超声微血流成像联合剪切波弹性成像在ACR TI-RADS 4类甲状腺结节诊断中的应用价值

目的 探讨超声微血流成像联合剪切波弹性成像在鉴别甲状腺超声影像报告和数据系统（thyroid imaging reporting and data system，TI-RADS）4类结节良恶性的应用价值。方法 回顾性选取2021年11月至2022年12月在杭州市中医院诊断为美国放射学会（American College of Radiology, ACR）TI-RADS 4类的114个甲状腺结节，所有结节均行超声微血流成像及剪切波弹性成像检查，并与手术病理结果对比，评估微血流成像、剪切波弹性成像及二者联合应用的诊断效能。结果 114例甲状腺TI-RADS 4类结节中，良性结节 35例，恶性结节79例，恶性结节微血流成像模式多为聚集中断征及穿支血管征，剪切波弹性成像Emax值对鉴别良恶性差异有统计学意义（P<0.05），并且恶性结节SWE Emax≥41.6 kPa；超声微血流成像联合剪切波弹性成像诊断甲状腺TI-RADS 4类结节的敏感度、特异性和准确性分别为96.20%、65.72%、86.84%，曲线下面积为0.810，敏感度、准确性均高于单一诊断模式，差异有统计学意义（P<0.05）。结论 超声微血流成像联合剪切波弹性成像能提高甲状腺TI-RADS 4类结节的良恶性诊断效能，具有较高的诊断敏感度及准确性，有助于此类结节的无创性鉴别诊断，避免不必要的穿刺活检。

Application value of ultrasound microvascular imaging combined with shear wave elastography in the diagnosis of ACR TI-RADS 4 thyroid nodules

Objective To explore the application value of ultrasound microvascular imaging combined with shear wave elastography in differentiating thyroid ultrasound image reporting and data system (TI-RADS) 4 benign and malignant thyroid nodules. Methods Totally 114 thyroid nodules diagnosed as ACR TI-RADS 4 in Hangzhou traditional Chinese medicine hospital from November 2021 to December 2022 were retrospectively selected. All nodules were examined by ultrasound microvascular imaging and shear wave elastography, and compared with the surgical pathological results to evaluate the diagnostic efficacy of microvascular imaging, shear wave elastography and the combination of the two. Results Among 114 cases of thyroid TI-RADS type 4 nodules, 35 cases were benign nodules, 79 cases were malignant nodules.The microvascular pattern of malignant nodules was mainly concentrated and interrupted sign and perforator sign. The Emax value of shear wave elastography was statistically significant in differentiating benign from malignant nodules, and the SWE Emax value of malignant nodules was greater than 41.6kPa (P<0.05). The sensitivity, specificity and accuracy of ultrasound microvascular imaging combined with shear wave elastography in the diagnosis of thyroid TI-RADS 4 nodules were 96.20%, 65.72% and 86.84%, respectively, and the area under curve (AUC) was 0.810. The sensitivity and accuracy were higher than those of single diagnosis mode, and the difference was statistically significant (P<0.05). Conclusion Ultrasound microvascular imaging combined with shear wave elastography can improve the diagnostic efficiency of benign and malignant thyroid TI-RADS 4 nodules with high diagnostic sensitivity and accuracy, which is helpful for the noninvasive differential diagnosis of such nodules and avoids some unnecessary needle biopsy.