剪切波弹性成像与实时组织弹性成像对甲状腺高度可疑恶性结节的诊断价值

Diagnostic value of shear wave elastography and real-time tissue elastography for thyroid ACR TR5 nodules

目的探讨剪切波弹性成像(SWE)、实时组织弹性成像(RTE)及二者联合应用在鉴别诊断甲状腺高度可疑恶性(TR5类)结节中的应用价值。方法选取2018年8月至2019年6月于哈尔滨医科大学附属第四医院超声检查,并诊断为甲状腺美国放射学会(ACR)TR5类结节患者作为调查对象,分别接受超声SWE及RTE检查以评估结节硬度。绘制受试者工作特性曲线(ROC曲线),得出应用SWE技术鉴别诊断甲状腺ACR TR5类结节良恶性的杨氏模量最大值(Emax)最佳诊断界值;采用5分法,用弹性评分(ES)对纳入的ACR TR5类结节的良恶性进行RTE技术评估;同时以病理结果为"金标准",比较SWE、RTE及两种弹性成像技术联合应用鉴别诊断甲状腺ACR TR5类结节良恶性的准确性、敏感度、特异性、阳性预测值及阴性预测值。结果共纳入65例患者,超声诊断73个ACR TR5类结节。SWE技术鉴别诊断ACR TR5类结节的Emax最佳阈值为41.8 kPa,预判恶性结节32个,良性结节41个。应用RTE技术检测73个ACR TR5类结节,弹性评分(ES)为1~3分(良性)的有38个,ES≥4分(恶性)的有35个。病理结果显示,73个甲状腺ACR TR5类结节中,良性结节占45.21%(33/73),恶性结节占54.79%(40/73)。SWE、RTE及两种弹性成像技术联合鉴别诊断甲状腺ACR TR5类结节良恶性的敏感度、特异性、准确性、阳性预测值及阴性预测值分别为72.50%、77.50%、87.50%,90.91%、87.88%、87.88%,80.82%、82.19%、87.67%,90.63%、88.57%、89.24%,73.17%、76.32%、85.29%。结论SWE和RTE两种不同成像原理的超声弹性成像技术都是鉴别诊断甲状腺ACR TR5类结节良恶性的有效方法,二者联合应用诊断更有优势。

Objective To investigate the application value of shear wave elastography(SWE)and real-time tissue elastography(RTE)in differential diagnosis of thyroid Amereican College Radiology(ACR)TR5 nodules.Methods Patients who underwent ultrasound examination at the Fourth Affiliated Hospital of Harbin Medical University from August 2018 to June 2019 diagnosed as ACR TR5 nodules were surveyed,and received SWE and RTE examinations to evaluate the nodules hardness.The receiver operating characteristic curve(ROC curve)was drawn to obtain the best diagnostic cutoff value for the Young's modulus maximum(Emax)of the benign and malignant thyroid ACR TR5 nodules using SWE technique;using the 5-point method,the elasticity score(ES)was used to evaluate the benign and malignant ACR TR5 nodules by RTE technology,and the pathological results were regarded as"gold standard".The accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of SWE,RTE and two elastography techniques in differential diagnosis of benign and malignant thyroid ACR TR5 nodules were compared.Results A total of 65 patients were enrolled,with a total of 73 ACR TR5 nodules.The optimal Emax threshold for differential diagnosis of ACR TR5 nodules by SWE technology was 41.8 kPa,and 32 malignant nodules and 41 benign ones were determined.Of the 73 ACR TR5 nodules using RTE technology,38 had ES scores of 1 to 3 and 35 had ES scores of≥4.Pathological results showed that among 73 thyroid ACR TR5 nodules,benign nodules accounted for 45.21%(33/73),malignant nodules accounted for 54.79%(40/73).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of SWE,RTE and two elastography techniques for differential diagnosis of benign and malignant thyroid ACR TR5 nodules were 72.50%,77.50%,87.50%;90.91%,87.88%,87.88%;80.82%,82.19%,87.67%;90.63%,88.57%,89.24%and 73.17%,76.32%,85.29%.Conclusions Ultrasound elastography of two different imaging principles of SWE and RTE is an effective method for differential diagnosis of benign and malignant thyroid ACR TR5 nodules.The combination of the two is more advantageous.