VTIQ联合BRAF基因突变对甲状腺TI-RADS 4类结节性质的鉴别价值  

The Value of VTIQ Combined with BRAF Gene Mutation in the Differential Diagnosis of TI-RADS 4 Thyroid Nodules

作　　者：李红玲[1] 张雪晶 刘建新 毛明锋 Li Hongling;Zhang Xuejing;Liu Jianxin;Mao Mingfeng(Department of Ultrasound Diagnosis,Wuhan Central Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属武汉市中心医院超声诊断科,武汉市430000

出　　处：《中国超声医学杂志》2024年第9期984-988,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨声触诊组织量化成像(VTIQ)联合鼠类肉瘤滤过性毒菌致癌同源体B1(BRAF)基因突变对甲状腺影像报告和数据系统(TI-RADS)4类甲状腺结节性质的鉴别价值。方法回顾性分析经术后病理检查证实的96例甲状腺结节患者(共计107个结节)。所有患者均接受VTIQ检查,获取结节剪切波速度最小值(SWVmin)、最大值(SWVmax)、平均值(SWVmean)、比值(SWVratio),检测BRAF V600E基因突变。依据术后病理结果将甲状腺结节分为恶性组、良性组,对比两组VTIQ参数、BRAF V600E基因突变检测结果。观察VTIQ参数、BRAF V600E基因突变对甲状腺结节性质的鉴别价值。分析甲状腺结节性质的影响因素,构建VTIQ参数联合BRAF V600E基因突变的回归诊断模型。评估模型拟合优度及对甲状腺结节性质的鉴别效能。结果恶性组SWVmin、SWVmax、SWVmean、SWVratio及BRAF V600E基因突变阳性率均高于良性组(P<0.05)。绘制受试者工作特征(ROC)曲线显示,VTIQ参数中SWVmin、SWVmax、SWVmean、SWVratio的诊断曲线下面积(AUC)分别为0.822、0.779、0.889、0.852,SWVmean诊断价值最高。BRAF V600E基因突变的诊断AUC为0.861。行二元Logistic回归分析显示,SWVmean、BRAF V600E基因突变均是甲状腺结节性质的独立预测因子(P<0.05)。Hosmer-Lemeshow检验可知,χ^(2)=11.195,P=0.130,提示模型构建良好。受试者工作特征(ROC)曲线显示,构建的回归诊断模型对甲状腺结节性质的鉴别的曲线下面积(AUC)为0.966,95%CI:0.931~1.000,诊断灵敏度为91.30%,特异度为93.44%,准确度为92.52%,阴性预测值为93.44%,阳性预测值为91.30%。结论VTIQ联合BRAF基因突变有利于提升对甲状腺TI-RADS 4类结节性质的鉴别效能,为临床诊断与治疗方案选择提供指导。Objective To investigate the value of virtual touch tissue imaging quantification(VTIQ)combined with v-Raf murine sarcoma viral oncogene homolog B1(BRAF)gene mutation in the differential diagnosis of thyroid imaging reporting and data system(TI-RADS)4 thyroid nodules.Methods A retrospective analysis of 96 patients with thyroid nodules(107 nodules)confirmed by postoperative pathological examination was performed.All patients underwent VTIQ examination to obtain the minimum shear wave velocity(SWVmin),maximum shear wave velocity(SWVmax),mean shear wave velocity(SWVmean),and SWVratio.BRAF V600E gene mutation was detected.Ac-cording to the postoperative pathological results,the thyroid nodules were divided into the malignant group and the be-nign group.The VTIQ parameters and BRAF V600E gene mutation detection results were compared between the two groups.To observe the value of VTIQ parameters and BRAF V600E gene mutation in the differential diagnosis of thyroid nodules.The influencing factors of the nature of thyroid nodules were analyzed,and the regression diagnosis model of VTIQ parameters combined with BRAF V600E gene mutation was constructed.The goodness of fit of the model and its ability to identify the nature of thyroid nodules were evaluated.Results The positive rates of SWVmin,SWVmax,SWVmean,SWVratio and BRAF V600E gene mutation in the malignant group were higher than those in the benign group(P<0.05).The receiver operating characteristic(ROC)curve showed that the diagnostic area under the curve(AUC)of SWVmin,SWVmax,SWVmean and SWVratio in VTIQ parameters were 0.822,0.779,0.889 and 0.852,respectively,and SWVmean had the highest diagnostic value.The diagnostic AUC of BRAF V600E gene mutation was 0.861.Binary Logistic regression analysis showed that SWVmean and BRAF V600E gene mutations were independent predictors of the nature of thyroid nodules(P<0.05).Hosmer-Lemeshow test showed that χ^(2)=11.195,P=0.130,suggesting that the model was well constructed.The ROC curve showed that the AUC of the re-gression di

关 键 词：声触诊组织量化成像 鼠类肉瘤滤过性毒菌致癌同源体B1 基因突变 甲状腺影像报告和数据系统 甲状腺结节 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]