实时组织弹性成像在甲状腺实性结节的定量研究

Quantitative research on supersonic shear imaging in diagnosis of thyroid nodules by elastography

目的应用剪切波弹性成像技术测定甲状腺实性结节的定量弹性模量值,评价该技术对甲状腺结节定量诊断价值。方法对75例患者共105个病灶用实时剪切波弹性成像检查,以手术病理为诊断金标准,获得甲状腺结节的定量弹性模量值,并用ROC曲线得出不同性质病灶的弹性模量参考数值。结果病理诊断良性56例(81个病灶),恶性19例(24个病灶)。恶性结节表现的平均、最大和最小弹性模量值分别为(45.84±19.41)kPa、(79.73±40.58)kPa和(23.22±12.61)kPa;良性结节表现的平均、最大和最小弹性模量值分别为(20.65±6.35)kPa、(31.28±13.03)kPa和(13.61±5.63)kPa,两者差异有统计学意义(P<0.05)。甲状腺结节弹性模量值的最大值、平均值和最小值分别在45kPa、30kPa和18kPa时诊断的敏感度、特异度为83.3%、91.4%,79.0%、95.1%和62.5%、86.4%。实时组织定量分析甲状腺结节弹性模量最大值、平均值和最小值诊断甲状腺结节的ROC曲线下面积分别为0.938、0.910和0.771(P<0.05)。结论根据结节的弹性模量值可以定量评价肿物硬度,为判断甲状腺结节良恶性提供诊断依据。

Objective To determine the appearance of thyroid nodules by using supersonic shear imaging （SSI） , which were used as the reference standard and to evaluate the value of quantitative elastography with SSI in diagnosis of thyroid nodules. Methods The SSI quantitative elastography were performed in 75 patients with 105 thyroid nodules with the available pathologic results in all cases. Receiver operating characteristic （ROC） curves were used to assess diagnostic performance. Results The malignant thyroid nodules exhibited a mean, a maximun and a minimum elasticity value of 45.84 ± 19.41 kPa,79.73 ±40.58 kPa and 23.22 ±12.61 kPa, respectively, while the benign ones had elasticity value of 20.65 ± 6.35 kPa, 31.28 ± 13.03 kPa and 13.61 ±5.63 kPa, respectively（P 〈0. 01 ）. The areas under the ROC curve （Az） of the three modalities were 0.938 （ max）, 0. 910（mean） and 0. 771 （ min）, respectively. When the max elasticity value was 45 kPa, the sensitiveness was 83.3%, and the specificity was 91.4% ; the mean elasticity value was 30 kPa, the sensitivenes was 79.0%, the specificity was 95.1% ; the minimum elasticity value was 18 kPa, the sensitiveness was 62.5% , and the specificity was 86.4%. Conclusion The SSI provides quantitative elasticity ts and complementary information that potentially could be helpful for diagnosis of thyroid nodules.