磁共振成像联合剪切波弹性成像技术在甲状腺微小乳头状癌诊断中的应用价值

Diagnostic value of magnetic resonance imaging combined with shear wave elastography for papillary thyroid microcarcinoma

目的探讨磁共振成像(MRI)联合剪切波弹性成像技术(SWE)对甲状腺微小乳头状癌(PTMC)的诊断价值,为PTMC的临床诊疗提供参考依据。方法根据术后病理学检查结果的不同将139例甲状腺结节患者分为74例PTMC患者和65例甲状腺良性病变患者。所有患者术前均进行了MRI和SWE检查。以病理结果为“金标准”,分析MRI、SWE单独及联合检查对PTMC及PTMC伴甲状腺外侵犯(ETE)的诊断价值。结果MRI、SWE单独及联合诊断PTMC的Kappa值依次为0.798、0.826、0.913,提示MRI、SWE联合诊断与病理结果的一致性最佳,但不同诊断方式的灵敏度、特异度、准确度、阳性预测值和阴性预测值比较,差异均无统计学意义(P﹥0.05)。MRI、SWE单独及联合诊断PTMC伴ETE的Kappa值依次为0.676、0.513、0.918,提示MRI、SWE联合诊断与病理结果的一致性最佳,且MRI、SWE联合诊断的灵敏度、特异度、准确度、阳性预测值和阴性预测值均高于任一方式单独诊断的结果(P﹤0.05)。结论MRI、SWE在PTMC的诊断中均具有良好的诊断价值,但二者联合诊断的效能更优,与病理检查结果的一致性较高,更利于PTMC及PTMC伴ETE的检出,值得临床重视。

Objective To analyze the diagnostic value of magnetic resonance imaging(MRI)combined with shear wave elastography(SWE)for papillary thyroid microcarcinoma(PTMC),and to accumulate evidence for clinical diagnosis and treatment.Method According to respective postoperative pathological findings,139 patients with thyroid nodules were divided into 74 patients with PTMC and 65 patients with benign thyroid lesions.All patients underwent MRI and SWE examination.Taking pathological findings as gold standard,the diagnostic value of MRI or SWE alone or in combination for PTMC and PTMC with extrathyroidal extension(ETE)was analyzed.Result The Kappa values of MRI or SWE alone and their combination for the diagnosis of PTMC were 0.798,0.826 and 0.913,respectively,indicating that the optimal consistency was observed in combined detection,though there were no significant differences in regard to the sensitivity,specificity,accuracy,positive predictive value or negative predictive value among these diagnostic approaches(P>0.05).The Kappa values of MRI or SWE alone and their combination for the diagnosis of PTMC with ETE were 0.676,0.513 and 0.918,respectively,suggesting the highest consistency in combined diagnosis again,besides,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the combined detection were significantly higher than those of either of the two used alone(P<0.05).Conclusion MRI and SWE are of good diagnostic value for PTMC,with enhanced diagnostic efficiency when the two methods are combined,which demonstrates the highest consistency with pathological findings,thus facilitating the detection of PTMC and PTMC with ETE.