ACR TI-RADS 5类甲状腺结节患者的剪切波弹性成像杨氏模量最大值与结节钙化的关联

Association of Shear Wave Elastography Young’s Modulus Maxima with Nodular Calcification in Patients with ACR TI-RADS Category 5 Thyroid Nodules

目的:探究美国放射学学会(ACR)甲状腺影像报告和数据系统(TI-RADS)5类甲状腺结节患者的剪切波弹性成像(SWE)杨氏模量最大值(Emax)与结节钙化的相关性。方法:选取2021年1月至2023年1月于本院就诊的95例ACR TI-RADS 5类甲状腺结节患者为研究对象,根据患者是否产生结节钙化分为无结节钙化组(46例)和结节钙化组(49例)。通过单因素检测和多因素Logistic回归分析筛选ACR TI-RADS 5类甲状腺结节患者结节钙化的独立危险因素,构建列线图预测模型并进行模型评价。通过曲线拟合分析ACR TI-RADS 5类甲状腺结节患者SWE Emax与结节钙化之间的关系。采用Spearman检验分析SWE Emax与结节钙化程度的相关性。采用受试者操作特征(ROC)曲线分析SWE Emax对甲状腺结节患者结节钙化的预测价值。结果:甲状腺结节钙化家族病史、高密度脂蛋白胆固醇(HDL-C)、促甲状腺激素(TSH)、口味偏重、Emax、长期不良情绪、恶性结节是ACR TI-RADS 5类甲状腺结节患者结节钙化的独立危险因素(P<0.05)。平滑曲线拟合显示,ACR TI-RADS 5类甲状腺结节患者SWE Emax与结节钙化呈正相关。Spearman检验结果提示,ACR TI-RADS 5类甲状腺结节患者的SWE Emax和结节钙化呈正相关,r_s=0.830(P<0.05)。ROC曲线分析结果显示,Emax预测结节钙化的ROC曲线下面积(AUC)为0.819(95%CI:0.776~0.891),灵敏度和特异度分别为81.64%和82.61%。基于7项独立危险因素构建的列线图模型评价结果显示,AUC为0.853(95%CI:0.785~0.937),C-index为0.817,Hosmer-Lemeshow拟合优度检验提示模型具有较好拟合度(P=0.359),且具有较高净获益值。结论:甲状腺结节钙化家族病史、HDL-C、TSH、口味偏重、Emax、长期不良情绪、恶性结节是ACR TI-RADS 5类甲状腺结节患者结节钙化的独立危险因素。ACR TI-RADS 5类甲状腺结节患者SWE Emax和结节钙化程度呈整体正相关。

Objective:To investigate the correlation between shear wave elastography(SWE)Young’s modulus maximum(Emax)and nodule calcification for patients with thyroid nodules from the American College of Radiology(ACR)Thyroid Imaging Report and Data Set(TI-RADS)in five categories of thyroid nodules.Methods:95 patients with ACR TI-RADS category 5 thyroid nodules seen in our hospital from January 2021 to January 2023 were selected for the study.The patients were divided into a group without nodular calcification(46 patients)and a group with nodular calcification(49 patients)according to whether they had nodular calcification.Independent risk factors for nodal calcification in patients with ACR TI-RADS category 5 thyroid nodules were screened using univariate and multivariate Logistic regression analysis,nomogram prediction models were constructed and the models were evaluated.The relationship between SWE Emax and nodal calcification in patients with ACR TI-RADS category 5 thyroid nodules was analysed by curve fitting.The correlation between SWE Emax and the degree of nodal calcification was analysed using the Spearman test.A receiver operator characteristic(ROC)curve was used to analyse the ability of SWE Emax to predict nodal calcification in patients with thyroid nodules.Results:Family history of calcified thyroid nodules,high density lipoprotein cholesterol(HDL-C),thyroid stimulating hormone(TSH),heavy taste,Emax,chronic adverse mood,and malignant nodules were independent risk factors for nodal calcification in patients with ACR TI-RADS category 5 thyroid nodules(P<0.05).The application of smoothing curve fitting analysis revealed a positive correlation between SWE Emax and nodular calcification in ACR TI-RADS category 5 thyroid nodules.The Spearman test suggested a positive correlation between SWE Emax and nodal calcification in patients with ACR TI-RADS category 5 thyroid nodules,r s=0.830(P<0.05).The ROC curve analysis demonstrated that the area under the curve(AUC)of Emax for predicting nodal calcification was 0.819(95%CI:0.776-0.891),the sensitivity and specificity were 81.64%and 82.61%respectively.The results of the evaluation of the nomogram model based on seven independent risk factors showed an AUC of 0.853(95%CI:0.785-0.937)and a C-index of 0.817,with the Hosmer-Lemeshow goodness-of-fit test suggesting a good fit(P=0.359)and a high net benefit value.Conclusion:Family history of thyroid nodular calcification,HDL-C,TSH,taste preference,Emax,long-term adverse mood,and malignant nodules were independent risk factors for nodular calcification in ACR TI-RADS category 5 thyroid nodules.There was an overall positive correlation between SWE Emax and the degree of nodular calcification in ACR TI-RADS category 5 thyroid nodules.