TI-RADS联合剪切波弹性成像对甲状腺结节良恶性的鉴别诊断价值

Differential diagnosis of benign and malignant thyroid nodules by TI-RADS combined with shear wave elastography

目的:评价甲状腺影像报告与数据系统(thyroid imaging reporting and data system,TI-RADS)联合剪切波弹性成像(shear wave elastography,SWE)对甲状腺结节良恶性鉴别诊断的价值。方法:术前对209例患者的209个甲状腺结节行TI-RADS风险评估和SWE参数测定,以手术病理诊断结果为金标准,评估以TI-RADS特征和SWE参数进行诊断的有效性,确定预测恶性结节SWE平均值的最佳界值,比较单独TI-RADS以及TI-RADS联合SWE的诊断效能。结果:209个甲状腺结节中,良性55个(占26.32%),恶性154个(占73.68%)。恶性结节的SWE参数明显高于良性结节(P<0.01),低回声或极低回声(P<0.001)和SWE平均值(≥15.65 kPa,P<0.01)是甲状腺恶性结节相关的预测指标。相比于单独TI-RADS诊断,TI-RADS联合SWE评价甲状腺良恶性结节的受试者工作特征曲线下面积明显增大(P<0.001);联合诊断的敏感度为96.75%,特异度为63.64%,准确度为88.04%,阳性预测值为88.17%,阴性预测值为87.50%。结论:SWE平均值是甲状腺恶性结节的独立预测因子,而且TI-RADS联合SWE能明显提高甲状腺良恶性结节的鉴别诊断效能。

Objective:To evaluate the diagnostic value of thyroid imaging reporting and data system(TI-RADS)combined with shear wave elastography(SWE)in the differential diagnosis of benign and malignant thyroid nodules.Methods:TI-RADS risk assessment and SWE parameters measurement were performed for 209 thyroid nodules from 209 patietns before operation.The surgical pathological results were used as gold criteria to assess the validity of TI-RADS features and SWE parameters,to determine the best bound of the SWE mean value for predicting the malignant nodules,and to compare the diagnostic efficacy of single TI-RADS and TI-RADS combined SWE.Results:Of 209 thyroid nodules,55(26.32%)were benign and 154(73.68%)were malignant.The SWE parameter of malignant nodules was significantly higher than that of benign nodules(P<0.01).Hypoechoic or very hypoechoic(P<0.001)and SWE mean value(≥15.65 kPa,P<0.01)were predictors associated with malignant nodules.Compared with individual TI-RADS,the area under the received operating characteristic curve from TI-RADS combined SWE to evaluate benign and malignant thyroid nodules was significantly increased(P<0.001).The sensitivity of the combined diagnosis was 96.75%,the specificity was 63.64%,the accuracy was 88.04%,the positive predictive value was 88.17%,and the negative predictive value was 87.5%.Conclusion:SWE mean value is an independent predictor of malignant thyroid nodules,and TI-RADS combined with SWE can significantly improve the differential diagnosis efficiency of benign and malignant thyroid nodules.