SWE联合CEUS在甲状腺结节鉴别诊断中的应用价值

Application of SWE combined with CEUS in the differential diagnosis of thyroid nodules

目的观察剪切波弹性成像(SWE)联合超声造影(CEUS)在甲状腺结节鉴别诊断中的应用价值。方法选取2019年1月—2022年1月四川省德阳市人民医院收治的200例甲状腺结节患者,对所有入选患者行SWE及CEUS检查,以术后病理诊断结果为金标准,比较SWE、CEUS以及二者联合诊断对甲状腺结节鉴别的价值。结果200例患者中,病理结果显示共有212个甲状腺结节,其中134个良性病变(结节性甲状腺肿82个,腺瘤30个,增生结节17个,桥本甲状腺炎5个),78个恶性病变(乳头状癌73个,滤泡状癌2个,髓样癌3个)。经术后病理检查诊断为甲状腺恶性结节患者的杨氏模量平均值(Emean)、最小值(Emin)、最大值(Emax)及达峰时间(Tp)均大于良性结节患者,峰值强度(Peak)低于良性结节患者,差异均有统计学意义(P<0.05)。采用SWE检查鉴别诊断甲状腺结节良恶性的敏感性、特异性及准确性分别为88.46%、87.31%及87.74%,CEUS检查鉴别诊断的敏感性、特异性及准确性分别为85.90%、90.30%及88.68%,二者联合检查的敏感性、准确性分别为98.72%、97.17%。SWE与CEUS联合检查的敏感性、准确性均高于单一检查方法,3种检查鉴别甲状腺结节良恶性的敏感性及准确性比较,差异均有统计学意义(χ^(2)=8.789,P=0.012;χ^(2)=14.255,P=0.001)。结论SWE联合CEUS检查能显著提高甲状腺结节鉴别的诊断效能,其敏感性及准确性较高,均优于单一检查方法,值得在临床推广。

Objective This paper aims to observe the application of shear wave elastography(SWE)combined with contrast-enhanced ultrasound(CEUS)in the differential diagnosis of thyroid nodules.Methods From January 2019 to January 2022,200 patients with thyroid nodules were examined by SWE and CEUS in Deyang People's Hospital.The value of SWE,CEUS,and their combination in the differentiation of thyroid nodules was compared with the results of postoperative patho-logical diagnosis as the gold standard.Results Of the 200 cases,212 thyroid nodules were pathologically confirmed,inclu-ding 134 benign lesions(82 nodular goiter,30 adenoma,17 hyperplastic nodules,and 5 Hashimoto's thyroiditis)and 78 malignant lesions(73 papillary carcinomas,2 follicular carcinomas,and 3 medullary carcinomas).The mean elastic modu-lus(Emean),minimum elastic modulus(Emin),maximum elastic modulus(Emax),and time to peak(Tp)values of patients with malignant thyroid nodules diagnosed by surgical pathology were greater than those of patients with benign nodules,and the peak intensity(Peak)was lower than that of patients with benign nodules,with statistical significance(P<0.05).The sensitivity,specificity,and accuracy of SWE were 88.46%,87.31%,and 87.74%,respectively;those of CEUS were 85.90%,90.30%,and 88.68%,respectively.The sensitivity and accuracy of the combined examination were 98.72%and 97.17%,respectively.The sensitivity and accuracy of combined SWE and CEUS were significantly higher than those of the single examination method in differentiating benign from malignant thyroid nodules(χ^(2)=8.789,P=0.012;χ^(2)=14.255,P=0.001).Conclusion SWE combined with CEUS can significantly improve the diagnostic efficacy of thyroid nodule dif-ferentiation,with high sensitivity and accuracy,which is superior to the single examination method.These benefits hold promise for a wider application of this technique clinically.