声辐射力脉冲弹性成像技术结合常规超声诊断甲状腺癌

Acoustic Radiation Force Impulse Combined with Conventional Ultrasound in Diagnosing Thyroid Carcinoma

目的探讨常规超声（CUS）和声辐射力脉冲（ARFI）弹性成像在甲状腺结节良恶性鉴别诊断中的价值。方法CUS和ARFI弹性成像检查甲状腺癌和良性结节，分析甲状腺结节的内部回声、边界、血流分布和阻力指数等常规超声特征；采用声触诊组织定性成像（VTI）判断结节的物理性质和病灶的范围，并对病灶进行分级；利用声触诊组织定量（VTQ）技术，测量病灶内的横向剪切波速度。结果甲状腺癌和良性结节的PSV分别为36．45±11．36cm／s和33．78±10．21cm／s，良恶性结节之间无统计学差异（P〉0．05）；甲状腺癌和良性结节的R1分别为0．74．±O．18和0．654±0．11，差异有统计学意义（P〈0．01）。甲状腺恶性结节的血流供应以Ⅲ和Ⅳ型为主，而甲状腺良性结节以I和Ⅱ型为主。甲状腺良性病变VTI图像分级多为1-3级，甲状腺恶性病变VTI图像分级多为4-5级。低回声、边界不清、内部微钙化作为鉴别甲状腺良恶性结节差异有统计学意义（P〈0．01）。内部血流较丰富、高阻力型动脉血流频谱是甲状腺癌较特异的征象。甲状腺良性结节和甲状腺癌的平均剪切波速度值分别为2．36±0．97m／s和4．94±2．58m／s，对比组之间的差异具有统计学意义（t=10．688，P〈0．01）。病灶内的剪切波速度值鉴别甲状腺良恶性结节，受试者工作特征曲线的曲线下面积为0．913。ARFI成像结合常规超声诊断甲状腺癌，其准确性、敏感度、特异性、阳性预测值和阴性预测值分别为88．8％、88．5％、89．1％、86．8％和90．5％。结论ARFI弹性成像技术结合高频彩色超声对鉴别甲状腺良恶性结节具有重要临床价值。

Objective To investigate the usefulness of conventional ultrasound （CUS） and acoustic radiation force impulse （ARFI） in differential diagnosis malignant thyroid nodules from benign. Methods CUS and ARF! were used to examine 119 thyroid nodules in 116 patients. Internal echo, border, blood flow distribution and the resistance index of the thyroid nodules were analyzed. Virtual touch tissue imaging （VTI） and virtual touch tissue quantification （VTQ） of ARFI elastography were used to estimate the properties and extent and measured the shear wave velocities （SWV） of the thyroid nodules, respectively. The shear wave velocities （SWV） of the nodules were calculated. Results Peak systolic velocity of thyroid cancers and benign nodules were 36.45 ± 11.36cm/s and 33.78 ± 10.21cm/s, respectively. There was no statistical difference （P 〉 0.05）. Resistance index of those were 0.74 ± O. 18 and 0.65 ± 0.11, respec- tively. There was statistical difference （P 〈 0. O1 ）. Grade Ⅲ and 1V blood flow, VTI 4 and 5 were major in thyroid cancers, while Grade Ⅰ and Ⅱ blood flow, VTI 1, 2 and 3 were major in thyroid benign nodules. Hypoechoic, ill - defined boundary, internal micro - calcifica- tion as identification of benign nodule and thyroid cancer had statistically significant difference （P 〈 0. O1 ）. The rich internal blood flow and high resistance index had more specific signs of thyroid cancer. The mean SWV of benign nodule and thyroid cancer were 2.36 ± 0. 97 m/s and 4.94 ± 2.58 m/s. There was significant difference in the SWV between benign nodule and thyroid cancer （ t = 10. 688, P 〈 0.01 ）. The area under curve of receiver operating characteristic curve of the SWV in differentiating malignant from benign thyroid nodules was 0. 913. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value by ultrasound diagnosis were 86.6% , 83.6% , 89.1% , 86.8 and 87.7% , respectively. Conclusion ARFI elastography combined with high frequency ultrasound has great value for diagnosis of thyroid carcinoma.