剪切波弹性成像鉴别甲状腺良恶性结节的诊断价值  

Value of Shear Wave Elastography Imaging in Differentiating Benign and Malignant Thyroid Nodules

作　　者：王丹[1,2,3] 徐辉雄[1,2,3] 贺亚萍[2,3] 赵崇克 郭乐杭[2,3] 王撬 周邦国[2,3] 

机构地区：[1]安徽医科大学上海临床学院,上海市200072 [2]同济大学附属第十人民医院超声医学科,上海市200072 [3]同济大学医学院超声医学研究所,上海市200072

出　　处：《中国全科医学》2017年第18期2279-2284,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81401417)

摘　　要：目的探讨剪切波弹性成像鉴别甲状腺良、恶性结节的诊断价值。方法选择2016年3—6月在同济大学附属第十人民医院因甲状腺结节接受甲状腺手术且经病理检查确诊的甲状腺结节患者180例,对患者进行剪切波弹性成像检查,分别测得结节的杨氏弹性模量及剪切波速度的最大值(E-max)、最大值标准差(E-max-SD)、最大值以正常甲状腺组织为参照的硬度比值(E-max-Ratio),平均值(E-mean)、平均值标准差(E-mean-SD)、平均值以正常甲状腺组织为参照的硬度比值(E-mean-Ratio)。以手术病理检查结果为金标准,绘制以上指标鉴别甲状腺良、恶性结节的受试者工作特征曲线(ROC曲线),分析其对甲状腺良、恶性结节的鉴别诊断价值。结果共选取180例患者的180个结节,其中良性结节69个、恶性结节111个。恶性结节杨氏弹性模量及剪切波速度的E-max、E-max-SD、E-max-Ratio、E-mean、E-mean-SD、E-mean-Ratio均高于良性结节(P<0.05)。各指标中,剪切波速度的E-max鉴别甲状腺良、恶性结节的ROC曲线下面积最大[0.793,95%CI(0.727,0.850)],截断值为3.58 m/s,其灵敏度、特异度、阳性预测值、阴性预测值、正确率分别为64.86%、85.51%、87.80%、60.20%、72.78%。结论剪切波弹性成像有助于鉴别良、恶性甲状腺结节,为甲状腺疾病诊断提供了更多的依据。其中,剪切波速度的E-max定量评价的效果更优。Objective To assess the performance of shear wave elastography（SWE） in differentiating benign and malignant thyroid nodules.Methods The selected 180 thyroid nodules participants were from Tenth People′s Hospital of Tongji University,who were treated by surgery,and were diagnosed confirmedly by pathological examination of the surgical specimens between March and June 2016.All of them underwent SWE for measuring the E-max,E-max-SD,E-mean,and E-mean-SD of Young′s elasticity modulus and shear wave speed（SWS） and ratio referenced as normal thyroid（E-max-Ratio,E-mean-Ratio）,respectively.The pathological results were set as the gold standard.ROC curve of the above diagnostic markers was used to assess their performance in differentiating benign and malignant thyroid nodules.Results There were 69 benign and 111 malignant nodules in the total 180 thyroid nodules.E-max,E-max-SD,E-max-Ratio,E-mean,E-mean-SD,E-mean-Ratio of Young′s elasticity modulus and SWS in malignant nodules were significantly higher than those in benign nodules（P〈0.05）.The area under the curve（AUC） of SWS E-max was〔0.793,95%CI（0.727,0.850）〕,larger than that of the other markers,with a cutoff point of 3.58 m/s,providing sensitivity of 64.86%,specificity of 85.51%,positive predict value of 87.80%,negative predict value of 60.20%,accuracy of 72.78% in detecting malignant lesions.Conclusion The SWE technique could be helpful for the differential diagnosis of thyroid nodules by providing reference.Furthermore,the SWS E-max was better than other parameters in the differential diagnosis of thyroid nodules.

关 键 词：甲状腺结节 弹性成像技术 超声检查 

分 类 号：R581[医药卫生—内分泌] R445.1[医药卫生—内科学]