实时超声弹性成像技术在甲状腺良恶性病变中的应用价值

目的:探讨实时超声弹性成像技术在甲状腺良恶性病变鉴别诊断中的应用价值。方法:回顾性分析56例经病理证实的甲状腺肿瘤患者的二维超声+CDFI、实时超声弹性成像特征,并与病理结果对照分析2种方法在甲状腺肿瘤良恶性鉴别诊断中的价值。结果:56个甲状腺结节(良性34个,恶性22个)中,33个弹性分级为Ⅰ～Ⅱ级,其中良性30个(90.91%)、恶性3个(9.09%);23个弹性分级为Ⅲ～Ⅳ级,其中良性4个(17.39%)、恶性19个(82.61%)。超声弹性成像的敏感度与特异度分别为86.36%和88.24%,与二维超声+CDFI的68.18%和79.41%比较差异有统计学意义(P<0.05)。结论:实时超声弹性成像技术鉴别诊断甲状腺肿瘤良恶性优于二维超声+CDFI,提高了超声鉴别诊断甲状腺良恶性肿瘤的能力。     

甲状腺小结节灰阶超声和超声弹性成像的Logistic回归分析

目的:应用二分类Logistic回归法分析甲状腺小结节灰阶超声检查各指标及超声弹性成像对良恶性结节鉴别诊断的意义。方法:总结经手术病理证实的201个甲状腺小结节术前的二维灰阶及弹性成像的各项超声诊断指标,进行Logistic回归分析。结果:共有内部低回声、微钙化和超声弹性成像评分4⁵分等3个变量进入回归方程,对甲状腺小结节良恶性诊断的正确率为97.5%。结论:Logistic回归分析在甲状腺实性小结节良恶性的鉴别诊断中具有较高的应用价值。     

超声弹性成像在甲状腺结节鉴别诊断中的临床应用

目的探讨超声弹性成像在甲状腺良、恶性结节鉴别诊断中的价值。方法依据术后病理检查结果,将152个甲状腺结节分为良性和恶性,分析比较2组间的常规超声特征与超声弹性成像特征。结果良性甲状腺结节104个,恶性甲状腺结节48个。与良性甲状腺结节相比,恶性甲状腺结节常规超声特征多为形态不规则、边界不清、结节内有钙化、纵横比＞1,而超声弹性成像分级多位于Ⅲ~Ⅳ级。超声弹性分级Ⅲ~Ⅳ级诊断甲状腺恶性结节的敏感性和特异性分别为85.57%和79.17%。结论超声弹性成像在鉴别甲状腺结节性质方面有较高的临床应用价值。     

高频超声弹性成像及超声造影对甲状腺良恶性结节的诊断分析

目的探讨高频超声弹性成像及超声造影对甲状腺良恶性结节诊断的效果。方法选取甲状腺结节患者180例,分别通过高频超声弹性成像和超声造影技术进行检查。结果高频超声在甲状腺良恶性诊断的图像特征的病症类型为病变内部结构、内部回声情况、形状、边界清晰度、周边声晕规则性和钙化程度,甲状腺良性结节弹性成像分级Ⅰ、Ⅱ级比例(89.09%)明显比甲状腺恶性结节(21.43%)高,甲状腺良性结节弹性成像分级Ⅲ、Ⅳ级比例(18.57%)明显比甲状腺恶性结节(81.43%)低,甲状腺良性结节不均匀增强模式比例(10.91%)明显低于甲状腺恶性结节(82.86%),甲状腺良性结节环形增强(63.64%),明显高于甲状腺恶性结节(2.86%),两组相比差异有统计学意义(P0.05)。结论甲状腺结节的临床诊断可以通过高频超声弹性成像和超声影像技术来鉴别,具有较高的诊断价值。     

超声弹性成像诊断甲状腺结节的价值

目的: 探讨超声弹性成像诊断甲状腺结节性疾病的价值.材料和方法: 分析68例共116个甲状腺结节的纵、横切面超声弹性图,按弹性硬度将其分为5级,以0～II级作为判断甲状腺良性结节的诊断标准,III～IV级作为判断甲状腺恶性结节的诊断标准,并与病理结果对照.结果: 超声弹性图纵切面的诊断敏感性为100%,特异性为73.3%,准确性为76.8%;横切面的诊断敏感性为100%,特异性为72.3%,准确性为75.9%.纵、横切面鉴别甲状腺良、恶性结节的差异无统计学意义(P＞0.05).结论: 超声弹性成像对甲状腺结节的诊断有较大的应用价值,综合常规超声表现有助于提高诊断的信心.     

