实时剪切波弹性成像联合超声造影参数在鉴别甲状腺实性结节良恶性的诊断价值研究

The diagnostic value of real-time shear-wave elastography combined with contrast-enhanced ultrasound parameters in differentiating benign and malignant thyroid nodules

目的 评估实时剪切波弹性成像(SWE)杨氏模量联合超声造影(CEUS)参数在鉴别甲状腺结节良恶性中的诊断价值。方法 以2020年6月至2022年11月在宝鸡市人民医院经细针穿刺活检或手术病理证实的甲状腺结节病人为研究对象,按照研究目标设定的纳入/排除标准,最终纳入106例共106个结节,行常规超声及SWE检查,记录结节超声特征及弹性参数,后行CEUS检查,并对结节动态造影图像进行定量参数分析,获取造影时间-强度曲线(TIC)图及相关CEUS参数。比较SWE参数Еmax、Еmin、Еmean与CEUS参数PI、TTP、MTT、超声造影TIC曲线下面积(AUC)及联合参数在鉴别甲状腺结节良恶性中的诊断价值。结果 106例甲状腺结节中,甲状腺良性结节(TBN)组60例和恶性结节(TMN)组46例;两组结节一般资料比较中,病人年龄平均值TBN组(42.37±5.54)岁与TMN组(39.56±4.69)岁相比差异有统计学意义(P<0.05),结节血流分布差异有统计学意义(P<0.05);两组结节SWE杨氏模量Emax、Emin、Emean平均值中,TBN组平均值分别为(39.29±12.59)Kp、(14.19±4.60)Kp、(23.01±7.93)Kp,TMN组平均值分别为(104.35±35.62)Kp、(35.09±17.53)Kp、(62.13±22.94)Kp,两组相比差异有统计学意义(P<0.05);两组结节CEUS定性及定量各参数PI、TTP、AUC平均值中,TBN组各参数平均值分别为(45.88±4.22)dB、(22.02±1.97)s、(4177.58±426.29)dB·s,TMN组各参数平均值分别为(35.64±4.16)dB、(24.98±3.91)s、(3280.94±315.76)dB·s,TMN组PI、AUC均低于TBN组,而TMN组TTP长于TBN组,两组相比差异有统计学意义(P<0.05);SWE及CEUS参数联合诊断受试者操作特征(ROC)曲线下面积(AUC)、准确性及对应的灵敏度、特异度均高于各参数单独诊断,且均差异有统计学意义(P<0.05)。SWE各参数单独及联合诊断ROC曲线成对比较,Еmax比Еmin、Еmean比Еmin成对比较差异有统计学意义(Z=2.60、3.00,P<0.05)。CEUS各参数单独及联合诊断ROC曲线成对比较,TTP与联合诊断成对比较差异有统计学意义(Z=2.35,P<0.05)。Emean截断值为32.21 KPa时,SWE-Emean联合CEUS特征鉴别甲状腺结节良恶性的诊断效能均优于SWE-Emean或CEUS单独诊断。结论SWE杨氏模量联合CEUS参数可提高甲状腺结节诊断准确性。

Objective To evaluate the diagnostic value of real-time shear-wave elastography(SWE)combined with Young's modulus and contrast-enhanced ultrasound(CEUS)parameters in differentiating benign and malignant thyroid nodules.Methods The patients with thyroid nodules confirmed by fine-needle aspiration biopsy or surgical pathology,who were admitted to Baoji People's Hospital from June 2020 to November 2022,were chosen as the research subjects,and 106 patients(106 nodules)were finally included in the study according to the inclusion/exclusion criteria set by the research goal.Routine ultrasound and SWE examinations were performed to record the ultrasonic characteristics and elastic parameters of nodules,followed by CEUS examination.Quantitative parameter analy-sis was performed on the dynamic angiography images of nodules,and the angiographic time-intensity curve(TIC)and related CEUS pa-rameters were obtained.The diagnostic values of SWE parametersЕmax,Еmin andЕmean,CEUS parameters PI,TTP,MTT,and AUC and the combination of the two kinds of parameters were compared in the differentiation of benign and malignant thyroid nodules.Re-sults Among 106 cases of thyroid nodules,60 cases were benign thyroid nodules(TBN group)and 46 cases were malignant thyroid nodules(TMN group).The comparison results of the baseline information of nodules between the two groups showed that the mean ages of patients between the TBN group and the TMN group were significantly different[(42.37±5.54)vs.(39.56±4.69),P<0.05],and the nodular blood flow distributions were also significantly different(P<0.05).Emax,Emin and Emean mean values of Young's modulus of nodular SWE in the two groups were(39.29±12.59)Kp,(14.19±4.60)Kp and(23.01±7.93)Kp in the TBN group,and(104.35±35.62)Kp,(35.09±17.53)Kp and(62.13±22.94)Kp in the TMN group,with statistically significant differences between the two groups(P<0.05).The mean values of qualitative and quantitative CEUS parameters PI,TTP and AUC were(45.88±4.22)dB,(22.02±1.97)s and(4177.58±426.29)dB·s in the TBN group and(35.64±4.16)dB,(24.98±3.91)s and(3280.94±315.76)dB·s in the TMN group,re-spectively.Both PI and AUC in the TMN group were lower than those in the TBN group,while TTP in the TMN group was longer than that in the TBN group.There were statistically significant differences between the two groups(P<0.05).The areas under ROC curve(AUC),accuracies,corresponding sensitivities and specificities of diagnosis by combined parameters of SWE and CEUS were higher than those of separate-parameter diagnosis,and the differences were statistically significant(P<0.05).For pair-wise comparisons of ROC curves diagnosed by each parameter of SWE alone and in combination,there were statistically significant differences in the pair-wise comparison of Emax/Emin and Emean/Emin(Z=2.60,3.00,P<0.05).For pair-wise comparisons of ROC curves of diagnosis by each parameter of CEUS alone and in combination,there were statistically significant differences between TTP and the combined diag-nosis(Z=2.35,P<0.05).When the Emean cut-off value was 32.21 KPa,the diagnostic efficacy of SWE-Emean combined with CEUS in differentiating benign and malignant thyroid nodules was superior to that of SWE-Emean or CEUS alone.Conclusion SWE Young's modulus combined with CEUS parameters can improve the diagnostic accuracy of thyroid nodules.