声触诊组织成像与定量技术及实时弹性成像技术在甲状腺影像报告与数据系统4类结节的应用价值

The value of virtual touch tissue imaging quantification and real-time elastography techniques in the differentiation of Thyroid Imaging Reporting and Data System 4 nodules of thyroid

目的比较声触诊组织成像与定量技术及实时弹性成像(VTIQ)技术在甲状腺影像报告与数据系统(TI-RADS)4类结节良恶性鉴别诊断中的应用价值。方法选取2015年11月至2016年3月在浙江大学附属第一医院与浙江金华市中心医院就诊的110例患者(共117个结节),常规超声检查为TI-RADS 4类甲状腺结节的实时弹性技术成像与声触诊组织成像与定量及VTIQ技术图像特征,实时弹性技术采用测定结节的应变比值(SR)评估结节硬度,VTIQ技术采用测定结节的剪切波速度(SWV)评估结节硬度。以术后病理结果为"金标准",分别计算2种方法单独以及联合应用的敏感度、特异度、准确性、阳性预测值、阴性预测值并绘制受试者工作特征(ROC)曲线,获得曲线下面积(AUC)及最佳临界值。结果 117个甲状腺结节中良性结节43个,恶性结节74个。声触诊组织成像与定量、实时弹性成像技术单独以及联合应用诊断甲状腺癌的敏感度、特异度、准确度、阳性预测值、阴性预测值、ROC曲线下面积分别为80.3%vs 86.7%vs 83.7%,72.5%vs 82.3%vs84.2%,76.1%vs 84.6%vs 87.5%,73.3%vs 83.4%vs 84.5%,79.7%vs 85.5%vs 88.7%,0.786 vs 0.869vs 0.881;根据ROC曲线SR的最佳诊断界值为3.3,VTIQ的最佳诊断界值为3.03 m/s。声触诊组织成像与定量与实时弹性成像方法单独以及两者联合应用不同组间曲线面积比较,差异均无统计学意义(Z=1.95、1.83、1.03,P值均>0.05)。结论声触诊组织成像与定量及VTIQ技术单独或联合应用对诊断甲状腺TI-RADS 4类结节的良恶性均有一定价值,3种方式的诊断价值相当。

Objective To study the value of virtual touch tissue imaging quantification（VTIQ） and real-time elastography technology in the differential diagnosis of benign and malignant Thyroid Imaging Reporting and Data System（TI-RADS） 4 thyroid nodules. Methods The real-time elastography imaging and touch tissue imaging quantitative（VTIQ） image features of 110 patients（117 nodules） with TI-RADS 4 thyroid nodules were retrospectively analyzed. The real-time elastic technology was used to measure strain ratio（SR） of nodules. VTIQ technique was used to measure the shear wave velocity（SWV） of nodules. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the two methods alone and in combination were calculated using postoperative pathology as the gold standard. Then, the ROC curve was drawn, and the area under the curve（AUC） and the optimal cut-off value were obtained. Results There were 43 benign nodules and 74 malignant nodules in 117 thyroid nodules. The specificity, accuracy, positive predictive value, negative predictive value, the area under the ROC curve of the two technologies alone and in combination were 80.3% vs 86.7% vs 83.7%, 72.5% vs 82.3% vs 84.2%, 76.1% vs 84.6% vs 87.5%, 73.3% vs 83.4% vs 84.5%, 79.7% vs 85.5% vs 88.7%, 0.786 vs 0.869 vs 0.881. According to the ROC curve, the optimal cut-off value of SR was 3.3 and the optimal cut-off value of VTIQ was 3.03 m/s. The Z values and P values of the two methods alone and in combination were（Z=1.95, 1.83, 1.03, all P〉0.05）, respectively. There was no difference statistically among the three methods. Conclusion The two techniques alone or in combination are valuable in the differential diagnosis of TI-RADS 4 thyroid nodules with similar diagnostic value in the three methods.