声脉冲辐射力弹性成像对甲状腺实性结节的诊断价值

Acoustic radiation force impulse technology in the diagnosis of thyroid solid nodules

目的应用声脉冲辐射力(ARFI)弹性成像技术测量甲状腺实性结节的剪切波速度值(SWV),间接分析甲状腺不同性质结节组织硬度,评估ARFI技术对良、恶性结节的诊断及鉴别诊断价值。方法应用ARFI弹性成像技术,测量甲状腺实性结节及同一深度相邻正常组织的SWV值(m/s)。所有结节经穿刺活检或手术获得明确病理诊断结果。统计分析良性、恶性及正常甲状腺组织的SWV值,使用ROC曲线初步确立诊断甲状腺恶性肿瘤的SWV参考临界值。结果 102例患者共128个实性病灶纳入本研究,其中良性结节75个,恶性结节53个。良性结节与相邻甲状腺组织之间的SWV值差异无统计学意义[(2.05±0.82)m/s vs.(1.82±0.67)m/s,t=1.881,P=0.062];恶性结节与相邻组织的SWV值[(4.42±2.17)m/s vs.(1.82±0.67)m/s,t=8.335,P=0.000]、良性结节与恶性结节的SWV值[(2.05±0.82)m/s vs.(4.42±2.17)m/s,t=-8.637,P=0.000]差异具有统计学意义。当SWV临界值采用2.76 m/s时,诊断甲状腺恶性肿瘤的敏感度为94.3%,特异度为85.3%。结论利用ARFI弹性成像技术定量评价甲状腺不同性质结节的硬度,有助于提高超声对甲状腺实性结节的诊断水平,为良恶性结节的鉴别提供新的诊断依据。

Objective To evaluate the value of acoustic radiation force impulse （ARFI） technology in differentiating between benign and malignant thyroid solid nodules. Methods ARFI were performed on both benign thyroid nodules and malignant nodules to obtain shear wave velocity （SWV） value; that of the adjacent nodule-free tissue at the same depth was also obtained. T test was used to analyze the SWV values of different groups, while receiver operating characteristic （ROC） curves were used to assess its diagnostic performance. Results ARFI were performed in 102 patients with 128 thyroid solid nodules and the pathologic results of all these nodules were available. Seventy-five nodules were benign and 53 nodules were malignant. There was no significant difference of the SWV value between benign nodules and adjacent nodule-free tissue [（2.05±0.82）m/s vs. （1.82±0.67）m/s, t = 1.881, P = 0.062]. There were significant differences in the SWV value between malignant nodules and adjacent nodule-free tissue [（4.42±2.17）m/s vs. （1.82±0.67）m/s, t = 8.335 ,P = 0.000], as well as benign nodules and malignant nodules [（2.05±0.82）m/s vs. （4.42±2.17）m/s, t = -8.637 ,P = 0.000]. With a cutoff value of 2.76 m/s, the sensitivity and specificity of the SWV value were 94.3% and 85.3% in diagnosing malignant thyroid nodules. Conclusion ARFI could provide quantitative measurement of the hardness of the nodules, which then could help to provide complementary information in differentiating between benign and malignant thyroid solid nodules.