剪切波弹性成像鉴别诊断甲状腺良恶性病变

Shearing wave elastography imaging in the differential diagnosis of benign and malignant thyroid nodules

目的探讨剪切波弹性成像技术中的杨氏模量值对甲状腺良恶性结节的鉴别诊断价值。方法对186例患者行实时剪切波弹性成像检查,绘制ROC曲线,取得良恶性结节鉴别诊断的最佳临界值。结果共219个结节,良性结节90个,恶性结节129个。良性结节杨氏模量的平均、最大和最小值分别为(46.11±19.49)k Pa、(69.13±32.26)k Pa和(13.12±7.29)k Pa,恶性结节杨氏模量的平均、最大和最小值分别为(81.22±21.99)k Pa、(104.45±42.36)k Pa和(24.76±10.91)k Pa;良恶性结节杨氏模量平均值、最大值及最小值差异具有统计学意义(P<0.01);病灶杨氏模量最大值和平均值ROC曲线下面积(AUC)分别为0.783和0.893;最大值、平均值最佳诊断界值分别为80.5 k Pa和63.5 k Pa,以其为诊断界值其诊断敏感度、特异度分别为75.4%、73.3%和80.8%和85.6%。结论实时剪切波弹性成像的杨氏模量值能够直接、定量地反映甲状腺结节的软硬度,为甲状腺结节良恶性病变鉴别诊断提供更为客观的诊断依据,具有广阔的临床应用前景。

Objective To explore the value of Young＇ s modulus of shearing wave elastography （SWE） imaging technique in the differential diagnosis of benign and malignant of thyroid nodules. Methods A total of 186 patients with thyroid nodules underwent real-time shear wave e- lasticity imaging. The value of Young＇ s modulus was calculated for all nodules. Then the ROC curve was drawn and the optimal cutoff of Young＇ s modulus to differentiate the benign from malignant thyroid nodules was calculated. Results A nodules and 129 malignant nodules were found and total of 219 thyroid nodules with 90 benign included in the final analysis. The mean, maximum and minimum value of Young＇ s modulus of benign nodules were （46. 11 ±19.49 ） kPa, （69. 13 ±32.26） kPa and （13.12 ±7. 29） kPa,respectively. The mean, maximum and minimum value of Young＇ s modulus of malignant nodules were （ 81.22 ±21.99 ） kPa, （104.45 ±42. 36） kPa, and （24. 76 ±10. 91） kPa, respectively. The mean, maximum and minimum value of Young＇ s modulus of malignant nodules were all higher than benign nodules （all P 〈0. 01）. The mean and maximum of the area under the curve （AUC） of the Young＇ s modulus value were 0. 783 and 0. 893. The optimal cutoff of maximum value of Young＇ s modulus was 80. 5 kPa, the sensitivity was 75.4% and specificity was 73.3%. The optimal cutoff of mean value of Young＇ s modulus was 63.5 kPa, the sensitivity was 80. 8% and specificity was 85.66%. Conclusion Young＇ s modulus value of real-time shear wave elasticity imaging could reflect the texture of thyroid nodules directly and quantitatively and then provide objective information for the differential diagnosis of benign and malignant thyroid nodules.