声脉冲辐射力弹性成像诊断甲状腺微小癌的价值

Value of acoustic radiation force impulse imaging in the differential diagnosis of thyroid microcarcinoma

目的探讨声脉冲辐射力(ARFI)弹性成像技术诊断甲状腺微小癌(TMC)的价值。方法分析经病理证实的40例TMC患者45个直径≤1cm甲状腺结节的ARFI弹性特征,包括声触诊组织定量成像(VTQ)及声触诊组织成像(VTI)。分别绘制VTQ及VTI诊断TMC的ROC曲线,比较曲线下面积。结果 45个结节包括良性病变21个(结节性甲状腺肿20个,纤维胶原组织增生1个)、恶性病变24个(均为乳头状癌)。VTQ检查SWV≥2.87m/s结节21个,包括良性病变6个、恶性15个;SWV<2.87m/s结节24个,包括良性病变15个、恶性9个。VTQ诊断TMC的敏感性、特异性及准确率分别为62.5%(15/24)、71.4%(15/21)及66.7%(30/45)。VTI检查VTI分级≥Ⅳ级结节19个,包括良性病变0个、恶性19个;VTI分级<Ⅳ级结节26个,包括良性病变21个、恶性5个。VTI诊断TMC的敏感性、特异性及准确率分别为79.2%(19/24)、100%(21/21)及88.9%(40/45)。VTQ及VTI的ROC曲线下面积分别为0.670和0.896(z=2.32,P<0.05)。结论 ARFI弹性成像可用于鉴别诊断TMC,VTI较VTQ具有更高的诊断价值。

Objective To explore the value of acoustic radiation force impulse(ARFI) elastography in the differential diagnosis of thyroid microcarcinoma(TMC).Methods The ARFI elastography characteristics of 45 histologically proven thyroid sub-centimeter nodules in 40 patients were retrospectively reviewed.Virtual touch tissue quantification(VTQ) and virtual touch tissue imaging(VTI) were both used.The receiver operator characteristic(ROC) curves were used to compare the diagnostic values of VTI and VTQ.Results There were 21 benign nodules(20 nodular goiters and one fibro collagen hyperplasia) and 24 malignant nodules(all thyroid papillary carcinomas).The SWV values of 21 nodules were greater than or equal to 2.87 m /s(including 6 benign nodules and 15 malignant nodules),and 24 nodules less than 2.87 m /s(including 15 benign nodules and 9 malignant nodules).The sensitivity,specificity and accuracy of VTQ were 62.5%(15 /24),71.4%(15 /21),66.7%(30 /45),respectively.There were 19 nodules with VTI scores greater than or equal to Ⅳ(all malignant nodules) and 26 nodules with VTI score less thanⅣ(including 21 benign nodules and 5 malignant nodules),respectively.The sensitivity,specificity and accuracy of VTI were 79.2%(19 /24),100%(21 /21),88.9%(40 /45),respectively.The AUC of VTQ was 0.670 and that of VTI was 0.896(z = 2.32,P < 0.05).Conclusions ARFI is useful in the differential diagnosis of TMC,and VTI is more useful than VTQ.