实时剪切波弹性成像技术在鉴别甲状腺影像报告和数据系统4类甲状腺病灶良恶性中的诊断价值

目的探讨实时剪切波弹性成像技术在鉴别常规超声诊断为甲状腺影像报告和数据系统（TI-RADS）4类的甲状腺单发实性病灶良恶性中的诊断价值。方法对常规超声发现的106例甲状腺单发实性结节行剪切波弹性成像,获得病灶杨氏模量最大值、平均值、最小值,以病理结果为金标准,分析良、恶性病灶杨氏模量最大值、最小值、平均值之间的差异,并用受试者操作特性（ROC）曲线评价杨氏模量值鉴别甲状腺可疑恶性病灶的价值。结果良恶性病灶杨氏模量平均值、最大值间差异有统计学意义（t值分别为7.57、3.87,P均〈0.01）,最小值差异无统计学意义（t=0.559,P=0.577）。杨氏模量平均值鉴别良恶性结节能力优于最大值（P〈0.05）。ROC曲线示平均值30.91 kPa为最佳界点,当界点降至19.8 kPa时,敏感度由76.6%升至100%,而特异度由79.7%降至30.5%。结论实时剪切波弹性成像平均值对常规超声发现的甲状腺TI-RADS 4类单发实性病灶的鉴别诊断有较好的应用价值。

Value of real-time shear wave elastogfaphy in differentiating benign and malignant thyroid solid lesions

Objective To evaluate the clinical value of real-time shear wave elastography（SWE） to identify benign and malignant thyroid singe solid nodules of Thyroid Imaging Reporting and Data System（TI-RADS） 4 diagnosed by conventional ultrasound. Methods SWE was performed on patients with thyroid single solid lesion of TI-RADS 4 by conventional ultrasound. All the nodules were confirmed by pathology. Receiver operating characteristic（ROC） curves were drawn to identify the value of SWE for differential diagnosis of thyroid nodules of TI-RADS 4 according to Young′ s modulus. Results The mean and maximum value of Young′s modulus of benign nodules were significantly different from the value of malignant nodules（t=7.57, 3.87, both P 0.01） and the mean value was better than the maximum value for differentiating benign and malignant thyroid solid lesions. For the minimum value of Young′ s modulus between benign and malignant thyroid solid lesions, there was no difference. If the cut-off point was 30.91 kPa for the mean value of Young′ s modulus, the sensitivity and specificity were 76.6% and 79.7%, respectively. If the cut point was 19.8 kPa, the sensitivity and specificity were 100% and 30.5%, respectively. Conclusion SWE can significantly improve the accuracy of differentiating benign and malignant thyroid nodules of TI-RADS 4 diagnosed by conventional ultrasound.