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目的观察CT、高分辨率超声及两者联合在甲状腺结节良恶性鉴别中的应用价值。方法对2012年1月—2015年6月在本院手术治疗并经病理证实的甲状腺结节患者156例进行调查,对所有患者病理资料、超声和CT检查结果进行回顾性分析。采用Med Calc进行ROC分析,计算三种方式的灵敏度、特异性、曲线下面积(area under the curve,AUC),组间AUC比较采用Z检验,P<0.05为差异有统计学意义。结果超声正确诊断17例,漏诊13例,误诊13例,灵敏度为56.67%,特异度为89.68%;CT正确诊断13例,漏诊17例,误诊17例,灵敏度为41.94%,特异度为86.40%;联合检测正确诊断24例,漏诊6例,误诊11例,灵敏度为68.57%,特异度为95.04%。超声检测的AUC为0.732,CT检测的AUC值为0.649,CT联合超声的AUC为0.856。组间AUC比较,CT联合超声高于单纯CT和超声,差异均有统计学意义(Z=4.517、3.141,均P<0.05);超声高于CT,差异有统计学意义(Z=2.538,P<0.05)。结论 CT和超声均是鉴别甲状腺肿块良恶性的重要影像学检查手段,两种方法联合检测可增加甲状腺恶性结节鉴别的价值。
Objective To observe the value of CT, high resolution ultrasound and the combination of both in benign and malignant thyroid nodules. Methods From January 2012 to June 2015, 156 cases of thyroid nodules surgically treated and pathologically confirmed in our hospital were investigated. Pathological data, ultrasound and CT findings of all patients were retrospectively analyzed. The ROC analysis of Med Calc was used to calculate the sensitivity, specificity and area under the curve (AUC) of the three methods. Z-test was used to compare the AUC of the two groups. P <0.05 was considered as statistically significant. Results The correct diagnosis of ultrasound in 17 cases, missed diagnosis in 13 cases, misdiagnosed in 13 cases, the sensitivity was 56.67%, specificity was 89.68%; CT correct diagnosis in 13 cases, missed diagnosis in 17 cases, misdiagnosis in 17 cases, sensitivity was 41.94%, specificity was 86.40% 24 cases were correctly diagnosed by joint detection, 6 cases were missed diagnosis and 11 cases were misdiagnosed. The sensitivity was 68.57% and the specificity was 95.04%. The AUC of ultrasound was 0.732, the AUC of CT was 0.649, and the AUC of CT was 0.856. The differences of AUC between the two groups were statistically significant (Z = 4.517, P <0.05, P <0.05), and the value of CT was higher than that of CT and ultrasound alone (Z = 2.538, P <0.05). Conclusion Both CT and ultrasonography are important imaging modalities for differentiating benign and malignant thyroid masses. The combination of these two methods can increase the value of differentiating thyroid malignant nodules.