甲状腺实性结节的声脉冲辐射力弹性成像诊断研究

目的评估声脉冲辐射力弹性成像技术（ARFI）对甲状腺实性结节良恶性鉴别诊断价值。方法对100例患者的118个实性结节行ARFI弹性成像声触诊组织成像（vTI）及声触诊组织定量（VTQ）两种技术检查，以VTI弹性分级≥Ⅳ级判断为恶性结节；VTQ中计算结节剪切波速度（SWV）平均值、结节周围非病灶组织平均值及两者的比值。结果根据ROC曲线得出甲状腺良恶性结节swV平均值及比值的最佳诊断界值分别为2．66m／s、1．21，曲线下面积（AUC）分别为0．780、0．762，敏感性、特异性、准确率分别为56％、89％、74％，69％、73％、71％；以VTI弹性分级≥Ⅳ级判断甲状腺实性结节良恶性具有显著性意义（P=0．000），其敏感性为78％，特异性为77％，准确率为77％。结论ARFI技术定性及定量评价组织硬度，对甲状腺实性结节良恶性鉴别均有较高价值，两者结合应用对甲状腺实性结节的超声鉴别诊断有较大帮助。

Objective To evaluate the diagnostic value of acoustic radiation force impulse elastography （ ARFI ） for differential diagnosis of thyroid solid nodules. Methods 100 patients with 118 thyroid solid nodules were performed virtual touch tissue imaging （ VTI ） and virtual touch tissue quantitfication （ VTQ ） examination of ARFL Elasticity of VTI〉IV grade level was considered malignant. Shear wave velocity （ SWV ） of nodule and non-nodule tissue were measured for 7 times. Average SWV of nodules and non-nodule tissue and the ratio of them were calculated. Results Optimum diagnosis cutoff of SWV averages and the ratios were 2.66m/s, 1.21, AUC were 0.780, 0.762 respectively according to ROC curve. Sensitivity, specificity, accuracy rate of average SWV and the ratio were 56%, 89%, 74%, 69%, 73%, 71% separately.VTI _〉IV grade level to differentiate benign and malignant thyroid nodules had significant difference （ P=0.000 ） with the sensitivity, specificity and accuracy of VTI of 78%, 77% and 77%. Conclusions ARFI of qualitative and quantitative evaluation for tissue stiffness have a high value to differentiating thyroid solid nodules. Both methods have their advantages and combined application would have greater value.