超声弹性成像应变率比值法在甲状腺良、恶性结节鉴别诊断中的临床应用

目的：探讨超声弹性成像应变率比值法在甲状腺良、恶性结节鉴别诊断中的临床价值。方法对117例甲状腺结节疾病患者的154个结节分别采用超声弹性应变率比值法和弹性分级法检测,与病理检查结果进行比较,计算两种检查方法的诊断敏感性、特异性及诊断符合率。结果154个结节中有94个良性病灶和60个恶性病灶,良性病灶中结节性甲状腺肿结节62个,甲状腺嗜酸性细胞瘤7个,甲状腺腺瘤22个,亚急性甲状腺炎3个;0～Ⅱ级74个,Ⅲ级16个,Ⅳ级4个。恶性病灶中乳头状癌48个,滤泡状癌7个,髓样癌5个;0～Ⅱ级16个,Ⅲ级20个,Ⅳ级24个。超声弹性应变率比值法对甲状腺良、恶性结节的诊断敏感性、特异性及诊断符合率均明显高于弹性分级法（P<0.05）。结论超声弹性成像应变率比值法对甲状腺良、恶性结节的鉴别诊断价值明显优于弹性分级法。     

常规超声、超声造影、剪切波弹性成像超声在甲状腺结节良恶性鉴别诊断中的应用价值

目的:研究常规超声、超声造影、剪切波弹性成像超声在甲状腺结节良恶性鉴别诊断中的应用价值.方法:选取我院2012年9月～2015年12月收治的甲状腺结节患者45例为研究对象,所有患者均接受常规超声、超声造影与剪切波弹性成像超声检查,并且将病理结果作为对照,对不同超声检查方式的诊断结果进行分析.结果:在甲状腺结节良恶性鉴别诊断中,常规超声、超声造影、剪切波弹性成像超声均具备有诊断价值,相对于其它诊断方式,剪切波弹性成像与病理诊断具有最高的诊断符合率,Kappa值高达0.578;常规超声+剪切波弹性成像在断甲状腺结节良恶性诊断上的特异性最高,为85.8％.结论:剪切波弹性成像诊断甲状腺结节良恶性的效果显著;联合应用剪切波弹性成像超声与常规超声,能够将诊断价值进一步增强.     

高频彩超及弹性成像对甲状腺结节良恶性的鉴别诊断价值

目的：对甲状腺小结节高频彩超及弹性成像表现进行多因素 Logistic 回归分析,探讨其对良恶性鉴别诊断的价值。方法：回顾性分析经手术病理确诊的126个直径≤2 cm 的甲状腺结节的超声表现,根据每个结节的高频超声及弹性成像声像图特征进行分类,采用二分类多因素 Logistic 回归分析,筛选出评价甲状腺恶性结节的因素,建立概率方程。结果：根据多因素 logistic 回归分析结果,边界不清、纵横比≥1、微钙化、极低回声、弹性成像评分是鉴别甲状腺小结节良恶性的关键因素。回归模型预测超声诊断甲状腺结节良恶性的符合率为89．7％,其中良性结节的诊断符合率为90．0％,恶性结节的诊断符合率为89．3％,ROC 曲线下面积为0．959。结论：多因素 Logistic 回归模型可筛选出对甲状腺小结节良恶性有鉴别诊断意义的特征性变量,综合评价各个变量,有利于甲状腺结节良恶性的鉴别诊断。     

实时超声弹性成像对良恶性甲状腺结节的鉴别

目的:探讨实时超声弹性成像对良恶性甲状腺结节的鉴别价值。方法 :收集我院2011年2月至2014年2月98例甲状腺结节患者(112个甲状腺结节)的临床及影像资料,比较超声弹性成像与常规彩超诊断的准确性、特异性、敏感性等指标。结果:112个甲状腺结节中,79个为良性病变,其中52个为结节性甲状腺肿,22个为甲状腺腺瘤,5个为其他;33个为恶性病变,其中26个为乳头状腺癌,3个为髓样癌,2个为滤泡性腺癌,2个为未分化癌。常规彩超对良、恶性甲状腺结节的诊断准确度分别为64.56%、72.73%,实时超声弹性成像对良、恶性的诊断准确度分别为83.54%、90.91%,2种检测方法差异有统计学意义(P0.05)。结论:实时超声弹性成像在良恶性甲状腺结节的诊断及鉴别诊断中具有较高的临床应用价值,值得大力推广。     

