剪切波弹性成像杨氏模量最大值与ACR TI-RADS分类对甲状腺结节的诊断价值

The diagnostic value of the maximum value of Young’s modulus of shear-wave elastography and ACR TI-RADS for thyroid nodules

目的:探讨剪切波弹性成像(SWE)杨氏模量最大值(Emax)联合2017年美国放射协会(ACR)的甲状腺影像学报告及数据系统(TI-RADS)对甲状腺结节的诊断价值。方法:回顾性分析113个甲状腺结节的声像图资料。所有结节均行SWE及常规超声检查,记录Emax并按照2017年ACR TI-RADS分类。以病理为金标准,构建ROC曲线,选取最佳诊断切点。比较单独应用Emax、ACR TI-RADS以及两者联合应用诊断甲状腺良恶性结节的价值。结果:113个甲状腺结节中良性结节51个,恶性结节62个,SWE最佳分界点为Emax>40kPa,其诊断甲状腺结节良恶性的灵敏度、特异度及准确率分别为74.2%,76.5%,75.2%。ACR TI-RADS最佳分界点为TI-RADS分级>TR4,其诊断甲状腺结节良恶性的灵敏度、特异度及准确率分别为80.6%,78.4%,79.6%。2种方法联合诊断甲状腺结节良恶性的灵敏度、特异度及准确率分别为93.5%、68.6%、82.3%。2种方法联合应用较单独应用诊断甲状腺良恶性结节的灵敏度升高,差异有统计学意义(P<0.05),而特异度和准确率差异均无统计学意义(P>0.05)。结论:SWE及ACR TI-RADS分类系统对于鉴别甲状腺结节的良恶性具有重要的临床价值,2种方法联合应用较单独应用能提高诊断的灵敏度,特异度及准确率不变。

Objective:The aim of this study is to assess the application value of maximum Young’s modulus of shear wave elastography in combination with Thyroid Imaging Reporting and Data System set by the American College of Radiology in the diagnosis of benign and malignant thyroid nodules.Method:A retrospective analysis of113 thyroid nodules with ultrasonographic imaging data was carried out.All nodules were subjected to SWE and conventional ultrasonography,and Emax was recorded and classified according to the 2017 ACR TI-RADS.With pathology as the gold standard,the ROC curve was drawn and the best diagnostic cut-off was selected for comparing their diagnostic performance.Result:Of the 113 thyroid nodules,51 were benign and 62 were malignant.Best cut-off point for diagnosing malignant by SWE was Emax>40 kPa.And at that point,the sensitivity,specificity and accuracy of the average value of it were 74.2%,76.5%and 75.2%.Best cut-off point for diagnosing malignant by ACR TI-RADS was>TR4.The sensitivity,specificity and accuracy of the average value of it were80.6%,78.4%and 79.6%.The sensitivity of the combination of the two examinations was significantly higher than that of simple application of each of them,while there was no significant difference in the specificity and accuracy between them.Conclusion:The SWE and ACR TI-RADS classification systems have important clinical value in identifying the benign and malignant thyroid nodules.The combination of the two methods can improve the sensitivity,specificity and accuracy of the diagnosis.