剪切波弹性成像与实时组织弹性成像诊断儿童先天性肌性斜颈的对比研究

A comparative study of shear wave elastography and real-time tissue elastography in the diagnosis of congenital muscular torticollis in children

目的对比分析剪切波弹性成像与实时组织弹性成像在儿童先天性肌性斜颈中的诊断价值。方法选取105例疑似重度儿童先天性肌性斜颈患儿,均行剪切波弹性成像和实时组织弹性成像检查,获得弹性模量平均值(Emean)和应变率比值(SR),并与健侧对比。以病理结果为金标准,计算二维剪切波弹性成像与实时组织弹性成像诊断儿童先天性肌性斜颈的敏感性、特异性、准确率、阳性预测值及阴性预测值;绘制受试者工作特征(ROC)曲线分析Emean和SR对儿童先天性肌性斜颈的诊断效能。比较先天性肌性斜颈患儿非手术及手术治疗前后Emean和SR的变化。结果105例患儿中,经病理证实先天性肌性斜颈52例(肿块型33例、弥漫型19例),二维剪切波弹性成像准确检出肿块型32例,弥漫型18例;实时组织弹性成像准确检出肿块型30例,弥漫型12例,两种方法比较差异有统计学意义(χ^(2)=6.029,P=0.014)。肿块型与弥漫型Emean和SR均高于健侧,且肿块型Emean和SR均低于弥漫型,差异均有统计学意义(均P<0.05)。Emean截断值为24.725 kPa时,诊断儿童先天性肌性斜颈敏感性94.7%,特异性94.1%,曲线下面积0.975;SR截断值为2.785时,诊断敏感性100%,特异性77.6%,曲线下面积0.922,其曲线下面积比较差异有统计学意义(P<0.05)。52例先天性肌性斜颈患儿经非手术治疗后Emean为(20.21±1.21)kPa,SR为3.02±0.45,与治疗前比较差异无统计学意义;转为手术治疗后Emean为(13.23±1.06)kPa,SR为1.67±0.14,均低于治疗前,差异均有统计学意义(均P<0.05)。结论二维剪切波弹性成像诊断儿童先天性肌性斜颈的价值较实时组织弹性成像更高,可为临床诊断和疗效评估提供参考依据。

Objective To compare the diagnostic value of shear wave elastography and real-time tissue elastography in children with congenital muscular torticollis.Methods A total of 105 children with suspected severe pediatric congenital muscular torticollis were selected,all of them underwent shear wave elastography and real-time tissue elastography to obtain mean elastic modulus(Emean)and strain rate ratio(SR),which were compared with the healthy side.Using pathological results as the gold standard,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of twodimensional shear wave elastography and real-time tissue elastography in the diagnosis of congenital muscular torticollis in children were calculated.ROC curve was drawn to analyze the diagnostic efficacy of Emean and SR for children with congenital muscular torticollis.The changes of Emean and SR in congenital muscular torticollis before and after treatment were observed.Results Among the 105 cases,a total of 52 cases of congenital muscular torticollis were pathologically confirmed(33 cases of mass type,19 cases of diffuse type).A total of 32 cases of mass type and 18 cases of diffuse type were detected by twodimensional shear wave elastography,a total of 30 cases of mass type and 12 cases of diffuse type were detected by real-time tissue elastography,and there was significant difference between the two methods(χ^(2)=6.029,P=0.014).The Emean and SR of the mass type and the diffuse type were higher than those of the healthy side,the Emean and SR of the mass type were lower than those of the diffuse type(all P<0.05).When the cut-off value of Emean was 24.725 kPa,the diagnostic sensitivity was 94.7%,the specificity was 94.1%,and the area under the curve was 0.975.When the cut-off value of SR was 2.785,the diagnostic sensitivity was 100%,the specificity was 77.6%,and the area under the curve was 0.922.There was a statistically significant difference in the area under the curve between the two parameters(P<0.05).The Emean of 52 children with congenital muscular torticollis after non-surgical treatment was(20.21±1.21)kPa,and the SR was 3.02±0.45,there was no statistically significant difference compared with before treatment.For non-surgical treatment,the Emean after treatment was(20.21±1.21)kPa,and the SR was 3.02±0.45,there were no significant difference compared with those before treatment.For surgical treatment,the Emean after surgery was(13.23±1.06)kPa,and the SR was 1.67±0.14,which were both lower than those before treatment(both P<0.05).Conclusion Compared with real-time tissue elastography,two-dimensional shear wave elastography has higher value in the diagnosis of congenital muscular torticollis in children,which can provide reference for clinic.