3种方法单独及联合诊断甲状腺微小结节的价值比较

Comparison of value of three methods alone and their combination in diagnosis of thyroid micronodules

目的 比较二维高频超声、声脉冲辐射力成像(ARFI)-声触诊组织定量(VTQ)技术及应变弹性成像3种方法单独及联合诊断甲状腺微小结节良恶性的价值。方法 回顾性分析2021年6月—2023年6月在陕西省宝鸡市人民医院就诊的99例(107个甲状腺微小实性结节)结节直径≤10.0 mm患者的临床资料,均采用二维高频超声、ARF-VTQ技术及应变弹性成像进行检查,获得超声资料评分及数据,以穿刺活检和手术病理结果为诊断“金标准”,比较3种超声检查方法单独及联合应用对甲状腺微小结节的诊断效能。结果 62例患者(共68个结节)选择FNAB,37例患者(共39个结节)选择手术。107个甲状腺微小结节中,诊断为恶性微小结节45个,良性微小结节62个。恶性微小结节与良性微小结节相比,结节内回声(等回声和高回声、极低回声和低回声)、边界、微钙化、纵横比>1及血供情况和供血动脉阻力指数(RI)比较,差异均有统计学意义(P<0.05)。二维高频超声诊断甲状腺微小结节C-TIRADS积分临界值≥2分(C-TIRADS 4b)时,诊断灵敏度为73.33%,特异度为79.03%,曲线下面积[AUC(95%CI)]为0.762(95%CI:0.670~0.839);ARFI-VTQ技术中,107个甲状腺微小结节SWV测值为0.52~7.55 m/s,平均(2.62±0.61)m/s,其中24个实性结节多次出现×.××m/s,最后测值以7.55 m/s记录。恶性微小结节SWV均值为(5.24±2.23) m/s,高于良性微小结节的(2.11±0.70) m/s,差异有统计学意义(t=10.258,P<0.05);当SWV临界值为3.19 m/s时,诊断灵敏度为77.78%,特异度为80.65%,AUC(95%CI)为0.792(95%CI:0.703~0.865);应变弹性成像检查中,当评分临界值≥3分时,诊断的灵敏度为75.56%,特异度为77.42%,AUC(95%CI)为0.765(95%CI:0.673~0.841)。三者联合应用诊断的阳性微小结节为44个,阴性微小结节63个,诊断灵敏度为93.33%,特异度为96.77%,AUC(95%CI)为0.951(95%CI:0.891~0.983)。三者联合诊断效能与二维高频超声检查、ARFI-VTQ、应变弹性成像单独检测比较,差异均有统计学意义(Z=4.861、4.393、4.842,P<0.05)。结论 二维高频超声联合ARFI-VTQ技术及应变弹性成像可提高甲状腺微小结节良恶性的诊断准确性。

Objective To compare the value of two-dimensional high-frequency ultrasound,acoustic pulsed radiant force imaging(ARFI)-acoustic palpation tissue quantification(VTQ) technology,and strain elastography alone and their combination in diagnosis of benign and malignant thyroid micronodules.Methods A retrospective analysis was conducted in 99 patients(107 thyroid micro-solid nodules with diameters ≤ 10.0 mm) who were treated at Baoji People′s Hospital in Shaanxi Province from June 2021 to June 2023.All patients underwent two-dimensional high-frequency ultrasound,ARFI-VTQ technology,and strain elastography to obtain ultrasound data scores and data.Using biopsy and surgical pathology as the diagnostic "gold standard",the diagnostic efficacy of the three ultrasound methods alone and their combination was compared for thyroid micro-nodules.Results A total of 62 patients(68 nodules) underwent fine-needle aspiration biopsy(FNAB),and 37 patients( 39 nodules) underwent surgery.Among 107 thyroid micro-nodules,45 were diagnosed as malignant,and 62 as benign.Significant differences were observed between malignant micro-nodules and benign micro-nodules in terms of internal echo( isoechoic and hyperechoic echo,very hypoechoic and hypoechoic echo),boundary,microcalcification,aspect ratio > 1,blood supply,and resistance index( RI) of the artery( P < 0.05).When the critical value of the C-TIRADS score for diagnosing thyroid micro-nodules using two-dimensional high-frequency ultrasound was ≥ 2 points( C-TIRADS 4b),the diagnostic sensitivity was 73.33%,specificity was 79.03%,and the area under the curve( AUC) was 0.762[95% CI,0.670 to 0.839].In ARFI-VTQ technology,the SWV values ranged from 0.52 to 7.55 m/s,with an average of( 2.62 ± 0.61) m/s.The mean SWV of malignant micro-nodules was( 5.24 ± 2.23) m/s,which was higher than( 2.11 ± 0.70) m/s of benign micro-nodules( t = 10.258,P < 0.05).When the critical SWV value was 3.19 m/s,the diagnostic sensitivity was 77.78%,specificity was 80.65%,and the AUC( 95% CI) was 0.792( 95% CI,0.703 to 0.865).In strain elastography,when the critical score was ≥3,the diagnostic sensitivity was 75.56%,specificity was 77.42%,and the AUC( 95% CI) was 0.765( 95% CI,0.673 to 0.841).Combined detection of the three methods showed that there were 44 positive micro-nodules,63 negative micro-nodules,the diagnostic sensitivity was 93.33%,specificity was96.77%,and the AUC( 95% CI) was 0.951( 95% CI,0.891 to 0.983).There was statistical significance in the diagnostic efficacy of combined application compared with that of 2D high-frequency ultrasonography,ARFI-VTQ technology and strain-elasticity imaging alone( Z = 4.861,4.393,4.842,P < 0.05).Conclusion The combination of two-dimensional high-frequency ultrasound,ARFI-VTQ technology,and strain elastography can improve the diagnostic accuracy of benign and malignant thyroid micro-nodules.