实时剪切波弹性成像定量参数结合C-TIRADS指南在甲状腺结节鉴别诊断中的价值

Value of Shear Wave Elastography Combined with C-TIRADS Guidelines in the Differential Diagnosis of Thyroid Nodules

目的探讨剪切波弹性成像技术(Shear Wave Elastography,SWE)结合甲状腺结节超声恶性危险分层中国指南(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS)在甲状腺结节鉴别诊断中的价值。方法回顾性分析176例甲状腺结节患者,共179个结节,其中良性结节78个,恶性结节101个。小结节(≤10 mm)77个,大结节(>10 mm)102个。以粗针穿刺或手术病理结果为“金标准”,分析常规超声C-TIRADS分类诊断、SWE及两者联合诊断与“金标准”的一致性,绘制受试者工作特征曲线,分析常规超声C-TIRADS分类诊断、SWE及两者联合诊断的诊断效能。结果良性结节杨氏模量最大值(SWE_(max))、最小值(SWE_(min))、平均值(SWE_(mean))、标准差(SWE_(SD))均小于恶性结节,差异有统计学意义(P<0.05);恶性大、小结节的SWE_(max)、SWE_(mean)、SWE_(min)、SWE_(SD)值均大于良性大、小结节的各杨氏模量值,差异有统计学意义(P<0.001)。C-TIRADS指南诊断敏感度、特异性、准确度、曲线下面积(Area Under Curve,AUC)、Kappa值分别为97.03%、60.26%、81.0%、0.786、0.597;SWE诊断敏感度、特异性、准确度、AUC、Kappa值分别为89.11%、87.18%、88.3%、0.881、0.762;两者联合诊断的Kappa值、敏感度、特异性、准确度、AUC分别为0.874、99.01%、88.46%、94.4%、0.937。结论恶性大、小结节杨氏模量值均大于良性大、小结节的杨氏模量值。SWE与C-TIRADS指南联合诊断甲状腺结节可进一步提高敏感度、特异性、准确度,可应用于临床实际工作中。

Objective To explore the value of shear wave elastography(SWE)combined with Chinese Thyroid Imaging Reporting and Data System(C-TIRADS)classification guidelines in the differential diagnosis of thyroid nodules.Methods The data of 176 patients with thyroid nodules were retrospectively analyzed,with a total of 179 nodules,including 78 benign nodules and 101 malignant nodules.There were 77 small nodules(≤10 mm)and 102 large nodules(>10 mm).With crude needle puncture or surgical pathological results as the“gold standard”,the consistency between conventional ultrasonic C-TIRADS classification diagnosis,SWE and their combined diagnosis and“gold standard”was analyzed,and the working characteristic curve of subjects was drawn to analyze the diagnostic efficacy of conventional ultrasonic C-TIRADS classification diagnosis,SWE and their combined diagnosis.Results The maximum value(SWE_(max)),the minimum value(SWE_(min)),the mean value(SWE_(mean))and the standard deviation(SWE_(SD))of SWE Young's modulus of benign nodules were smaller than those of malignant nodules,and the difference was statistically significant(P<0.05).With regard to malignant nodules,the SWE_(max),SWE_(mean),SWE_(min),and SWE_(SD) values of the large nodule group were higher than the small nodule group,and the difference was statistically significant(P<0.001).The sensitivity,specificity,accuracy,area under curve(AUC)and Kappa values of C-TIRADS guideline diagnosis were 97.03%,60.26%,81.0%,0.786 and 0.597,respectively.The sensitivity,specificity,accuracy,AUC,and Kappa values of SWE diagnosis were 89.11%,87.18%,88.3%,0.881 and 0.762,respectively.The kappa value,sensitivity,specificity,accuracy,and AUC of the combined diagnosis were 0.874,99.01%,88.46%,94.4%,and 0.937,respectively.Conclusion Young’s modulus values of large and small malignant nodules were higher than those of large and small benign nodules.The combination of SWE and C-TIRADS guidelines in the diagnosis of thyroid nodules can further improve the sensitivity,specificity,accuracy,which can be extended to clinical practice.