实时组织弹性成像在桥本甲状腺炎合并甲状腺结节鉴别中的临床应用

Differential diagnosis value of real-time elastography for Hashimoto's thyroiditis complicated with benign and malignant thyroid nodules

目的:应用实时组织弹性成像技术对合并甲状腺结节的桥本甲状腺炎(Hashimoto’s thyroiditis,HT)患者进行检测,鉴别其在诊断甲状腺良恶性结节中的临床价值。方法:选取HT合并甲状腺结节患者54例(共162个结节)。每例患者均经穿刺活检或术后病理证实结节良恶性。根据结节良恶性分为良性组和恶性组。对每例患者的甲状腺结节进行弹性图像评分,计算弹性应变率比值,并绘制良性及恶性结节的受试者工作特征(receiver operating characteristic,ROC)曲线。结果:54例HT患者共162个结节,其中,良性结节131个,恶性结节31个。HT合并良性结节、恶性结节的弹性图像分级为0~Ⅱ级、Ⅲ~Ⅳ级。应变率比值的均值分别为2.54±1.39、7.48±3.64。良性组与恶性组应变率比值的均值差异有统计学意义(t=12.78,P<0.05)。以病理结果为"金标准",通过ROC曲线确定应变率比值的均值的诊断临界点为4.91,灵敏度、特异度、阳性似然比和阴性似然比分别为90.63%、81.25%、4.83和0.12。结论:实时组织弹性成像技术可以对HT合并结节的性质进行判定,有助于提高甲状腺良恶性结节诊断的准确率。

Objective： To evaluate the differential diagnosis value of real-time elastography for Hashimoto＇s thyroiditis（HT） disease with benign or malignant thyroid nodules. Methods： Fifty-four cases（162 nodules） of HT disease were confirmed by biopsy or pathology. They were divided into benign nodule group and malignant nodule group. All nodules were classified with elastic images. The elastic strain ratios were calculated. The receiver operating characteristic（ROC） curve of benign and malignant nodules was drawn. Results： There were 54 cases with 162 nodules, including 131 benign nodules, 31 malignant nodules. The elasticity grades for benign and malignant nodules were 0-Ⅱ, Ⅲ-Ⅳ. The mean values of strain ratios for benign and malignant nodules were 2.54±1.39, 7.48±3.64. There was statistical difference between benign and malignant nodules in mean values of strain ratios（t=12.78, P〈0.05）. Taking surgical pathologic results as the gold standard, 4.91 was regarded as the diagnostic cut-off by ROC curve. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 90.63%, 81.25%, 4.83 and 0.12. Conclusion： Real-time elastography technique can estimate the essence of the nodules in the patients with HT disease complicated with thyroid nodules, and can help to improve the diagnostic accuracy.