声脉冲辐射力成像技术鉴别甲状腺良恶性结节的应用价值

Application value of acoustic radiation force impulse in differentiating benign and malignant thyroid nodules

目的探讨通过声脉冲辐射力成像（ARFI）技术中的声触诊组织成像（VTI）和声触诊组织定量（VTQ）技术鉴别诊断甲状腺良恶性结节的临床价值。方法分析48例患者经手术或穿刺病理证实的甲状腺结节的VTI分级和VTQ测得的结节及结节周围组织的剪切波速度（SWV）,结果进行统计分析,用ROC曲线评估其诊断效能。结果 VTQ检测甲状腺良性结节的SWV值为（2.05±0.25）m/s,范围1.45～2.44 m/s,95%可信区间1.95～2.15 m/s;良性结节周围组织的SWV值为（1.78±0.26）m/s,范围1.32～2.28 m/s,95%可信区间1.68～2.88 m/s。甲状腺恶性结节的SWV值为（3.57±1.29）m/s,范围2.33～7.28 m/s,95%可信区间3.06～4.09 m/s;恶性结节周围组织的SWV值为（1.85±0.29）m/s,范围1.23～2.36 m/s,95%可信区间1.73～1.96 m/s。良恶性结节比较差异有统计学意义（P〈0.01）,恶性结节与其周围组织比较差异有统计学意义（P〈0.01）,良性结节与其周围组织比较差异有统计学意义（P〈0.01）,良恶性结节周围组织比较差异无统计学意义。以结节SWV≥2.416 m/s为诊断恶性结节的标准,其预测甲状腺恶性结节的敏感性88.89%,特异性96.43%,阳性预测值96.00%,阴性预测值90.00%,阳性似然比24.89,阴性似然比0.12。VTI≥Ⅲ级时诊断甲状腺恶性结节的敏感性81.48%,特异性78.57%,阳性似然比3.80,阴性似然比0.24,阳性预测值78.57%,阴性预测值81.48%,正确指数60.05%,准确性80.00%;与病理结果一致性可靠（Kappa=0.60）。结论 VTI可通过灰度分级、VTQ通过SWV值提供结节及组织的硬度信息,对甲状腺良恶性结节的鉴别诊断有重要价值。

Objective To investigate the diagnostic value of virtual touch tissue imaging（VTI）and virtual touch tissue quantification（VTQ） of acoustic radiation force impulse（ARFI） elastography in differentiating benign and malignant thyroid nodules.Methods Forty-eight pathologically proven thyroid nodules were included in this study.The VTI grade and the shear wave velocities（SWV）of nodules and surrounding tissue detected by VTQ were analyzed.The results were statistically analyzed.Receiver-operating characteristic（ROC）curve analysis was performed to assess the diagnostic performance.Results The SWV value of benign nodules was（2.05±0.25）m/s,range：1.45～2.44 m/s,95%CI：1.95～2.15 m/s,surrounding tissue of benign nodules was（1.78±0.26）m/s,range：1.32～2.28 m/s,95%CI：1.68～2.88 m/s.The SWV value of malignant nodules was（3.57±1.29）m/s,range：2.33～7.28 m/s,95%CI：3.06～4.09 m/s,surrounding tissue of malignant nodules was（1.85±0.29）m/s,range：1.23～2.36 m/s,95%CI：1.73～1.96 m/s.The SWV value of malignant nodules was higher than that of surrounding tissue and benign nodules（both P〈0.01）.The SWV value of the benign nodules was higher than that of tsurrounding tissue（P〈0.01）.The SWV value of the surrounding tissue of benign nodules was the same as that of malignant nodules.Taking ≥2.416 m/s of SWV as the cut off value,the sensitivity,specificity,positive predictive value,negative predictive value,＋Likelihood ratio,-Likelihood ratio for differentiating benign and malignant lesions were 88.89%,96.43%,96.00%,90.00%,24.89,0.12,respectively.Taking ≥GradeⅢ of VTI as the cut off value,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value,＋Likelihood ratio,-Likelihood ratio and Kappa value for differentiating benign and malignant lesions were 81.48%,78.57%,80.00%,78.57%,81.48%,3.80,0.24,0.60,respectively.Conclusion VTI grade and SWV detected by VTQ provide the stiffness of nodule and tissue,which might play an important role in differentiating between benign and malignant nodules.