弹性应变率在甲状腺良恶性结节鉴别诊断中的应用进展

甲状腺结节是临床常见的甲状腺疾病,常规二维甲状腺超声检查约50%的受检者可以发现甲状腺结节,其中约9.2%～14.8%细针穿刺结果为恶性,而临床确诊的甲状腺结节中约5%为恶性。研究表明,常规超声在评价甲状腺结节时有一定的主观性,病变特性在观察者之间无显著的一致性[4],其对结节的良恶性鉴别诊断率则更低,约29.0%～59.2%[5],且甲状腺微小结节更容易漏诊。超声弹性成像是近年来医学超声领域的一种新的具体而客观的技术方法,其能够提供组织弹性这一基本力学属性,是对常规超声进行甲状腺结节良恶性进行鉴别的一种很好的补充,可提高鉴别诊断甲状腺良恶性结节的敏感性、特异度和准确性[6]。超声弹性成像主要有弹性评分法和弹性应变率比值法,弹性评分法已广泛应用于临床,弹性应变率比值作为超声弹性成像量化参数,其相关应用报道目前尚不多见,本文就弹性应变率在鉴别甲状腺结节良恶性中的应用进行综述。     

超声剪切波成像联合ACR TI-RADS分类诊断甲状腺结节良恶性的价值

 目的 探讨超声实时剪切波弹性成像联合美国放射学会(ACR)颁布的甲状腺影像报告和数据系统(TI-RADS)分类诊断良恶性甲状腺结节的价值。方法 选择2016-12至2018-12医院收治的甲状腺结节患者277例,均于超声科进行剪切波弹性成像检查获得杨氏模量值,并对超声图像进行TI-RADS分级。根据病理结果将患者分为良性组和恶性组,对比良恶性甲状腺结节杨氏模量值、TI-RADS分级差异,分析杨氏模量值、TI-RADS分级、联合诊断对鉴别良恶性甲状腺结节的价值。结果 本组恶性甲状腺结节75例,良性甲状腺结节202例。良性组甲状腺结节弹性评分、SR值均低于恶性组(P＜0.05),根据ACR TI-RADS分类标准诊断恶性甲状腺结节正确率为88.09%(244/277)。ROC分析结果示联合ACR TI-RADS分类、UE诊断甲状腺癌的效能最高,其曲线下面积(AUC)为0.922(95%CI:0.853~0.991,P=0.000),灵敏度、特异度分别为97.33%、99.50%。结论 UE联合ACR TI-RADS分类可提高对良恶性甲状腺结节的诊断正确率。     

Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy

Objective

To evaluate real-time shear wave ultrasound elastography (SWE) for characterizing focal thyroid lesions in routine clinical practice.

Methods

Seventy-four patients with 81 focal thyroid lesions undergoing conventional US with needle cytology also underwent SWE. Absolute and relative SWE stiffness measurements on colour-coded elastograms were correlated with cytology and their discriminatory performances assessed.

Results

Seventeen nodules were malignant (13 papillary, 4 other cancers), 45 benign (43 hyperplastic nodules, 2 focal thyroiditis), 5 indeterminate (“follicular lesions”), and 5 had inadequate cytology. SWE results were higher in malignant than benign nodules (P values 0.02–0.05) although their discriminatory performances were mediocre (AUCs 0.58–0.74). The most accurate SWE cut-off, 34.5 kPa for a 2-mm region of interest, achieved 76.9?% sensitivity and 71.1?% specificity for discriminating papillary cancer from benign nodules. No thresholds produced high sensitivity without lowering specificity appreciably, and vice versa. Nodule size correlated with SWE for benign nodules (P?<?0.01). Intranodular cystic change or calcification did not influence SWE. Qualitatively, elastographic artefacts and foci lacking colour elasticity signal occurred in some solid nodules.

Conclusion

Although malignant nodules are generally stiffer than benign nodules, the precision results do not suggest a definitive role for SWE, at present, in identifying or excluding thyroid malignancy.

