Value of time-intensity curve analysis of contrast-enhanced ultrasound in the differential diagnosis of thyroid nodules
Value of time-intensity curve analysis of contrast-enhanced ultrasound in the differential diagnosis of thyroid nodules
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DOI：
10.1016/j.ejrad.2018.05.013
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发表时间：
2018-08-01
影响因子：
3.3
通讯作者：
Luo, Wen
中科院分区：
文献类型：
--
作者：
Gu, Fen;Han, Lu;Luo, Wen
目的：目的：探讨超声造影（CEUS）时间-强度曲线（TIC）分析在甲状腺良恶性结节鉴别诊断中的应用价值。最终诊断通过手术切除后的组织学或细针抽吸（FNA）后的细胞学来确认。在使用细胞学证实且未手术切除的良性结节中，那些具有> 50%囊性成分且在随访US中1年未显示变化的结节被诊断为临床良性结节。同样，囊性成分< 50%的结节抽吸两次，随访超声显示1年无变化，也被视为临床良性结节。TIC参数，包括峰值强度（PI）相对值（RV）灌注参数（Delta PI），上升时间的RV（Delta RT），达峰时间的RV（Δ TTP），洗入最大斜率系数（MSC）的RV（Delta MSCWI），上升曲线下面积RV（Δ AUC（R）），下降曲线下面积的RV清除参数（Δ AUC（F）），洗脱期MSC的RV（Delta MSCWO），平均渡越时间RV综合参数（Δ MTT）和下降曲线下面积（Δ AUC（F））。与良性甲状腺结节相比，恶性结节在CEUS TIC分析中显示出较低的Delta PI（119.73（115.34，129.7），-15.82（-17.7，-4.31）），之后的Delta RT（-0.27（-0.51，-0.2），0.58（-0.26，0.65））和Delta TTP（-0.52（-0.55，-0.36），0.69（-0.04，0.74）），更温和的Delta MSCWI（6.18（5.29，7.44），-6.1（-7.6，2.14）），AUC（R）更小（75.7（56.95，93.22），-88.43（-108.89，-73.21））;较小的Δ AUC（F）（112.92（87.77，137.58），-75.55（-105.28，-59.32））;和较小的Delta AUC综合参数变化差异有统计学意义（181.7（151.50，219.06），-160.64（-200.08，-144.11）），Delta MTT值变化差异有统计学意义（2.00（1.85，3.14），-2.09（-2.48，-0.95）），P < 0.05。多因素分析显示，Delta MSCWI（OR = 0.112，95% CI，0.025-0.507）和Delta MTT（OR = 0.099，95% CI，0.028-0.346）为保护因素。
Objective: To assess the feasibility of time-intensity curve (TIC) analysis of contrast-enhanced ultrasound (CEUS) in demonstrating features of benign and malignant thyroid nodules.Methods: CEUS images of 98 patients with 103 thyroid nodules were retrospectively analyzed. The final diagnosis was confirmed by histology after surgical excision, or cytology after fine needle aspiration (FNA). Among the benign nodules, which were confirmed using cytology and not surgically removed, those with a > 50% cystic component that showed no changes for 1 year on follow-up US, were diagnosed as clinically benign nodules. Similarly, nodules with a < 50% cystic component that were aspirated twice and showed no changes for 1 year on follow-up US were also regarded as clinically benign nodules. TIC parameters, including perfusion parameters of relative values (RV) of peak intensity (PI) (Delta PI), RV of rise time (Delta RT), RV of time to peak (Delta TTP), RV of maximum slope coefficient (MSC) of wash-in (Delta MSCWI), RV of area under the rising curve (Delta AUC(R)), clearance parameters of RV of area under the falling curve (Delta AUC(F)), RV of MSC of washout (Delta MSCWO), comprehensive parameters of RV of mean transit time (Delta MTT), and area under the falling curve (Delta AUC(F)) were observed.Results: Compared with benign thyroid nodules, malignant nodules on TIC analysis of CEUS showed a lower Delta PI (119.73 (115.34, 129.7), -15.82 (-17.7, -4.31)), later Delta RT (-0.27 (-0.51, -0.2), 0.58 (-0.26, 0.65)) and Delta TTP (-0.52 (-0.55, -0.36), 0.69 (-0.04, 0.74)), gentler Delta MSCWI (6.18 (5.29, 7.44), -6.1 (-7.6, 2.14)), and smaller AUC(R) (75.7 (56.95, 93.22), -88.43 (-108.89, -73.21)) in perfusion parameters; a smaller Delta AUC(F) (112.92 (87.77, 137.58), -75.55 (-105.28, -59.32)) in clearance parameters; and a smaller Delta AUC (181.7 (151.50, 219.06), -160.64 (-200.08, -144.11)), and an earlier Delta MTT (2.00(1.85, 3.14), -2.09 (-2.48, -0.95)) in comprehensive parameters (P < 0.05). Multivariate analysis of RV of TIC parameters demonstrated that Delta MSCWI (OR = 0.112; 95% confidence interval [CI], 0.025-0.507) and Delta MTT (OR = 0.099; 95% CI, 0.028-0.346) were protective factors.Conclusions: TIC of CEUS is a very promising and valuable technique for differentiating benign and malignant thyroid nodules.