甲状腺结节内部动脉阻力指数差异鉴别诊断结节良恶性
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摘要
目的评估结节内部动脉阻力指数与甲状腺上动脉阻力指数的差异对甲状腺结节良恶性的鉴别诊断价值。方法 100例甲状腺结节患者,共129个结节,所有患者均接受甲状腺功能检查,超声检查及外科手术治疗。脉冲波多普勒测量甲状腺结节内部动脉及结节同侧甲状腺上动脉阻力指数(RIN、RISTA),计算|RIN-RISTA|及ΔRI(ΔRI=|RIN-RISTA|/RISTA)。根据术后病理诊断将结节分为良性结节组(n=76)和恶性结节组(n=53),对|RIN-RISTA|、ΔRI及RIN行组间对比;并绘制|RIN-RISTA|、ΔRI及RIN诊断甲状腺恶性结节的受试者工作曲线(ROC)。结果良性结节组与恶性结节组间,|RIN-RISTA|及ΔRI差异分别具有显著统计学意义(P=0.000),|RIN-RISTA|、ΔRI在恶性结节组均高于良性结节组;以|RIN-RISTA|=0.0950为诊断截断值时,诊断敏感性和特异性分别为83.0%、63.2%;以ΔRI=0.1794为诊断截断值时,诊断敏感性和特异性分别为79.2%、68.4%。结论 |RIN-RISTA|及ΔRI是鉴别甲状腺结节良恶性的良好指标。
Objective To evaluate the value of arterial resistance index deviation in differentiation diagnosis of benign and malignant thyroid nodules. Methods 100 patients with 129 thyroid nodules, thyroid function tests, ultrasonography and surgery were received. Resistance index of thyroid nodules interior artery(RIN) and ipsilateral superior thyroid artery(RISTA) were measured by spectral Doppler pre-surgery. We calculated the variability of RIN to RISTA |RIN-RISTA| and ΔRI(ΔRI=|RIN-RISTA|/RISTA). The nodules were divided into benign group(n=76) and malignant group(n=53) by postoperative pathological diagnosis. We compared of |RIN-RISTA|, ΔRI and RIN between the groups respectively and the receiver operating characteristic curve(ROC) for malignant thyroid nodule diagnosis via ΔRI, |RIN-RISTA| and RIN were analyzed. Results The difference of ΔRI and |RIN-RISTA| between benign group and malignant group is statistically significant(P=0.000), respectively. Both ΔRI and |RIN-RISTA| in malignant group are higher than that in benign group. When the value of |RIN-RISTA| in diagnostic cutoff point is 0.0950, the sensitivity and specificity are 83.0% and 63.2% respectively. When the value of ΔRI in diagnostic cutoff point is 0.1794, the sensitivity and specificity are 79.2% and 68.4%. Conclusion |RIN-RISTA| and ΔRI are good indices to differentiate benign and malignant thyroid nodules.
Objective To evaluate the value of arterial resistance index deviation in differentiation diagnosis of benign and malignant thyroid nodules. Methods 100 patients with 129 thyroid nodules, thyroid function tests, ultrasonography and surgery were received. Resistance index of thyroid nodules interior artery(RIN) and ipsilateral superior thyroid artery(RISTA) were measured by spectral Doppler pre-surgery. We calculated the variability of RIN to RISTA |RIN-RISTA| and ΔRI(ΔRI=|RIN-RISTA|/RISTA). The nodules were divided into benign group(n=76) and malignant group(n=53) by postoperative pathological diagnosis. We compared of |RIN-RISTA|, ΔRI and RIN between the groups respectively and the receiver operating characteristic curve(ROC) for malignant thyroid nodule diagnosis via ΔRI, |RIN-RISTA| and RIN were analyzed. Results The difference of ΔRI and |RIN-RISTA| between benign group and malignant group is statistically significant(P=0.000), respectively. Both ΔRI and |RIN-RISTA| in malignant group are higher than that in benign group. When the value of |RIN-RISTA| in diagnostic cutoff point is 0.0950, the sensitivity and specificity are 83.0% and 63.2% respectively. When the value of ΔRI in diagnostic cutoff point is 0.1794, the sensitivity and specificity are 79.2% and 68.4%. Conclusion |RIN-RISTA| and ΔRI are good indices to differentiate benign and malignant thyroid nodules.
引文
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[14] 邱治民,邹宁生.甲状腺的血管[J].解剖学报,1980,(4):
[15] 陈继,周青,柏刚,等.瘤内动脉和同侧甲状腺上动脉的阻力指数差异诊断甲状腺肿瘤的临床价值[J].临床超声医学杂志,2013,15(7):471-474.
[2] Chandramohan A,Khurana A,Pushpa BT,et al.Is TIRADS a practical and accurate system for use in daily clinical practice [J].Indian J Radiol Imaging,2016,26(1):145-152
[3] Srinivas MN,Amogh VN,Gautam MS,et al.A Prospective study to evaluate the reliability of thyroid imaging reporting and data system in differentiation between benign and malignant thyroid lesions [J].J Clin Imaging Sci,2016,26(6):5.
[4] 中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南—甲状腺疾病的实验室及辅助检查[J].中华内科杂志,2007,46(8):697-702.
[5] Fukumura D,Jain RK.Tumor microenvironment abnormalities:causes,consequences,and strategies to normalize [J].J Cell Biochem,2007,101(4):937-949.
[6] Vaupel P,Kallinowski F,Okunieff P.Blood flow,oxygen and nutrient supply,and metabolic microenvironment of human tumors:a review [J].Cancer Res,1989,49(23):6449-6465.
[7] Less JR,Posner MC,Skalak TC.Geometric resistance and microvascular network architecture of human colorectal carcinoma [J].Microcirculation,1997,4(1):25-33.
[8] Algin O,Algin E,Tuncel E,et al.Role of duplex power Doppler ultrasound in differentiation between malignant and benign thyroid nodules.Korean journal of radiology:official journal of the korean radiological society (serial online) [J].November,2010,11(6):594-602.
[9] Spencer JA,Giussani DA,Moore PJ,et al.In vitro validation of Doppler indices using blood and water [J].J Ultrasound Med,1991,10(6):305-308.
[10] Ivanac G,Brkljacic B,Ivanac K.Vascularisation of benign and malignant thyroid nodules:CD US evaluation [J].Ultraschall Med,2007,28(5):502-506.
[11] Tamsel S,Demirpolat G,Erdogan M,et al.Power Doppler US patterns of vascularity and spectral Doppler US parameters in predicting malignancy in thyroid nodules [J].Clin Radiol,2007,62(3):245-251.
[12] Folkman J.Proceedings:tumor angiogenesis factor [J].Cancer Res,1974,34(8):2109-2113.
[13] Zhou JQ,Zhou P,Zhan WW,et al.Blood flow resistance in lesion vessels and normal host vessels evaluated by pulsed Doppler ultrasound [J].Microvasc Res,2012,84(1):99-104.
[14] 邱治民,邹宁生.甲状腺的血管[J].解剖学报,1980,(4):
[15] 陈继,周青,柏刚,等.瘤内动脉和同侧甲状腺上动脉的阻力指数差异诊断甲状腺肿瘤的临床价值[J].临床超声医学杂志,2013,15(7):471-474.