实时剪切波弹性成像技术对甲状腺良恶性结节鉴别研究  

Real-time shear wave elastography in quantitative differential diagnosis of thyroid nodule

作　　者：牟泳霖 曹军英[1] 里子彧[1] 苏晓妮 鲁超[1] MOU Yong-lin,CAO Jun-ying,LI Zi-yu,SU Xiao-ni,LU Chao(Department of Ultrasound,The General Hospital of Shenyang Military Command,Shenyang 110016,Chin)

机构地区：[1]沈阳军区总医院超声科,辽宁沈阳110016

出　　处：《临床军医杂志》2018年第9期1030-1032,共3页Clinical Journal of Medical Officers

基　　金：辽宁省自然科学基金(2015020419)

摘　　要：目的探讨剪切波弹性成像技术(SWE)鉴别甲状腺结节(TN)良恶性的价值。方法选取自2016年9月至2017年9月于沈阳军区总医院就诊的78例患者(78个结节)为研究对象。术前测量患者结节的弹性模量值,以每个肿块术后病理结果为对照标准,构建受试者曲线(ROC),计算曲线下面积(AUC)及其参考数值。结果 78例患者病理结果显示,48例良性病灶中,结节性甲状腺肿47例,其中2例合并桥本氏甲状腺炎,腺瘤1例;30例恶性病灶中,28例为乳头状腺癌,2例髓样癌。良性病灶表现的最大、最小及平均弹性模量值分别为(57. 9±20. 5) k Pa、(11. 9±5. 3) k Pa及(26. 6±12. 6) k Pa,恶性病灶表现的最大、最小及平均弹性模量值分别为(86. 5±38. 8)k Pa、(16±8. 4)k Pa及(35±14. 2)k Pa。其中,恶性病灶的弹性最大值显著高于良性病灶,差异有统计学意义(P <0. 05),良恶性病灶的最小值与平均值比较,差异无统计学意义(P>0. 05)。甲状腺病灶弹性最大值AUC为0. 77,以甲状腺病灶弹性模量最大值78 k Pa作为诊断界值时,诊断的敏感度为60%、特异度为87. 5%。结论二维灰阶超声检查是诊断TN良恶性的基础,超声弹性成像检查可以辅助获得更多的诊断信息,综合应用诊断准确度高,可减少术前不必要的活检。Objective To obtain the elasticity value of thyroid nodule（TN）with supersonic shear wave elastrography（SWE）.Methods A retrospective study was performed on 78 cases of patients（78 TN）who were admitted from September 2016 to September 2017.Before surgery,the elastic modulus of the patient′s nodules was measured,and the postoperative pathological results of each tumor were taken as the control standard to construct the subject curve（ROC）,the area under the curve（AUC）and its reference value were calculated.Results The pathological results of 78 patients showed that there were 47 cases of nodular goiter in 48 benign lesions,including 2 cases with hashimoto′s thyroiditis and 1 case with adenoma.Of the 30 malignant lesions,28 were papillary adenocarcinoma and 2 were myeloid.Benign lesions of maximum,minimum and average elastic modulus value was（57.9±20.5）kPa,（11.9±5.3）kPa and（26.6±2.6）kPa,respectively;malignant lesions of maximum,minimum and average elastic modulus value was（86.5±38.8）kPa,（16±8.4）kPa and（35±14.2）kPa,respectively.Among them,the maximum elastic was significantly higher than that of benign lesions of malignant lesions,and the difference was statistically significant（ P 〈0.05）,the minimum value of benign and malignant lesions compared with the average,there was no statistically significant difference（ P 〉0.05）.The maximum elasticity AUC of thyroid lesions was 0.77.When the maximum elastic modulus of thyroid lesions was 78 kPa,the diagnostic threshold was 60% in sensitivity and 87.5% in specificity.Conclusion Two-dimensional gray-scale ultrasound diagnosis TN is the basis of benign and malignant,ultrasound elasticity imaging can help get more diagnostic information,integrated application of diagnosis accuracy is high,which can reduce the preoperative unnecessary biopsies.

关 键 词：超声 剪切波超声弹性成像技术 甲状腺结节 鉴别 

分 类 号：R653[医药卫生—外科学]