Key Points

? Shear wave ultrasound elastography (SWE) offers new insight into thyroid disease. ? Papillary cancers have higher SWE indices (equating to higher stiffness) than benign nodules. ? SWE appears limited in terms of identifying or excluding thyroid malignancy accurately. ? Vertically aligned elastographic artefacts can occur in thyroid SWE. ? Areas lacking SWE colour signal can occur in some solid thyroid nodules.     

Thyroid gland tumor diagnosis at US elastography

PURPOSE: To prospectively evaluate the elastographic appearance of thyroid gland tumors and explore the potential sensitivity and specificity of ultrasonographic (US) elastography for differentiating benign and malignant tumors, with histopathologic analysis as the reference standard. MATERIALS AND METHODS: The study was institutional review board approved, and each patient gave written informed consent. Fifty-two thyroid gland lesions (22 malignant, 30 benign) in 31 consecutive patients (six men, 25 women; mean age, 49.7 years +/- 14.7 [standard deviation]) were examined with real-time elastography in the elasticity imaging mode implemented on a clinical US scanner modified for research. In addition, the radiofrequency echo data stored during US were exported from the scanner and used for off-line strain image reconstruction. All elastograms were evaluated for the lesion visibility, relative brightness, and margin regularity and definition by using a four-point scale. In addition, normal thyroid gland tissue and thyroid gland tumor strains were measured on off-line processed elastograms, and the thyroid gland-to-tumor strain ratio (ie, strain index) was calculated. The potential of elastographic criteria for the diagnosis of thyroid gland cancer was evaluated with univariate analysis and multivariate logistic regression. Qualitative variables were compared by using the chi2 test, and quantitative variables were compared by using the Mann-Whitney U test. P < .05 was considered to indicate significance. RESULTS: A strain index value greater than 4 on off-line processed elastograms was the strongest independent predictor of thyroid gland malignancy (P < .001); this criterion had 96% specificity and 82% sensitivity. Two other elastographic criteria, which were evaluated on real-time elastograms--a margin regularity score higher than 3 (88% specificity, 36% sensitivity) and a tumor area ratio higher than 1 (92% specificity, 46% sensitivity)--also were associated with malignancy (P < .05). However, the usefulness of these criteria was not considered to be high because of their low sensitivity. CONCLUSION: Elastography is a promising imaging technique that can assist in the differential diagnosis of thyroid cancer.     

Role of ultrasound,color doppler,elastography and micropure imaging in differentiation between benign and malignant thyroid nodules

Purpose

To evaluate the role of ultrasound elastography, Doppler and micropure imaging in the assessment of thyroid nodules, using the pathological analysis as the reference standard.

剪切波弹性成像对甲状腺良恶性结节的诊断价值

目的:探讨超声剪切波弹性成像(SWE)对甲状腺良恶性结节的诊断价值。方法:收集104例(126个结节)甲状腺结节为研究对象,采用常规超声检查结节的回声、边缘、内部钙化程度、组成及形状;采用CDFI评估结节血流;采用SWE定性和定量评估结节弹性,获取剪切波速度(SWV),并通过ROC曲线计算SWV的最佳临界值。以最大SWV(SWV_max)和平均SWV(SWV_mean)为离散变量,使用单变量Logistic回归分析将结果与超声特征的关键变量进行比较。结果:不规则边缘、低回声、微钙化、血流模式Ⅲ和Ⅳ级、弹性评分Ⅳ和Ⅴ级、SWV_max和SWV_mean与恶性肿瘤有显著相关性,其中SWV_max和SWV_mean的Nagelkerke R²值为43.6%和38.5%,高于常规超声与CDFI显示任何单个特征的Nagelkerke R2值;区分良性与恶性结节的最佳临界值是SWV_max为3.59 m/s(敏感度91.7%、特异度79.4%),SWV_mean为3.45 m/s(敏感度87.5%、特异度77.5%)。结论:恶性结节的SWV_mean和SWV_max显著高于良性结节,且结节的SWV_mean≥3.45 m/s、SWV_max≥3.59 m/s、弹性等级Ⅳ和Ⅴ级与甲状腺恶性结节具有显著相关性;SWV_max对甲状腺良恶性结节具有最优的预测价值。     

