声辐射力脉冲成像对甲状腺小结节的诊断价值

Diagnostic value of acoustic radiation force impulse for thyroid small nodules

目的探讨声辐射力脉冲成像(ARFI)对甲状腺小结节(<10 mm)良恶性的鉴别诊断价值。方法 78例甲状腺小结节患者,共95个直径<10 mm结节,对其行声触诊组织定性成像(VTI)和声触诊组织定量成像(VTQ)检查。结果甲状腺良性小结节57个,甲状腺微小癌38个。47个(82.5%)甲状腺良性小结节VTI成像模式为1级或2级,31个(81.6%)甲状腺癌表现为3级或4级,两者差异有统计学意义(P=0.000)。以VTI分级≥3级诊断为恶性结节,则VTI诊断敏感性、特异性、阳性预测值、阴性预测值及符合率分别为81.58%、82.46%、75.61%、87.04%、82.10%。甲状腺良性结节VTQ值(2.095±0.482)m/s,周边实质VTQ值(1.941±0.412)m/s,两者差异无统计学意义。恶性结节VTQ值(3.391±0.822)m/s,高于良性结节和周边甲状腺组织VTQ值(2.017±0.419),差异均有统计学意义(P<0.05)。以VTQ值2.785 m/s为分界点鉴别诊断甲状腺微小癌及良性小结节的敏感性、特异性及符合率分别为85.71%、85.24%、86.32%。结论 ARFI可从定性及定量两方面提供甲状腺小结节的弹性特征,有助于甲状腺小结节良恶性的鉴别诊断。

Objective To evaluate the diagnostic value of acoustic radiation force impulse （ARFI） elasticity imaging for differentiating benign from malignant thyroid nodules with a diameter less than 10 mm.Methods Seventy-eight patients with 95 thyroid nodules with a diameter less than 10 mm were included in this study.All patients underwent ARFI elasticity imaging,which including virtual touch tissue imaging （VTI） and virtual touch tissue quantification （VTQ）.Results There were 57 benign nodules and 38 thyroid microcarcinomas.Forty-seven benign nodules （82.5％） were grade 1 or 2 as showed by VTI,while 31 malignant nodules （81.6％） were grade 3 or 4.The differences were statistically significant（P=0.000）.When the VTI grade ≥ 3 to diagnose the malignant nodules,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy rate were 81.58％,82.46％,75.61％,87.04％,82.10％,respectively.There were no statistic difference in VTQ between benign nodules [（2.095 ±0.482） m/s] and the surrounding tissues [（1.941 ±0.412） m/s].The VTQ value of malignant nodules [（3.391 ±0.822） m/s] was significantly higher than that of benign nodules and the surrounding tissues [（2.017±0.419） m/s,P＜0.05].The cutoff point for the differential diagnosis was 2.785 m/s.The sensitivity,specificity and diagnostic accuracy were 85.71％,85.24％,86.32％,respectively.Conclusion ARFI images could reflect the elastic features of thyroid nodules less than 10 mm qualitatively and quantitatively,which is helpful to the diagnosis and differential diagnosis of small thyroid nodules.