剪切波弹性成像联合超微血流成像鉴别桥本甲状腺炎背景下肿块良恶性的临床价值  

Application of shear wave elastography combined with superb micro-vascular imaging in diagnosing benign and malignant thyroid masses co-existed with Hashimoto′s thyroiditis

作　　者：张佳藤 马笑[1] 付超[1] 崔可飞[1] ZHANG Jia-teng;MA Xiao;FU Chao;CUI Ke-fei(Department of Ultrasound,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院超声科

出　　处：《医药论坛杂志》2019年第11期22-26,共5页Journal of Medical Forum

摘　　要：目的探讨剪切波弹性成像(shear wave elastography,SWE)联合超微血流成像技术(superb microvascular imaging,SMI)诊断桥本甲状腺炎背景下(Hashimoto’s thyroiditis,HT)肿块良恶性的临床价值。方法选择经普通二维超声检出的有HT背景下肿块的患者120例,共计135个肿块。普通二维超声观察肿块后,先后启动SWE及SMI成像模式,分别评估肿块的弹性及血流分布模式,利用统计学知识分别分析单纯应用SWE技术及SWE联合SMI技术诊断HT背景下肿块良恶性的敏感性、特异性以及准确性。结果①良性组肿块Kim血流分型多以Ⅱ型(周边型)及Ⅳ型(混合型)血流分布模式为主,恶性组肿块多以Ⅲ型(中央型)血流分布模式为主,差异有统计学意义(P<0.001);②以病理结果为金标准,绘制SWE杨氏模量值ROC曲线,ROC曲线下面积为0.820,最佳诊断界值为48.25 kPa,在该截断值下应用SWE诊断HT背景下肿块良恶性的敏感性与特异性分别为76.71%和70.97%;③单纯应用SWE技术与SWE联合SMI技术诊断HT背景下肿块良恶性的敏感性,特异性和准确性分别为76.71%(89.04%),70.97%(88.71%)和74.07%(88.89%),差异有统计学意义(P值均<0.05)。结论SWE联合SMI技术相比较单纯应用SWE技术,可显著提高诊断HT背景下肿块良恶性的敏感性、特异性以及准确性,具有良好的临床应用价值。Objective To investigate the application value of shear wave elastography(SWE)combined with superb micro-vascular imaging(SMI)in differentiating malignant and benign thyroid masses co-existed with hashimoto’s thyroiditis(HT).Methods one hundred and twenty patients with hashimoto’s thyroiditis which were diagnosed by ultrasound were registered in the study,there were altogether one hundred and thirty-five masses.After two-dimensional ultrasonography was applied to observe thyroid masses,SWE was performed to evaluate the elasticity,then SMI was applied to evaluate the distribution of blood flow pattern in thyroid masses.The sensitivity,specificity and accuracy of SWE and SWE combined with SMI in differentiating malignant and benign thyroid masses co-existed with hashimoto’s thyroiditis were analyzed.Results①Benign masses were given priority to Kim classⅡ(around type)andⅣ(hybrid type),the malignant masses were given priority to Kim classⅢ(central type),and the difference was statistically significant(P<0.001);②Using pathological findings as the gold standard,the ROC curve of young’s modulus value was plotted,48.25 kPa was used as the best cut-off value of SWE.The area under the ROC curve were 0.820 with sensitivity and specificity of 76.71%and 70.97%;③Quantified with SWE or SWE combined with SMI,the sensitivity were were 76.71%and 89.04%,specificity were 70.97%and 88.71%,and accuracy were 74.07% and 88.89%,respectively,and the difference was statistically significant(P<0.05).Conclusion Compared to SWE alone,SWE combined with SMI has a good application value in differentiating the malignant and benign thyroid masses co-existed with hashimoto’s thyroiditis,which could significantly improve the sensitivity,specificity and accuracy.

关 键 词：实时剪切波弹性成像 超微血流成像 桥本甲状腺炎 甲状腺肿瘤 

分 类 号：R445.1[医药卫生—影像医学与核医学]