The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Department of Ultrasound, Guangdong Academy of Medical Sciences/Guangdong General Hospital, Guangzhou, Guangdong, People's Republic of China.
Int J Clin Oncol. 2019 Jun;24(6):632-639. doi: 10.1007/s10147-019-01397-y. Epub 2019 Mar 1.
Differential diagnosis of benign and malignant thyroid imaging reporting and data system category 4 (TI-RADS-4) nodules can be difficult using conventional ultrasound (US). This study aimed to evaluate whether multimodal ultrasound imaging can improve differentiation and characterization of benign and malignant TI-RADS-4 nodules.
Multimodal ultrasound imaging, including US, superb microvascular imaging (SMI), and real-time elastography (RTE), were performed on 196 TI-RADS-4 nodules (78, benign; 118, malignant) in 170 consecutive patients. The sensitivity, specificity, accuracy, false negative rate (FNR), and false positive rate (FPR) of each single method and that of multimodal US imaging were determined by comparison with surgical pathology results.
The sensitivity, specificity, accuracy, FNR, and FPR for US were 65.25%, 69.23%, 66.84%, 34.75%, 30.77%, respectively; for SMI were 77.97%, 93.59%, 84.18%, 22.03%, 6.41%, respectively; RTE, 80.51%, 84.62%, 82.14%, 19.49%, 15.38%; and for multimodal US imaging were 94.08%, 87.18%, 91.33%, 6.93%, 12.82%, respectively. The areas under the received operating characteristic curve for US, SMI, RTE, and multimodal US imaging in evaluating benign and malignant TI-RADS-4 nodules were 67.2%, 84.40%, 86.60%, and 95.50%, respectively.
The initial clinical results suggest that multimodal US imaging improves the diagnostic accuracy of TI-RADS-4 nodules and provides additional information for differentiating malignant and benign nodules.
使用传统超声（US）对甲状腺影像报告和数据系统分类 4 级（TI-RADS-4）结节的良恶性进行鉴别诊断可能较为困难。本研究旨在评估多模态超声成像是否能改善 TI-RADS-4 级良恶性结节的鉴别和特征分析。
对 170 例连续患者的 196 个 TI-RADS-4 级结节（78 个良性，118 个恶性）进行多模态超声成像检查，包括 US、超微血流成像（SMI）和实时弹性成像（RTE）。将手术病理结果作为参照，确定每种单模态方法及多模态 US 成像的敏感性、特异性、准确性、假阴性率（FNR）和假阳性率（FPR）。
US 的敏感性、特异性、准确性、FNR 和 FPR 分别为 65.25%、69.23%、66.84%、34.75%、30.77%；SMI 分别为 77.97%、93.59%、84.18%、22.03%、6.41%；RTE 分别为 80.51%、84.62%、82.14%、19.49%、15.38%；多模态 US 成像分别为 94.08%、87.18%、91.33%、6.93%、12.82%。US、SMI、RTE 和多模态 US 成像在评估 TI-RADS-4 级良恶性结节的受试者工作特征曲线下面积分别为 67.2%、84.40%、86.60%和 95.50%。
初步临床结果表明，多模态 US 成像可提高 TI-RADS-4 级结节的诊断准确性，为良恶性结节的鉴别提供更多信息。
