声辐射力脉冲成像技术在诊断甲状腺乳头状癌颈部淋巴结转移中的价值

The Value of Acoustic Radiation Force Pulse Imaging in Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma

目的研究声辐射力脉冲成像技术在诊断甲状腺乳头状癌颈部淋巴结转移中的价值。方法收集73例甲状腺乳头状癌患者的病历资料,根据颈部淋巴结转移情况分为转移组(28例)和未转移组(45例)。分析患者常规超声参数资料(包括甲状腺结节位置、大小、形态、边界、内部回声、血流分布及周围组织关系等)及声辐射力脉冲成像(ARFI)资料[包括声触诊组织定性成像(VTI)分级、VTI面积比(VAR)、VTQ下的剪切波速度(shear wave velocity,SWV)]。统计分析ARFI在诊断甲状腺乳头状癌颈部淋巴结转移(CLNM)中的价值。结果转移组和非转移组患者的性别、钙化形态、VTI分级、VAR>1、VTQ剪切波速度资料差异有统计学意义(P<0.05)。Logistic回归分析结果显示:微小钙化、VTI分级(4~5级)、VCR>1、VTQ剪切波速度≥4.5是CLNM发生的危险因素。构建Logistic回归模型为:Lpgistic(P)=-0.474+1.143×(微小钙化)+1.588×(VTI分级4~5级)+1.571×(VCR>1)+1.322×(VTQ剪切波速度≥4.5),以病理诊断结果作为金标准,模型对CLNM预测的敏感性、特异度和准确度分别为75.00%、82.22%和79.45%,阳性预测值和阴性预测值分别为72.41%和84.09%,与病理结果的Kappa值为0.754。结论声辐射力脉冲成像技术联合常规超声在诊断甲状腺乳头状癌颈部淋巴结转移中具有一定价值。

Objective To study the value of acoustic radiation force pulse imaging in cervical lymph node metastasis of papillary thyroid carcinoma.Methods 73 cases of thyroid papillary carcinoma were collected.The case data were divided into metastasis group(28 cases)and non-metastasis group(45 cases).Collect routine ultrasound parameters of the patient,including thyroid nodule location,size,shape,boundary,internal echo,blood flow distribution and surrounding tissue relationship,and acoustic radiation pulse imaging(ARFI)data,including acoustic palpation tissue qualitative imaging(VTI)grading,VTI area ratio(VAR),Shear Wave Velocity(SWV)at VTQ.Statistical analysis of the value of ARFI in cervical lymph node metastasis of papillary thyroid carcinoma.Results There were significant differences in gender,calcification morphology,VTI grade,VAR>1,and VTQ shear wave velocity data between the metastatic and non-metastatic groups(P<0.05).Logistic regression analysis showed that microcalcification,VTI grade(4~5),VCR>1,VTQ shear wave velocity≥4.5 were risk factors for CLNM;Logistic regression model was:Lpgistic(P)=-0.474+1.143×(microcalcification)+1.588×(VTI classification 4~5)+1.571×(VCR>1)+1.322×(VTQ shear wave velocity≥4.5).With the pathological diagnosis as the gold standard,the sensitivity,specificity and accuracy of the model for CLNM prediction were 75.00%,82.22%and 79.45%,respectively.The positive predictive value and negative predictive value were 72.41%and 84.09%,respectively.The Kappa value is 0.754.Conclusion Acoustic radiation force pulse imaging combined with conventional ultrasound has certain value in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma.