实时剪切波弹性成像技术鉴别诊断肺良恶性周围型肿块

Real-time shear wave elastography in differential diagnosis of benign and malignant peripheral lung masses

目的探讨实时剪切波弹性成像(SWE)技术鉴别诊断肺部良恶性周围型肿块的价值。方法采用SWE技术测量112例周围型肺部肿块患者的杨氏模量值,分析良恶性组及恶性病变不同病理类型亚组间的杨氏模量最大值(E_(max))和平均值(E_(mean))的差异。以病理结果为金标准,绘制ROC曲线获得其鉴别诊断良恶性肿块的效能。结果周围型肺部肿块良恶性组间E_(max)及E_(mean)差异均有统计学意义(t=-2.78、-3.28,P均<0.01),恶性组不同病理类型亚组间E_(max)及E_(mean)差异均无统计学意义(P均>0.05)。E_(max)和E_(mean)鉴别诊断肺良恶性肿块的阈值分别为10.35 kPa和5.85 kPa,AUC分别为0.74(P=0.003)、0.81(P=0.001),敏感度、特异度、阳性预测值、阴性预测值分别为74.36%、72.22%、85.29%、57.52%和81.58%、80.78%、89.57%和67.67%。结论 SWE技术可用于评估周围型肺部肿块的弹性特征,为鉴别肺部良恶性周围型肿块提供了重要的影像学手段。

Objective To investigate the value of shear wave elastography(SWE) in differential diagnosis of benign and malignant peripheral lung masses. Methods SWE examination was performed to measure the Young’s modulus of 112 patients with peripheral pulmonary masses. The maximum value of Young’s modulus(Emax) and the mean value of Young’s modulus(Emean) were statistically analyzed between benign and malignant groups and among subgroups of different pathological types in malignant group. Taken pathological results as gold standards, ROC curve was drawn to evaluate the differential diagnostic efficacy of benign and malignant masses. Results There were statistically significant differences of Emax and Emean between benign and malignant group(t=-2.78,-3.28, both P<0.01), while no significant difference of Emax and Emean was found among 3 subgroups of different pathological types in malignant group(both P>0.05). The cut-off value of Emax and Emean for differential diagnosis of benign and malignant masses was 10.35 kPa and 5.85 kPa, AUC was 0.74(P=0.003) and 0.81(P=0.001), respectively, while the sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of malignant masses were 74.36%, 72.22%, 85.29%, 57.52%, and 81.58%, 80.78%, 89.57%, 67.67%, respectively. Conclusion SWE technology can evaluate the elastic properties of peripheral lung masses and provide an important imaging diagnostic method for identifying benign and malignant peripheral lung masses.