中国中西医结合影像学杂志

目的：探讨常规超声和声触诊组织成像与定量(VTIQ)剪切波弹性成像技术组成的多模态超声联合光谱CT对甲状腺影像报告与数据系统(TI-RADS)4a、4b类结节的诊断价值。方法：选择75例患者，共82个甲状腺TI-RADS 4a、4b类结节，其中4a、4b类结节各41个。病理结果显示良性结节50个，恶性32个。先行常规超声检查，在VTIQ模式下测量病灶及同层面甲状腺腺体横向剪切波速度(SWV)5～7次，获取结节SWV平均值(SWV_结节)、病灶同层面甲状腺腺体SWV平均值(SWV_腺体)及SWV_结节/SWV_腺体。行颈部CT增强扫描，获取82个结节的动、静脉期光谱CT各参数结果，即碘浓度(IC)、标准化碘浓度(NIC)、能谱曲线斜率。对多模态超声及光谱CT各项指标行多因素回归分析，得出独立危险因素指标。以手术病理和/或细针抽吸活检结果为金标准，分析联合光谱CT前后多模态超声的诊断效能。结果：声晕、后方衰减、SWV_结节/SWV_腺体、动脉期IC、动脉期NIC是恶性结节的独立危险因素(均P<0.05)。常规超声二分类、多模态超声、多模态超声联合光谱CT的诊断效能分别为：AUC 0.696、0.773、0.891，敏感度59.38%、71.88%、78.13%，特异度78.00%、72.00%、90.00%，阳性预测值63.33%、62.16%、83.33%，阴性预测值75.00%、80.00%、86.54%。结论：多模态超声联合光谱CT后诊断效能大幅提高，对恶性风险较低的TI-RADS 4a类结节，可根据临床需求应用多模态影像学进一步评估结节的良恶性特征，从而减少不必要的细针抽吸活检，为临床决策提供更全面的依据。

Objective:To evaluate the diagnostic performance of multimodal ultrasound combined with spectral CT analysis,integrating conventional ultrasound and virtual touch tissue imaging quantification (VTIQ) shear wave elastography (SWE),for differentiating thyroid imaging reporting and data system (TI-RADS) 4a and 4b nodules.Methods:This study analyzed 82 thyroid nodules (41 TI-RADS 4a and 41 4b) from 75 patients.Pathological results revealed 50 benign and 32 malignant nodules.All lesions underwent conventional ultrasound followed by VTIQ measurements,where transverse shear wave velocity (SWV) was measured 5—7 times in each nodule and adjacent thyroid parenchyma at the same plane.Three parameters were obtained,mean nodule SWV (SWV₁),mean parenchymal SWV (SWV₂),and SWV₁/SWV₂ ratio.Contrast-enhanced spectral CT parameters including iodine concentration (IC),normalized iodine concentration (NIC),and spectral curve slope were acquired during arterial and venous phases.Multivariate regression identified independent risk factors.Using histopathology and/or fine needle aspiration as reference standards,diagnostic performance was compared between multimodal ultrasound alone and combined with spectral CT.Results:Independent risk factors for malignancy included acoustic halo,posterior attenuation,SWV₁/SWV₂ ratio,arterial-phase IC,and arterial-phase NIC (all P<0.05).The AUCs of conventional ultrasound binary classification,multimodal ultrasound,multimodal ultrasound combined with spectral CT were 0.696,0.773,0.891,the sensitivities of these methods were 59.38%,71.88%,78.13%,the specificities were 78.00%,72.00%,90.00%,the positive predictive values were 63.33%,62.16%,83.33%,the negative predictive values were 75.00%,80.00%,86.54%,respectively.Conclusions:The combination of multimodal ultrasound and spectral CT significantly enhances diagnostic accuracy.For TI-RADS 4a nodules,this integrated approach may reduce unnecessary fine needle aspiration procedures while providing comprehensive imaging evidence for clinical decision-making.