甲状腺结节中央区剪切波弹性成像与超声造影参数对良恶性的诊断价值

目的: 探讨甲状腺结节中央区剪切波弹性成像（shear wave elastography,SWE）参数与超声造影（contrast enhanced ultrasound,CEUS）定量分析参数联合诊断良恶性的临床意义。方法: 选取2019年1月至2021年1月在太仓市第一人民医院超声科行辅助诊断的甲状腺恶性结节患者71例和甲状腺良性结节患者65例,所有患者均行SWE、CEUS检查,分析良恶性结节二维超声表现、中央区SWE及CEUS参数的差异,采用Logistic回归模型筛选SWE及CEUS中判断恶性结节的参数。以病理结果为标准绘制受试者工作特征（receiver operator characteristic, ROC）曲线,计算曲线下面积（area under curve, AUC）,分析各参数及联合应用对甲状腺恶性结节的预测价值。结果: 良恶性甲状腺结节的二维超声表现在形态、边缘、纵横比及微钙化上具有显著差异。良恶性结节的中央区弹性模量最小值（Emin）、平均值（Emean）、最大值（Emax）、峰值强度（Peak）及时间强度曲线下面积（AUCt）间差异有统计学意义（P<0.001）；Logistic回归结果显示,Emax与Peak对预测恶性结节有统计学意义。ROC曲线结果表明,SWE参数中Emax的AUC最大,具有最高的诊断效能,Peak则是CEUS参数中最佳诊断指标, Emax与Peak联合诊断甲状腺恶性结节的AUC值为0.837,大于其他参数单独诊断。结论:甲状腺结节中央区Emax与Peak对良恶性的诊断价值高于单一参数,对临床上甲状腺结节无创检查和诊断具有一定的指导意义。

ultrasound parameters in the central region of thyroid nodules in the differential diagnosis of benign and malignant nodules

Objective:To investigate the clinical significance of combined shear wave elastography (SWE) parameters and quantitative analysis parameters of contrast enhanced ultrasound (CEUS) in the differential diagnosis of benign and malignant thyroid nodules. Methods: A total of 71 patients with malignant thyroid nodules and 65 patients with benign thyroid nodules who underwent auxiliary diagnosis in the ultrasound department of Taicang First People′s Hospital from January 2019 to January 2021 were selected. All patients underwent SWE and CEUS. The differences in two dimensional ultrasonographic appearance of benign and malignant nodules, SWE and CEUS parameters in the central area were analyzed.Logistic regression model was used to screen the parameters for judging malignant nodules in SWE and CEUS, the receiver operator characteristic (ROC) curve was drawn using pathological diagnosis as the gold standard, and the area under the curve (AUC) was calculated,and the predictive value of each factor and combined diagnosis of malignant thyroid nodules was analyzed.Results: The two dimensional ultrasonography of benign and malignant thyroid nodules had significant differences in morphology, margin, aspect ratio and microcalcification, and there were differences in central area Emin, Emean, Emax, Peak and AUCt of benign and malignant thyroid nodules (P<0.001). Logistic regression results showed that Emax and Peak entered the regression equation. The ROC curve results showed that among the SWE parameters, the area under the Emax curve was the largest and had the highest diagnostic performance, while Peak was the best diagnostic index in the CEUS parameters, and the AUC value of Emax and Peak in the diagnosis of malignant thyroid nodules was 0.837, which was greater than that of either SWE or CEUS alone.Conclusion:The diagnostic value of Emax and Peak in the central area of thyroid nodules is higher than that of other single parameters, and it has certain guiding significance for the noninvasive examination and diagnosis of thyroid nodules in clinical practice.