三维剪切波弹性成像诊断甲状腺结节良恶性的初步应用

Preliminary application of three-dimensional shear wave elastography in diagnosis of thyroid nodules

目的探讨三维剪切波弹性成像(3D-SWE)在甲状腺良恶性结节鉴别诊断中的应用价值。方法选取2018年12月至2019年10月因甲状腺结节于四川省肿瘤医院就诊的患者75例,共计94个结节。对其行常规超声及2D-SWE、3D-SWE检查,测量最大弹性值(Emax)、平均弹性值(Emean),取样框内弹性数据离散度值(Esd)。所有结节均经手术取得病理结果。以病理结果为“金标准”,绘制2D-SWE、3D-SWE不同弹性参数鉴别诊断甲状腺良恶性结节的受试者工作特征(ROC)曲线,分析比较2D-SWE与3D-SWE不同弹性参数的诊断效能。结果本研究中经病理证实良性结节共24个,恶性结节共70个。在2D-SWE横断面、矢状面及3D-SWE横断面、矢状面、冠状面,恶性结节的Emax、Emean、Esd均较良性结节大,差异均有统计学意义(P均<0.05)。2D-SWE横断面、矢状面以及3D-SWE横断面、矢状面、冠状面的Emax诊断甲状腺结节的ROC曲线下面积(AUC)分别为0.753、0.797、0.790、0.811、0.806,差异均无统计学意义(P均>0.05);Emean诊断甲状腺结节的AUC分别为0.740、0.745、0.771、0.780、0.802,差异均无统计学意义(P均>0.05);2D-SWE横断面的Esd鉴别诊断甲状腺良恶性结节的AUC小于2D-SWE矢状面、3D-SWE矢状面以及冠状面(0.675 vs 0.803/0.805/0.774),且差异均有统计学意义(Z=2.540、1.971、1.963,P均<0.05)。结论3D-SWE能够通过定量评估甲状腺结节的硬度鉴别甲状腺结节良恶性,3D-SWE矢状面及冠状面Esd综合诊断效能优于2D-SWE横断面,可作为甲状腺结节诊断的一种有效方法。

Objective To investigate the value of three-dimensional shear wave elastography(3D-SWE)in the differential diagnosis of benign and malignant thyroid nodules.Methods From December 2018 to October 2019,a total of 75 patients with 94 thyroid nodules at Sichuan Cancer Hospital were included.Ultrasound,2D-SWE,and 3D-SWE were performed,and the maximum Young's modulus(Emax),average Young's modulus(Emean),and elastic data dispersion(Esd)were measured.All nodules were confirmed by operation and pathology.According to the pathology results,the receiver operating characteristic(ROC)curves of 2D-SWE and 3D-SWE parameters were plotted to assess their value in distinguishing benign and malignant thyroid nodules.Results There were 24 benign nodules and 70 malignant nodules confirmed by pathology in this study.On all sections of 2D-SWE/3D-SWE,the Emax,Emean,and Esd of malignant nodules were significantly larger than those of benign nodules(P<0.05 for all).On the sagittal and transverse planes of 2D-SWE/3D-SWE and coronal plane of 3D-SWE,the areas under the ROC curves(AUCs)of Emax in diagnosing thyroid nodules were 0.753,0.797,0.79,0.811,and 0.806,respectively,and there were no significant differences between them(P>0.05 for all);the AUCs of Emean were 0.740,0.745,0.771,0.780,and 0.802,respectively,and there were no significant differences between them(P>0.05 for all).The AUC of Esd was significantly lower on the transverse plane of 2D-SWE than on the sagittal plane of 2D-SWE/3D-SWE and coronal plane of 3D-SWE(0.675 vs 0.803,0.805,and 0.774,Z=2.540,1.971,and 1.963,P<0.05 for all).Conclusion 3D-SWE can be used to identify benign and malignant thyroid nodules by quantitative evaluation of the hardness of thyroid nodules.The diagnostic performance of Esd on the sagittal and coronal planes of 3D-SWE is significantly better than that on the transverse plane of 2D-SWE,and Esd is a useful method for differential diagnosis of benign and malignant thyroid nodules.