SWE联合SMI在甲状腺良恶性结节鉴别诊断中的应用

Application of SWE combined with SMI in differential diagnosis of benign versus malignant thyroid nodules

目的探讨剪切波弹性成像(SWE)联合超微血管成像(SMI)技术在甲状腺良恶性结节鉴别诊断中应用的准确性与可行性。方法选取2021年1月至2022年12月我院超声科检出甲状腺结节并接受超声引导细针抽吸活检或术后组织病理完善的190例患者为研究对象,共检出224个甲状腺结节(病理学明确诊断良性结节74个,恶性结节150个)。患者甲状腺均进行超声、SWE和SMI检查,并计算组织杨氏模量相关参数以及微细血流、穿支血管情况。以组织病理结果作为金标准构建受试者操作特征(ROC)曲线,分析SWE联合SMI对甲状腺良恶性结节鉴别诊断的效果,比较不同检查方法在甲状腺结节诊断中的效能差异。结果甲状腺良性与恶性结节内部成分、回声、边缘、钙化、纵横比比较均有统计学差异(均P<0.05),但二者平均直径比较无统计学差异(P>0.05)。与甲状腺恶性结节比较,甲状腺良性结节弹性最大值、弹性均值、弹性比率、微血流评分、剪切波峰值速度、剪切波平均速度差异均有统计学意义(均P<0.05)。ROC曲线分析结果显示,弹性最大值曲线下面积最大,截断值为29.52 kPa;微血流评分截断值为2.3分。诊断效能分析结果显示,SWE联合SMI的灵敏度与特异度最高,分别为94.67%、94.59%。结论SWE联合SMI可进一步提高甲状腺良恶性结节的诊断效能,并可实现病灶的量化评估与动态观察,具有应用及推广价值。

Objective To investigate the accuracy and feasibility of shear wave elastography(SWE)combined with superb microvascular imaging(SMI)for the differential diagnosis of benign and malignant thyroid nodules.Methods A total of 190 patients with thyroid nodules detected in the Ultrasound Department of our hospital from January 2021 to December 2022 who underwent ultrasound-guided fineneedle aspiration biopsy or exhibited postoperative histopathological improvement were selected as the study subjects.Among them,a total of 224 thyroid nodules(74 benign and 150 malignant nodules)were detected,all of whom underwent thyroid ultrasonography,SWE,and SMI.The parameters related to the Young’s modulus of the tissue as well as the condition of fine blood flow and perforating vessels were calculated.Using histopathological results as the gold standard to construct receiver operating characteristic(ROC)curves,observe the effectiveness of SWE combined with SMI in the differential diagnosis of thyroid nodules,and compare the efficacy of different examination methods in the diagnosis of thyroid nodules.Results There were significant differences in the internal composition,echo,margin,calcification,and aspect ratio between the benign and malignant thyroid nodules(all P<0.05);however,there was no significant difference in the average diameter of the benign and malignant nodules(P>0.05).There were statistically significant differences in maximum elasticity,mean elasticity,elasticity ratio,microvascular score,peak shear wave velocity,and average shear wave velocity between the benign and malignant thyroid nodules(all P<0.05).The ROC curve showed that the area under the curve of the maximum elastic value was the highest,while the optimal diagnostic threshold was 29.52 kPa.The optimal diagnostic threshold for the microvascular flow score was 2.3 points.In terms of diagnostic efficacy,SWE combined with SMI showed the highest sensitivity(94.67%)and specificity(94.59%).Conclusion SWE combined with SMI can further improve the diagnostic efficiency of benign and malignant thyroid nodules and achieve quantitative evaluation and dynamic observation of lesions,which has application and promotion value.