应变力与剪切波弹性成像诊断甲状腺结节的价值比较

Comparison of The Value of Strain Elastography and Shear Wave Elastography in the Diagnosis of Thyroid Nodules

目的比较应变力(strain elastography,SE)与剪切波(shear-wave elastography,SWE)弹性成像对甲状腺结节的诊断价值。方法纳入北京协和医院2017年10月~2018年9月75例行甲状腺切除手术患者的116个结节(良性/恶性:34/82),术前进行常规超声、SE、SWE检查。常规超声利用2017版ACR-甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TI-RADS)进行分类,SE利用改良5分法进行评分,SWE取Emean并获取cut-off值;TR5、SE评分≥4分,SWE Emean大于cut-off值诊断为恶性。以病理结果为金标准,获得SE、SWE及常规超声联合两者的敏感度、特异性、阳性预测值、阴性预测值、准确度、受试者工作特征曲线下面积,并进行比较。结果SE的分值和SWE Emean值在良恶性组间比较,差异均有统计学意义。SE的敏感度显著高于SWE(87.80%vs 54.88%,P=0.000),受试者工作特征曲线下面积(0.748 vs 0.657,P=0.203)及准确度(80.17%vs 61.21%)高于SWE,而特异性低于SWE(61.76%vs 76.47%,P=0.359)。联合两种弹性成像后,常规超声的敏感度均有提高,特异性及准确度均下降。结论SE和SWE判断甲状腺结节性质均有一定价值,SE的诊断甲状腺结节敏感度、准确度高于SWE,而SWE的特异性高于SE,但两者单独诊断甲状腺结节价值有限。常规超声联合弹性成像能够提高诊断敏感度。

Objective To compare the performance of strain elastography(SE)and shear-wave elastography(SWE).Methods From October 2017 to September 2018,116 thyroid nodules in 75 patients who underwent thyroidectomy in our center were prospectively enrolled.Conventional ultrasound,SE and SWE were examined,and these were all confirmed later by pathology.According to ultrasound classification of ACR TI-RADS,thyroid nodules were evaluated.SE of nodules were scored according to the modified 5-point scale and the mean elasticity values(Emean)of SWE were obtained.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and the area under the receiver operating characteristic curve(AUC)of SE,SWE and combination of conventional ultrasound and elastography were compared.Results The point of SE and Emean of SWE were statistically different between the benign and malignant groups.The sensitivity of SE was significantly higher(87.80%vs 54.88%,P=0.000),AUC(0.748 vs 0.657,P=0.203)and accuracy(80.17%vs 61.21%)were higher,the specificity(61.76%vs 76.47%,P=0.359)was lower than that of SWE.After combined with elastography,the sensitivity of conventional ultrasound was higher,but the specificity and accuracy were lower.Conclusion SE and SWE have value in diagnosing thyroid nodules.The sensitivity and accuracy of SE are higher,but the specificity is lower than these of SWE.Elastography can help improve the sensitivity of conventional ultrasound.