剪切波弹性成像诊断甲状腺结节及预测恶性结节淋巴结转移的价值

目的探讨剪切波弹性成像(SWE)对甲状腺良恶性结节的诊断价值及其对恶性结节淋巴结转移的预测价值。方法回顾性分析经手术病理证实的甲状腺结节患者230例,分为恶性组122例和良性组108例,均行SWE检查,记录并比较两组结节杨氏模量最大值(Emax)、平均值(Emean)、最小值(Emin)及结节与周围正常组织的弹性比值(Eratio)。绘制受试者工作特征(ROC)曲线,确定上述杨氏模量值预测甲状腺结节良恶性的截断值并计算其曲线下面积。应用Logistic回归分析甲状腺恶性结节颈部淋巴结转移与杨氏模量值的相关性。结果恶性组与良性组Emax、Emean、Eratio比较,差异均有统计学意义(均P<0.05),Emin值比较差异无统计学意义。ROC曲线分析表明,Emax、Emean、Eratio截断值分别为57 kPa、39 kPa、2.7时,对应的曲线下面积分别为0.877、0.776、0.866,以Emax的曲线下面积最大。Logistic回归分析显示,甲状腺恶性结节颈部淋巴结转移与结节大小、Emax、Eratio均相关(均P<0.05),且转移淋巴结多位于中央区。结论SWE对甲状腺结节良恶性的鉴别诊断有一定价值,以Emax诊断效能最高;Emax和Eratio可预测甲状腺恶性结节淋巴结转移。

Value of shear wave elastography in the diagnosis of thyroid nodules and its prediction value of malignant nodules metastasis

Objective To explore value of shear wave elastography(SWE)in the diagnosis of thyroid benign and malignant nodules and its prediction value of invasiveness of malignant nodules.Methods A total of 230 patients with thyroid nodules confirmed by surgery and pathology were retrospectively analyzed,which were divided into malignant group(n=122)and benign group(n=108).All patients underwent SWE examination.The maximum Young’s modulus(Emax),average value(Emean),minimum value(Emin)of nodules and the elastic ratio of nodules to surrounding normal tissues(Eratio)were recorded and compared between the two groups.Receiver operating characteristic(ROC)curve was drawn to determine the cut-off value of Young’s modulus in predicting benign and malignant thyroid nodules,and the diagnostic efficacy was calculated.Logistic regression was used to analyze the correlation between cervical lymph node metastasis and Young’s modulus.Results There were statistically significant differences in Emax,Emean and Eratio between malignant group and benign group(all P<0.05),and there was no statistically significant difference in Emin.ROC curve analysis showed that when the cut-off values of Emax,Emean and Eratio were 57 kPa,39 kPa and 2.7 respectively,the corresponding areas under the curve were 0.877,0.776 and 0.866 respectively,and the area under the curve of Emax was the largest.Logistic regression analysis showedthatcervicallymphnodemetastasisofmalignantthyroidnoduleswascorrelatedwithnodulesize,EmaxandEratio(allP<0.05),and the metastatic lymph nodes were mostly located in the central region.Conclusion SWE has a certain significance in the differential diagnosis of thyroid nodule,and Emax has the highest diagnostic efficiency.Emax and Eratio can be used as predictors of lymph node metastasis of thyroid malignant nodules.