声触诊组织量化成像联合超声造影鉴别诊断TI-RADS 4类良恶性甲状腺结节

目的 探讨声触诊组织量化成像（VTIQ）联合超声造影（CEUS）鉴别诊断TI-RADS 4类甲状腺良恶性结节的价值。方法 对经手术切除及术后病理证实的86例TI-RADS 4类甲状腺结节患者的98个结节（以45个良性结节为良性组，53个恶性结节为恶性组）于术前行VTIQ及CEUS检查，获取结节剪切波速度最大值（SWV_max）、最小值（SWV_min）、平均值（SWV_mean）、病灶最大值与周围正常组织的比值（SWV_ratio）及CEUS特征，建立VTIQ联合CEUS的Logistic回归模型；以AUC比较VTIQ、CEUS及二者联合回归模型对TI-RADS 4类良恶性甲状腺结节的鉴别诊断效能。结果 恶性组SWV_max、SWV_min、SWV_mean、SWV_ratio值均高于良性组（P均<0.05）。CEUS强化程度、强化均匀度、强化方式、环状增强、消退方式组间差异均有统计学意义（P均<0.05）。SWV_mean（>2.96 m/s）、强化程度（低增强）是诊断TI-RADS 4类恶性甲状腺结节的重要指标（P均<0.05）。SWV_mean、CEUS及Logistic回归模型诊断TI-RADS 4类甲状腺良恶性结节的AUC分别为0.862、0.835和0.933。结论 VTIQ及CEUS均可鉴别TI-RADS 4类甲状腺良恶性结节，二者联合可明显提高诊断效能。

Virtual touch tissue imaging quantification combined with CEUS in differential diagnosis of benign and malignant TI-RADS 4 thyroid nodules

Objective To explore the value of virtual touch tissue imaging quantification (VTIQ) combined with contrast-enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant TI-RADS 4 thyroid nodules. Methods Totally 86 patients underwent surgical operation and were pathologically diagnosed were selected, including 45 benign(benign group) and 53 malignant (malignant group) TI-RADS 4 thyroid nodules. VTIQ and CEUS were performed before operation, and the maximal shear wave velocity (SWV_max), minimum shear wave velocity (SWV_min), mean shear wave velocity (SWV_mean) as well as the ratio of lesion SWV_max to the surrounding normal tissue shear wave velocity (SWV_ratio) and CEUS characteristics were obtained and recorded. Then Logistic regression model of VTIQ combined with CEUS was established, the diagnostic effectiveness of VTIQ, CEUS and the combination of VTIQ and CEUS regression models of benign and malignant TI-RADS 4 thyroid nodules were compared using area under the curve (AUC). Results SWV_max, SWV_min, SWV_mean and SWV_ratio in malignant group were all higher than those in benign group (all P<0.05). For CEUS, the enhancement degree, enhancement uniformity, enhancement mode, ring enhancement and regression mode were all significantly different between groups (all P<0.05). SWV_mean >2.96 m/s and low enhancement were important indexes for malignant nodules (P<0.05). AUC of SWV_mean, CEUS and Logistic regression model were 0.862, 0.835 and 0.933, respectively. Conclusion VTIQ and CEUS have good differential diagnostic ability for benign and malignant TI-RADS 4 thyroid nodules. Combination of VTIQ and CEUS can significantly improve the diagnostic effectiveness.