剪切波弹性成像与声辐射力脉冲弹性成像诊断良恶性甲状腺结节

Shear wave elastography and acoustic radiation force impulse imaging in differential diagnosis of benign and malignant thyroid nodules

目的比较剪切波弹性成像(SWE)与声辐射力脉冲弹性成像(ARFI)鉴别甲状腺良恶性结节的价值。方法43例患者共51个甲状腺结节,按直径分为小结节(直径≤1cm)和大结节(1cm<直径≤3cm)。于术前行SWE检查,测定甲状腺结节的最大、平均和最小SWE值(E_(max)、E_(mean)、E_(min)),同时行ARFI检查,测定甲状腺结节声触诊组织量化(VTQ)值和声触诊组织成像(VTI)面积比。绘制ROC曲线,获得甲状腺结节E_(max)、VTQ值和VTI面积比的最佳阈值及诊断恶性结节的敏感度、特异度和准确率。结果 E_(max)、VTQ、VTI面积比的最佳诊断阈值分别为37.74kPa、2.19m/s、1.24,诊断恶性甲状腺结节的敏感度为85.30%(29/34)、76.50%(26/34)、64.71%(22/34),特异度100%(17/17)、94.10%(16/17)、88.20%(15/17),准确率为90.20%(46/51)、90.20%(46/51)、72.55%(37/51)。E_(max)和VTQ值诊断恶性大结节的敏感度分别为92.31%(12/13)、100%(13/13);VTI面积比与E_(max)对诊断恶性小结节的敏感度均为80.95%(17/21)。结论SWE和ARFI判断甲状腺结节性质均有一定价值。E_(max)诊断甲状腺良恶性大小结节价值相当,VTQ值对甲状腺大结节性质判断有一定优势,而VTI面积比判断甲状腺小结节性质更有意义。

Objective To compare the diagnostic value of shear wave elastography（SWE）and acoustic radiation force impulse imaging（ARFI）in benign and malignant thyroid nodules（TNs）.Methods A total of 43 patients with 51 thyroid nodules were included.According to the diameter,all nodules were divided into small nodules（diameter≤1 cm）and large nodules（1 cmdiameter≤3 cm）.All patients underwent both SWE and ARFI examinations at the same time.SWE（Emax,Emean,Emin）,virtual touch tissue quantification（VTQ）and virtual touch tissue imaging（VTI）area ratio were obtained.The optimal cut-off values of SWE,VTQ,VTI area ratio were calculated with ROC curve to identify malignant thyroid nodules from benign ones,and the sensitivity,specificity,accuracy of Emax,VTQ and VTI area ratio were calculated respectively.Results The cut-off value of Emax,VTQ,VTI area ratio in differential diagnosis of benign and malignant TNs was 37.74 kPa,2.19 m/s and 1.24,respectively.The sensitivity was 85.30%（29/34）,76.50%（26/34）,64.71%（22/34）,the specificity was 100%（17/17）,94.10%（16/17）,88.20%（15/17）,the accuracy was90.20%（46/51）,90.20%（46/51）,72.55%（37/51）of Emax,VTQ and VTI area ratio in diagnosis of malignant thyroid nodules,respectively.The sensitivity of Emaxand VTQ in the diagnosis of malignant large NTs was 92.31%（12/13）and100%（13/13）,respectively,while the sensitivity of VTI area ratio and Emaxin the diagnosis of malignant small NTs were both 80.95%（17/21）.Conclusion Either SWE or ARFI has good diagnostic performance in distinguishing malignant thyroid nodules from benign ones.Emaxis of equal value in diagnosing thyroid benign and malignant nodules.VTQ has advantage for diagnosing large NTs,while VTI area ratio shows better diagnostic performance for small NTs.