剪切波弹性成像联合超微血管显像在甲状腺肿块良恶性鉴别诊断中的应用

摘要

目的 探讨剪切波弹性成像(shear wave elastography,SWE)联合超微血管显像(superb microvascular imaging,SMI)在甲状腺肿块良恶性鉴别诊断中的应用价值.方法 选取经超声检出并获得手术或细针抽吸细胞学检查(FNA)的甲状腺肿块患者78例,共88个肿块.常规超声观察二维及血流情况;进行SWE成像,得到杨氏模量值后绘制ROC曲线,获得SWE杨氏模量截断值及该截断值下的敏感性及特异性;进行SMI成像,根据Alder血流分级标准对肿块微血管信息进行分级;分析SWE、SWE联合SMI诊断甲状腺肿块良恶性的敏感性、特异性以及准确性.结果 ①根据病理结果分组,良性组42个肿块,恶性组46个肿块;②良、恶性两组间杨氏模量值(AveT1)差异有统计学意义(P＜0.01),AveT1以41.4 kPa为最佳诊断临界值时,ROC曲线下面积为0.83,敏感性为86.9％,特异性为88.1％;③恶性组Alder分级Ⅱ～Ⅲ级者明显多于良性组,差异有统计学意义(P＜0.01);④SWE、SWE联合SMI诊断甲状腺肿块良恶性的敏感性分别为86.9％、91.3％,特异性分别为88.1％、92.8％,准确性分别为87.5％、94.1％,差异有统计学意义(P＜0.01).结论 SWE联合SMI在甲状腺肿块良恶性鉴别诊断中具有一定的应用价值,可以提高诊断的敏感性、特异性以及准确性.%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.Methods Seventy-eight patients diagnosed by ultrasound and verified with postoperative pathological analysis were enrolled.Conventional two-dimensional ultrasound was applied to observe the masses.SWE was performed to evaluate the elasticity and the Young's modulus (AveT1) value acquired.ROC curve was drawn to calculate the sensibility and specificity using the cut-off value of AveT1.SMI was applied to define Adler's grading standard according to the degree of blood supply.The sensitivity,specificity and accuracy of SWE and SWE combined with SMI in differentiating malignant and benign thyroid masses were analyzed.Results ①According to pathological analysis,there were 42 benign and 44 malignant masses;②The AveT1 value between malignant and benign groups were all significantly different (P ＜0.01).41.4 kPa was used as the best cut-off value of AveT1.The area under the ROC curve were 0.83 with sensitivity 86.9％ and specificity 88.1％;③There were more masses with the Alder class Ⅱ-Ⅲ in malignant group than those in benign group,and the difference was statistically significant (P ＜0.01);④Quantified with SWE or SWE combined with SMI,the sensitivity were 86.9％ and 91.3％,specificity were 88.1％ and 92.8％,and accuracy were 87.5％ and 94.1 ％,respectively,and the difference was statistically significant (P ＜ 0.01).Conclusions SWE combined with SMI represents an excellent application value in differentiating malignant and benign thyroid masses,which could improve the sensitivity,specificity and accuracy of the diagnosis for thyroid masses using ultrasound.