甲状腺多发结节中偶发癌的检出:声脉冲辐射力弹性成像的应用价值  

Incidental carcinoma in thyroid multiple nodules:value of acoustic radiation force impulse elastography

作　　者：徐军妹[1] 徐辉雄[1] 张一峰[1] 刘畅[1] 何勇[1] 刘媛媛[1] 郭乐杭[1] 刘琳娜[1] 

机构地区：[1]同济大学附属第十人民医院超声医学科,上海200072

出　　处：《中华临床医师杂志（电子版）》2012年第24期8073-8077,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：新世纪优秀人才支持计划项目(NCET-06-0723)

摘　　要：目的探讨声脉冲辐射力(ARFI)弹性成像声触诊组织成像(VTI)和声触诊组织定量(VTQ)技术在检出甲状腺多发结节中偶发癌的临床价值。方法分析经病理证实的83例甲状腺多发结节患者112个结节的VTI及VTQ特征。VTI图像分为6级,VTQ以横向剪切波速度(SWV)值表示。探讨ARFI术前检出偶发癌的敏感性、特异性、准确性、阳性预测值及阴性预测值。结果 112个甲状腺结节,病理证实良性病变93个,恶性病变19个。恶性病变中VTI图像≥Ⅳ级的有15个,<Ⅳ级的有4个;良性病变中VTI图像≥Ⅳ级的有1个,<Ⅳ级的有92个。VTI弹性分级Ⅳ级及Ⅳ级以上检出甲状腺多发结节中偶发癌的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为78.9%、98.9%、95.5%、93.8%及95.8%;良性和恶性结节的SWV值平均值分别为(2.37±1.08)m/s(范围:0.61～4.68m/s)和(4.40±2.53)m/s(范围:1.28～9m/s)(P=0.000)。恶性病变中VTQ的SWV值≥2.87m/s的有11个,<2.87m/s的有8个;良性病变中SWV值≥2.87m/s的有16个,<2.87m/s的有77个。以SWV值>2.87m/s为标准检出甲状腺多发结节中偶发癌的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为57.9%、82.8%、78.6%、40.7%及90.6%。结论 ARFI弹性成像中的VTI对检出甲状腺多发结节中偶发癌有较高的临床价值,而VTQ的价值偏低。Objective To investigate the value of virtual touch tissue imaging(VTI)and virtual touch tissue quantification(VTQ)of acoustic radiation force impulse(ARFI)elastography in the detection of incidental carcinoma in thyroid multiple nodules.Methods Image analysis was performed to evaluate the VTI and VTQ features of 112 histologically proven thyroid nodules in 83 patients with multiple nodules.The VTI features were divided into 6 grades and the VTQ denoted by the shear wave velocities(SWV).Then the sensitivity,specificity,accuracy,positive predictive value(PPV)and negative predictive value(NPV)for presurgical detection of incidental carcinoma in thyroid multiple nodules were investigated.Results 112 pathologically proven thyroid nodules included 93 benign and 19 malignant lesions.In the malignant nodules,15≥grade Ⅳ,4<grade Ⅳ on the VTI while in the benign diseases,1≥grade Ⅳ,92<grade Ⅳ.Using grade Ⅳ or higher as the diagnostic criteria,the sensitivity,specificity,accuracy,PPV and NPV of VTI in the detection of incidental carcinoma in thyroid multiple nodules were 78.9%,98.9%,95.5%,93.8% and 95.8%,respectively.The mean SWVs of benign and malignant thyroid nodules were(2.37±1.08)m/s(range:0.61-4.68 m/s)and(4.40±2.53)m/s(range:1.28-9 m/s)respectively(P=0.000).In the malignant nodules,11≥2.87 m/s and 8<2.87 m/s were found while 16≥2.87 m/s and 77<2.87 m/s were found in the benign nodules.Using the standard of SWV≥2.87 m/s,the sensitivity,specificity,accuracy,PPV and NPV for VTQ in the detection of incidental carcinoma in thyroid multiple nodules were 57.9%,82.8%,78.6%,40.7% and 90.6%,respectively.Conclusions VTI of ARFI elastography is highly valuable in detecting incidental carcinoma in thyroid multiple nodules,whereas the value of VTQ is moderate.

关 键 词：甲状腺结节 弹性成像技术 偶发癌 

分 类 号：R736.1[医药卫生—肿瘤]