Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.
Health Management Center, The Second Hospital of Dalian Medical University, Dalian, China.
Int J Hyperthermia. 2020;37(1):1139-1148. doi: 10.1080/02656736.2020.1825835.
To determine a novel quantitative index, residual vital ratio(RVR) by contrast-enhanced ultrasound(CEUS) with conventional Ultrasound(US), to early predict nodule regrowth after radiofrequency ablation (RFA)for benign thyroid nodules.
This retrospective study evaluated 186 patients with 206 benign thyroid nodules underwent RFA. Patients were followed at 1, 3, 6, 12 months and every 12 months thereafter by conventional US, CEUS and clinical evaluation. RVR was defined as the initial ratio of residual vital volume to the total volume calculated by CEUS and conventional US at the first follow-up period after RFA. The relationship between RVR and regrowth was investigated.
The mean volume of thyroid nodules was 10.09 ± 12.90 ml (range 0.40-71.39 ml), which decreased significantly to 2.33 ± 4.65 ml (range 0-36.75 ml) ( < .001) after a mean follow-up time of 22.50 ± 13.29 months (range 6-68 months) with a mean VRR as 85.26 ± 15.02% (range 32.23-100%). The overall incidence of regrowth was 12.62% (26/206) and the mean timing of regrowth was 20.77 ± 12.03 months (range 6-48 months). Multivariate logistic regression revealed that RVR (OR = 1.050, 95%CI 1.025-1.075), initial volume(OR = 1.033, 95%CI 1.000-1.066), location close to critical structures (OR = 5.967, 95%CI 1.898-18.760) and vascularity (OR = 2.216, 95%CI 1.185-4.143) were independent factors associated with regrowth. According to receiver-operating characteristic curve, the area under curve for RVR to regrowth was 0.819 (95% CI 0.740-0.897, < .001) with the optimal cutoff value of 44.5% (sensitivity 80.8%, specificity 74.7%).
RVR was not only an independent factor but also an early quantitative predictor for regrowth. If RVR was larger than 44.5%, the nodule tended to regrowth in the follow-up.
通过对比增强超声（CEUS）与常规超声（US），确定一个新的定量指标——残余生命比（RVR），以早期预测良性甲状腺结节射频消融（RFA）后结节的复发生长。
本回顾性研究纳入了 186 名接受 RFA 治疗的 206 名良性甲状腺结节患者。患者在 RFA 后 1、3、6、12 个月及此后每 12 个月通过常规 US、CEUS 和临床评估进行随访。RVR 定义为 RFA 后首次随访时 CEUS 和常规 US 计算的残余活体积与总体积的初始比值。研究了 RVR 与复发生长的关系。
甲状腺结节的平均体积为 10.09 ± 12.90ml（范围 0.40-71.39ml），在平均 22.50 ± 13.29 个月（范围 6-68 个月）的随访时间内，体积显著下降至 2.33 ± 4.65ml（范围 0-36.75ml）（ < .001），平均 RVR 为 85.26 ± 15.02%（范围 32.23-100%）。复发生长的总发生率为 12.62%（26/206），复发生长的平均时间为 20.77 ± 12.03 个月（范围 6-48 个月）。多因素 logistic 回归显示，RVR（OR=1.050，95%CI 1.025-1.075）、初始体积（OR=1.033，95%CI 1.000-1.066）、靠近关键结构（OR=5.967，95%CI 1.898-18.760）和血管生成（OR=2.216，95%CI 1.185-4.143）是与复发生长相关的独立因素。根据受试者工作特征曲线，RVR 预测复发生长的曲线下面积为 0.819（95%CI 0.740-0.897， < .001），最佳截断值为 44.5%（敏感性 80.8%，特异性 74.7%）。
RVR 不仅是一个独立的因素，也是复发生长的早期定量预测指标。如果 RVR 大于 44.5%，则结节在随访中倾向于复发生长。
