实时剪切波弹性成像鉴别甲状腺结节良恶性的定量分析

目的应用剪切波弹性成像测定甲状腺结节的杨氏模量值,探讨其在结节良恶性鉴别诊断中的价值.资料与方法对79例甲状腺结节患者进行实时剪切波弹性成像,测得结节的杨氏模量值,以病理结果为“金标准”,绘制 ROC 曲线,分析鉴别良恶性病灶的参考界值.结果79例共分析甲状腺结节88个,良性63个,恶性25个,良性结节的平均、最大杨氏模量值分别为(27.56±25.22)kPa 和(41.79±30.66)kPa,恶性结节的平均、最大杨氏模量值分别为(88.38±35.27)kPa 和(137.36±56.81)kPa ;良恶性结节杨氏模量最大值和平均值差异有统计学意义(P <0.05);甲状腺结节杨氏模量最大值与平均值诊断恶性病变的 ROC 曲线下面积为0.971和0.802(P <0.05),分别以结节杨氏模量最大值90.34kPa 和平均值60.25kPa 作为诊断界值,其诊断敏感度、特异度为90.34%、86.89%和63.67%、91.66%;2名观察者间符合率为93.2%(Kappa =0.83).结论剪切波弹性成像测得的甲状腺结节杨氏模量最大值与平均值可以定量评价病灶硬度,有助于甲状腺结节良恶性的鉴别诊断.

Quantitative Assessment of Real-time Shear Wave Elastography Imaging in Differentiating Benign and Malignant Thyroid Nodules

Purpose To assess the value of quantitative parameters of shear wave elastography (SWE) in the differential diagnosis of benign and malignant thyroid nodules by measuring the Young’s modulus value. Materials and Methods A total of 79 patients underwent real-time SWE to measure the Young’s modulus value. According to pathologic results, ROC curve was drawn to evaluate the best cut-off value in differentiating benign and malignant lesions. Results There were 63 benign nodules and 25 malignant nodules in the total 88 thyroid lesions. The mean Young’s modulus value of benign lesions was (27.56±25.22) kPa and the maximum Young’s modulus value was (41.79±30.66) kPa, as compared with (88.38±35.27) kPa and (137.36±56.81) kPa in malignant lesions (P<0.05). On ROC curve, the area under the curve (AUC) of the maximum and the mean Young’s modulus value was 0.971 and 0.802 (P < 0.05), respectively. Taking 90.34 kPa as the threshold of maximum Young’s modulus value, the sensitivity was 90.34% and specificity was 86.89%. Taking 60.25 kPa as the threshold, the sensitivity was 63.67% and specificity was 91.66%. The inter-observe agreement was achieved in 93.2% of the lesions, and the Kappa value was 0.83. Conclusion The maximum and the mean Young’s modulus value of thyroid nodules can quantitatively assess the lesions’ elasticity. SWE is helpful in differentiating malignant and benign thyroid nodules.