声触诊组织成像和定量(VTIQ)技术对TI-RADS4(a-b)级甲状腺结节良恶性鉴别应用价值初步探讨  

Value of virtual touch tissue imaging quantification(VTIQ) in the differential diagnosis of TI-RADS 4(a-b) thyroid nodules on ultrasound

作　　者：吴墅 徐辉雄[1] 徐军妹[1] 伯小皖 李小龙[1] 刘博姬 李丹丹[1] 房林[3] 曲伸[4] 

机构地区：[1]同济大学附属第十人民医院超声医学科暨同济大学医学院超声医学研究所,上海200072 [2]上海浦东公利医院超声科,200135 [3]同济大学附属第十人民医院甲状腺乳腺外科,上海200072 [4]同济大学附属第十人民医院内分泌与代谢科,上海200072

出　　处：《影像诊断与介入放射学》2015年第5期369-375,共7页Diagnostic Imaging & Interventional Radiology

基　　金：国家自然科学基金(81401417);上海市人才发展基金(2012045);上海市科委生物医药领域科技支撑项目(14441900900);上海申康医院发展中心市级医院适宜技术联合开发应用推广项目(SHDC12014229)

摘　　要：目的探讨声触诊组织成像和定量(VTIQ)技术在TI-RADS 4(a-b)级甲状腺结节良恶性鉴别诊断中的临床应用价值。方法回顾分析经细针穿刺细胞学检查(FNAC)及病理证实的115个TI-RADS 4(a-b)级甲状腺结节的常规超声与VTIQ特征。分析结节的超声声像图特征,如结节的回声、血流、有无微钙化、边界及纵横比;VTIQ以横向剪切波速度(SWV)值表示。以病理学为金标准,绘制受试者操作特征(ROC)曲线,并进行曲线下面积比较,获取最佳界值。探讨TIRADS、VTIQ及两者联合鉴别诊断甲状腺结节良恶性的敏感度、特异度、准确性、阳性预测值及阴性预测值。结果 115个甲状腺结节,病理及FNA证实良性结节61个,恶性结节54个。TI-RADS分类5项恶性指标中2项或以上提示恶性,其敏感度、特异度、准确性、阳性预测值及阴性预测值分别为79.6%(43/54)、50.8%(31/61)、64.3%(74/115)、58.9%(43/73)、73.8%(31/42);TI-RADS、VTIQ及两者联合诊断甲状腺癌的ROC曲线下面积(AUC)分别为0.652、0.694、0.692,不同组间曲线面积比较均无统计学意义(P>0.05);VTIQ的最佳诊断界值为2.77 m/s,其对应敏感度、特异度、准确性、阳性预测值及阴性预测值分别为66.7%(36/54)、72.1%(44/61)、69.5%(80/115)、67.9(36/53)、71.0%(44/62);两者联合的敏感度、特异度、准确性、阳性预测值及阴性预测值分别为48.1%(26/54)、90.2%(55/61)、70.4%(81/115)、81%(26/32)、66.3%(55/83)。结论 VTIQ技术联合TI-RADS分级在TI-RADS 4(a-b)级甲状腺结节的良恶性鉴别诊断中,其特异性及阳性预测值高于单独的TI-RADS分级,VTIQ可作为常规超声TI-RADS分级的辅助诊断技术,具有较高的临床应用价值。Objective To assess the value of virtual touch tissue imaging quantification（VTIQ） in differentiating benign and malignant TI-RADS 4（a-b） thyroid nodules on ultrasound. Methods The ultrasound and VTIQ features of 115 TI-RADS 4（a-b） thyroid nodules confirmed by pathology or fine needle aspiration cytology（FNAC） in 115 patients were reviewed. Sonographic features including echogenicity, blood flow, microcalcification, margin, and antiparallel shape of the nodules, were analyzed. The VTIQ was expressed as the shear wave velocity（SWV） with greater SWV representing stiffer tissue. Receiver operating characteristic（ROC） curve was analyzed and the best cutoff value was obtained using pathology finding as gold standard. The sensitivity,specificity, accuracy, positive predictive value and negative predictive value for differential diagnosis were calculated. Results The115 FNAC and pathologically proven TI-RADS 4（a-b） thyroid nodules included 61 benign and 54 malignant nodules. More than or equal to two malignant features of ultrasound TI-RADS were regarded as malignant nodule..The sensitivity,.specificity,accuracy,.positive predictive value and negative predictive value of ultrasound TI-RADS for differential diagnosis were 79.6%（43 /54）, 50.8%（31 / 61）, 64.3%（74 / 115）, 58.9%（43 / 73）, 73.8%（31 / 42）, respectively. The areas under the ROC curve（AUC）of TI-RADS, VTIQ and combining diagnosis of thyroid cancer were 0.652, 0.694 and 0.692, respectively. There were no statistical differences between the three methods in terms of AUC（all P0.05）;.The best cutoff value of VTIQ is 2.77 m / s and its corresponding sensitivity, specificity, positive, accuracy, predictive value and negative predictive value of VTIQ were 66.7%（36 / 54）, 72.1%（44 /61）, 69.5%（80 / 115）, 67.9（36 / 53）, 71.0%（44 / 62）, respectively. For the combined technology, the values were 48.1%（26 /54）, 90.2%（55 / 61）, 70.4%（81 / 115）, 81%（26 / 32）, 66.3%（55 / 83）, respecti

关 键 词：甲状腺结节 声触诊组织量化技术 剪切波弹性成像 甲状腺影像报告与数据系统 

分 类 号：R445.1[医药卫生—影像医学与核医学] R736.1[医药卫生—诊断学]