彩色多普勒超声诊断良恶性甲状腺结节的参考价值

目的分析良、恶性甲状腺结节的彩色多普勒超声表现,以提高超声诊断和鉴别诊断良、恶性甲状腺结节的价值。方法回顾性分析经手术、病理明确诊断的157个良、恶性甲状腺结节的彩色多普勒超声表现,良、恶性结节的形态、回声、钙化特点、彩色多普勒血流图血流信号分布等。结果157个甲状腺结节经病理诊断,其中 90个为良性结节,67个为恶性结节;本组病例彩色多普勒超声检查的特异性为92.2%,敏感性为80.6%,诊断符合率为87.2%;彩色多普勒超声图像显示甲状腺良、恶性结节的形态、边界、包膜、回声、血流信号分布、内部钙化情况、血流阻力指数值比较,差异比较均具有统计学意义（P<0.05）。结论彩色多普勒超声可诊断甲状腺病变,依据重要的参考指标,可评价甲状腺结节的良、恶性。     

The value of computer-assisted sonographic tissue characterization in focal lesions of the thyroid

Thyroid lesions are a common observation in ultrasound examination. In most cases the differentiation of malignant and benign tissue is difficult. In this study 133 thyroid lesions were examined by an ultrasonographic tissue characterization system prior to surgery. The pathologic findings (29 cancers, 31 adenomas, 46 nodular goiters, 27 cysts) were examined with reference to the quantitative evaluation of the ultrasonic images (ROI method). The selected regions of interest (ROI) were analyzed with regard to the three most discriminating parameters. The overall accuracy of differentiation between malignant and benign thyroid nodules was 83.9%.     

超声弹性成像联合常规超声鉴别诊断甲状腺良恶性结节的临床价值

目的：探讨超声弹性成像（ultrasonic elastography,UE）联合常规超声（coventional ultrasonogaphy,CUS）在甲状腺良恶性结节鉴别诊断中的临床价值。方法：应用弹性成像和常规超声分别对98例（119个结节）甲状腺结节患者进行检查,所有病例均以手术后病理诊断作为金标准。比较单独应用常规超声、单独应用弹性成像、弹性成像联合常规超声综合诊断对甲状腺良、恶性结节鉴别诊断的灵敏度（Sen）、特异度（Spe）、粗符合率（CA）、阳性预测值（PV＋）、阴性预测值（PV-）。结果：超声弹性成像联合常规超声鉴别诊断甲状腺良恶性结节的敏感性、特异性和准确性均高于常规超声和弹性成像（P〈0.05）。结论：超声弹性成像与常规超声联合应用可以明显提高对甲状腺良恶性结节的判断,具有重要的临床价值。     

Role of combined grey scale US and US tissue elastography in differentiating solid thyroid nodules

Background

Ultrasonographic (US) examination is an accurate method for detecting thyroid nodules, but its use in differentiating between benign and malignant thyroid nodules is relatively low. US elastography has been applied to study the hardness/elasticity of nodules to differentiate malignant from benign lesions thus deviating a significant group of patients from unnecessary FNAB.

Objectives

The aim of the study is to evaluate the validity of combined grey scale US and tissue elastography in differentiating benign form malignant solid thyroid nodules.

Methods

The study included 46 selected patients with solid thyroid nodules according to our inclusion and exclusion criteria. The patients underwent surgery for compressive symptoms or suspicion of malignancy on FNA cytology. US features and tissue elastography were scored according to the Rago criteria (1).

Results

On US elastography: all the 31 cases with a final diagnosis of benign nodule had a score of 1–3, while 14 of 15 (94.1%) with a final diagnosis of carcinoma had a score of 4–5, with a sensitivity of 93.3%, a specificity of 100% and an accuracy of 97.8%. Combined US and elastography reveals that hypoechogenicity/score 4–5 was most predictive of malignancy with sensitivity 80% and specificity 100%; and accuracy 93.4%.

Conclusions

US elastography seems to have great potential as a new tool for differentiating solid thyroid nodules and for recommending FNAC. Combined grey scale US features and US elastography added no significant value when compared with US elastography alone. Further prospective studies are needed.     

Additional value of qualitative strain ultrasound elastography and strain ratio in predicting thyroid malignancy

Objective

To detect if strain ultrasound elastography and strain ratio have additional value to the conventional grey scale ultrasound in predicting thyroid malignancy.