声脉冲辐射力弹性成像技术对甲状腺良恶性结节的鉴别诊断价值

目的   探讨声脉冲辐射力弹性成像技术（ARFI）用于鉴别诊断甲状腺良、恶性结节的临床应用价值。方法  选取2015年6月至2016年9月在河南科技大学第一附属医院拟行甲状腺结节切除手术的68例患者（共99个结节），对其影像学资料进行回顾性分析。患者术前行ARFI检查，观察并记录ARFI技术剪切波的速度（SWV）值，分析良性和恶性结节、病变结节同周边无病变组织间SWV值的差异。采用受试者工作特征曲线（ROC）获取鉴别甲状腺良、恶性结节SWV值的截断值，以病理组织学诊断结果 作为金标准，分析ARFI技术对诊断良、恶性结节性甲状腺病灶的灵敏度、特异度、准确率、阳性预测值及阴性预测值。结果 甲状腺良性、恶性结节及周边正常甲状腺组织的SWV平均值分别为（2.68±0.51）m／s、（3.09±0.53）m／s和 （2.42±0.22）m／s，恶性结节的SWV值高于良性结节，差异有统计学意义（P＜0.001），甲状腺良、恶性结节SWV值均高于周边正常组织，差异有统计学意义（P＜0.001）。甲状腺良性结节和恶性结节与周围组织的SWV比值分别为（1.108±0.205）、（1.277±0.258），差异有统计学意义（P＜0.001）。SWV值诊断甲状腺病灶良、恶性的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为63.41％、74.14％、69.70％、63.41％和74.14％。SWV比值诊断良、恶性甲状腺结节的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为58.54％、79.31％、69.70％、64.86％和72.58％。结论 ARFI技术作为一项无创技术用于鉴别结节性甲状腺病灶的良、恶性有很高的临床应用价值，能够被广泛应用于临床初步鉴别结节性甲状腺病灶。

The value of acoustic radiation force impulse imaging in differentiating benign and malignant thyroid nodules

Objective To investigate the diagnostic value of acoustic radiation force impulse imaging（ARFI） in differentiating solid malignant and benign thyroid nodules. Methods A total of 68 patients（99 nodules） who underwent thyroid nodule resection were selected from June 2015 to September 2016 in the First Affiliated Hospital of Henan University of Science and Technology. All these imaging data were analyzed retrospectively. ARFI were performed in all patients before operation， and the shear wave velocity （SWV） of ARFI were observed and recorded. Pathological examination was considered as gold standard， the differences between benign and malignant nodules and the surrounding normal thyroid tissue were analyzed using the independent sample t test. The cut-off point of the SWV value of thyroid benign nodules was obtained by using the receiver operating characteristic curve （ROC）. The sensitivity， specificity， accuracy， positive predictive value and negative predictive value of ARFI technique in the diagnosis of benign and malignant nodular thyroid lesions were analyzed. Results The SWV of benign nodules， malignant nodules and the surrounding normal thyroid tissue were （2.68±0.51）m／s， （3.09±0.53）m／s and （2.42±0.22）m／s. The SWV of malignant nodules were higher than the benign thyroid nodules，and the SWV of benign and malignant nodules were higher than the surrounding normal thyroid tissue， the above differences were statistically significant（P＜0.001）. The SWV ratio of malignant nodule and surrounding normal thyroid tissues were 1.277±0.258， higher than 1.108±0.205 of benign nodule and surrounding normal thyroid tissues， and the difference was statistically significant（P＜0.001）. The sensitivity， specificity， accuracy， positive predictive value and negative predictive value of SWV value and SWV ratio in the diagnosis of thyroid lesions were 63.41％， 74.14％， 69.70％， 63.41％， 74.14％ and 58.54％， 79.31％， 69.70％， 64.86％，72.58％ respectively. Conclusion As a noninvasive technique，ARFI is of high value in differenting benign and malignant thyroid nodules. It can be widely used in clinical diagnosis.