超声杂志（电子版）》
2014年第12期44-48,共5页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
国家自然科学基金资助项目(81271648)
