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目的探讨分析能量多普勒超声（PDUS）半定量分级、剪切波弹性成像（SWE）对甲状腺结节的定性诊断价值，并探讨其与组织病理结构的关联关系。方法：纳入2019年1月-2023年1月于我院就诊并经手术病理证实的170例甲状腺结节患者作为研究对象，所有患者均行PDUS和SWE检查。以病理结果为金标准，分析PDUS半定量分级、SWE单独及联合应用检查对甲状腺结节良恶性的定性诊断效能。并根据术后病理组织结构中实质及间质的排列分布情况进行分析，以多因素Logistic回归分析PDUS半定量分级、SWE结果和组织病理结构学的关联影响关系。结果：PDUS、SWE两种超声方法诊断甲状腺结节良恶性的Kappa值(0.868)、灵敏度(0.944)、特异度(0.929)、准确度(0.935)均明显高于两法单独诊断。多因素Logistic回归分析发现，各组织学特征与PDUS半定量分级关联程度依次为：广泛纤维化（P=0.000，OR＝6.592）＞乳头结构（P=0.000，OR＝4.362）＞微滤泡结构（P＝0.036，OR＝1.950）；各组织学特征与SWE关联程度依次为：广泛纤维化（P=0.007，OR＝7.903）＞乳头结构（P=0.016，OR＝4.297）＞炎性细胞浸润（P＝0.011，OR＝2.025）＞局部纤维化（P＝0.030，OR＝1.736）。结论：PDUS半定量分级联合SWE可显著提高甲状腺结节良恶性的定性诊断价值，且间质广泛纤维化是影响PDUS和SWE检测甲状腺结节的最显著组织病理因素。

英文摘要:

Objective:To investigate the diagnostic value of power doppler ultrasound (PDUS) semi quantitative grading and shear wave elastography (SWE) in the qualitative diagnosis of thyroid nodules, and to explore its correlation with histopathological structure.Methods:A total of 170 patients with thyroid nodules who were admitted to our hospital from January 2019 to January 2023 and confirmed by surgery and pathology were included in the study. All patients underwent PDUS and SWE examinations.The pathological results were used as the gold standard to analyze the qualitative diagnostic efficacy of PDUS semi quantitative grading, SWE alone and combined examination for benign and malignant thyroid nodules.According to the distribution of parenchyma and stroma in postoperative pathological tissue structure,the relationship between PDUS semi quantitative grading,SWE results and histopathological structure was analyzed by multivariate Logistic regression analysis.Results: The Kappa value (0.868), sensitivity (0.944), specificity (0.929) and accuracy (0.935) of PDUS and SWE in the diagnosis of benign and malignant thyroid nodules were significantly higher than those of the two methods alone.Multivariate logistic regression analysis showed that the correlation between histological features and PDUS semi quantitative grading was as follows:extensive fibrosis (P=0.000,OR=6.592)>papillary structure (P=0.000,OR=4.362)>microfollicular structure(P=0.036,OR=1.950),and the correlation between various histological features and SWE was as follows:extensive fibrosis (P=0.007,OR=7.903) > papillary structure (P=0.016,OR=4.297)>inflammatory cell infiltration (P=0.011,OR=2.025)>local fibrosis (P=0.030,OR=1.736).Conclusion:PDUS semi quantitative grading combined with SWE can significantly improve the qualitative diagnostic value of benign and malignant thyroid nodules,and extensive interstitial fibrosis is the most significant histopathological factor affecting the detection of thyroid nodules by PDUS and SWE.

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