应变弹性成像与剪切波弹性成像诊断甲状腺良恶性结节的价值

Value of strain elastography and shear wave elastography in the diagnosis of benign and malignant thyroid nodules

目的 比较应变弹性成像(SE)与剪切波弹性成像(SWE)诊断甲状腺良恶性结节的应用价值。方法 选取2021年3月—2023年3月在超声科检查并经穿刺活检或手术病理确诊的甲状腺单发实性结节患者109例为研究对象,均行SE和SWE检查。以病理结果为诊断“金标准”,记录SE应变平均值(SEmean)、周围正常甲状腺组织应变平均值与甲状腺结节应变平均值的比值(SR)、SWE杨氏模量弹性平均值(Emean)、甲状腺结节弹性平均值与周围正常甲状腺组织弹性平均值的比值(ER),比较2种弹性技术鉴别甲状腺结节良恶性的价值,并分析SEmean、SR与Emean、ER的相关性。结果 109例甲状腺结节患者经病理检查证实,良性69例(良性组),恶性40例(恶性组)。恶性组最大直径小于良性组,结节纵横比>1、边界不清、实性低回声及乏血供的患者占比均高于良性组,差异有统计学意义(P<0.05);2组年龄、性别及结节内部细小钙化患者占比比较,差异无统计学意义(P>0.05)。恶性组SR、Emean及ER均高于良性组(P<0.05)。受试者工作特征(ROC)曲线分析显示,SEmean和SR的曲线下面积(AUC)为0.902、0.884,均大于Emean和ER的AUC(0.795、0.806),差异有统计学意义(P<0.05)。SEmean与Emean、ER呈负相关(r=-0.689 0、-0.634 9,P<0.05), SR与Emean、ER呈正相关(r=0.537 2、0.688 3,P<0.05)。结论 SE和SWE技术在鉴别甲状腺结节良恶性具有一定临床应用价值,SE技术的诊断效能较高,但2种技术均存在不足,实际应用中可通过互补提高甲状腺良恶性结节诊断效能。

Objective To compare the value of strain elastography(SE)and shear-wave elastog-raphy(SWE)in the diagnosis of benign and malignant thyroid nodules.Methods A total of 109 pa-tients with single solid thyroid nodules who were examined by ultrasound and confirmed by puncture bi-opsy or surgical pathology from March 2021 to March 2023 were selected as study subjects.All patients underwent SE and SWE examinations.Pathological results were taken as the"gold standard"for diag-nosis,and the mean value of SE strain(SEmean),the ratio of the mean strain of surrounding normal thyroid tissue to the mean strain of thyroid nodule(SR),elastic mean value of Young's modulus of SWE(Emean)and ratio of the average elasticity of thyroid nodule to the average elasticity of surround-ing normal thyroid tissue(ER).The value of the two elasticity techniques in differentiating benign and malignant thyroid nodule was compared,and the correlations of SEmean and SR with Emean and ER.Results The pathologic examination of 109 patients with thyroid nodules confirmed that 69 cases(be-nign group)were benign and 40 cases(malignant group)were malignant.The maximum diameter of nodules in the malignant group was significantly smaller,and the proportion of patients with nodular aspect ratio>1,unclear boundary,solid hypoecho and lack of blood supply was higher than that in the benign group(P<0.05).There were no significant differences in age,gender and the propor-tion of small calcification inside nodules between two groups(P>0.05).SR,Emean and ER in ma-lignant group were higher than those in benign group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the ROC curve(AUC)of SEmean and SR were 0.902 and 0.884,which were higher than 0.795 of Emean and 0.806 of ER(P<0.05).SEmean was negatively correlated with Emean and ER(r=-0.6890,-0.6349,P<0.05),and SR was posi-tively correlated with Emean and ER(r=0.5372,0.6883,P<0.05).Conclusion SE and SWE have certain clinical application value in differentiating benign and malignant thyroid nodules,but SE technique has a high diagnostic efficiency.The two techniques have shortcomings,and they can be complementary in practical application to improve the diagnosis efficiency of benign and malig-nant thyroid nodules.