弹性应变率比值鉴别诊断甲状腺影像报告和数据系统4～6类甲状腺结节的影响因素分析

摘要

目的 分析弹性应变率比值鉴别诊断甲状腺影像报告和数据系统(TI-RADS)4～6类结节的影响因素,探讨不同影响因素作用下弹性应变率比值鉴别诊断TI-RADS 4～6类甲状腺良恶性结节的应用价值.方法 2013年9月至2014年3月于南京医科大学第一附属医院行常规超声检查进行TI-RADS分类并同时进行超声弹性成像检查的甲状腺结节患者270例,共278个结节.选取TI-RADS 4～6类的105个结节作为研究对象.采用Logistic回归模型分析弹性应变率比值鉴别诊断TI-RADS 4～6类甲状腺结节的影响因素.绘制弹性应变率比值鉴别诊断TI-RADS 4～6类甲状腺结节良恶性的操作者工作特征(ROC)曲线.以手术病理结果作为金标准,计算弹性应变率比值鉴别诊断TI-RADS 4～6类甲状腺结节良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值.结果ROC曲线显示,弹性应变率比值鉴别诊断TI-RADS 4～6类甲状腺结节良恶性的最佳诊断界值为0.54.Logistic回归分析结果显示,结节大小、钙化、是否合并弥漫性病变是弹性应变率比值鉴别诊断TI-RADS 4～6类甲状腺结节的影响因素.对<1 cm、未合并弥漫性病变、未合并钙化的TI-RADS 4～6类甲状腺结节,弹性应变率比值鉴别诊断其良恶性的敏感度、特异度、准确性、阳性预测值均较高,分别为87.9％、72.7％、84.1％、90.6％,83.9％、83.4％、83.6％、94.0％,82.1％、83.3％、82.5％、92.0％.结论 甲状腺结节的大小、是否合并钙化、是否合并弥漫性病变是弹性应变率比值鉴别诊断TI-RADS 4～6类结节良恶性的影响因素,综合分析这3类影响因素可提高弹性应变率比值在鉴别诊断甲状腺结节良恶性中的应用价值.%Objective To analyze the influencing factors of strain ratio in diagnosing thyroid lesions of thyroid imaging reporting and data system (TI-RADS) 4-6 categories, and explore the application value of elastic strain ratio in differentiating malignant thyroid nodules from benign ones under different influencing factors.Methods A retrospective analysis was made on the pathologic data of 278 nodules undergone TI-RADS ultrasonography stratification and ultrasound elestography, and 105 nodules of TI-RADS 4-6 categories were selected as research objects. A receiver-operating characteristic (ROC) curve was used to identify the cut-off point for differential diagnosis of thyroid nodules. A logistic regression model was established to analyze the factors affecting strain ratio in the differential diagnosis on thyroid nodules of TI-RADS 4-6 categories. Analyses were made in groups to judging the sensitive, specificity, accuracy, positive predictive value and negative predictive of strain ratio under the impact of different factors. Results The best cut-off point of ROC curve for benign and malignant nodules was 0.54. It was found through the logistic regression model that the strain ratio value was closely related to the size, calcification, and thyroid diffuse disease, and strain ration was of higher value in the thyroid nodules which were less than 1 cm without calcification and thyroid diffuse disease.Conclusions Three factors including size, calcification, and diffuse lesions of the thyroid nodules can influence the elastic strain ratio of TI-RADS 4-6 thyroid nodules. Comprehensive analysis of these three influencing factors can improve the application value of elastic strain ratio in differential diagnosis of benign and malignant thyroid nodules.