| 邵春晖,赵君智,罗永科,等.实时剪切波弹性成像联合超声造影参数在鉴别甲状腺实性结节良恶性的诊断价值研究[J].安徽医药,2024,28(4):685-690. |
| 实时剪切波弹性成像联合超声造影参数在鉴别甲状腺实性结节良恶性的诊断价值研究 |
| The diagnostic value of real-time shear-wave elastography combined with contrast-enhanced ultrasound parameters in differentiating benign and malignant thyroid nodules |
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| DOI：10.3969/j.issn.1009-6469.2024.04.010 |
| 中文关键词: 甲状腺结节 实时剪切波弹性成像 超声造影 定量参数 良恶性 |
| 英文关键词: Thyroid nodule Real-time shear-wave elastography Contrast-enhanced ultrasound Quantitative parameter Be? nign and malignant |
| 基金项目:陕西省重点研发计划项目( 2023-YBSF-011) |
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| 中文摘要: |
| 目的评估实时剪切波弹性成像( SWE)杨氏模量联合超声造影( CEUS)参数在鉴别甲状腺结节良恶性中的诊断价值。方法以 2020年 6月至 2022年 11月在宝鸡市人民医院经细针穿刺活检或手术病理证实的甲状腺结节病人为研究对象，按照研究目标设定的纳入 /排除标准，最终纳入 106例共 106个结节，行常规超声及 SWE检查，记录结节超声特征及弹性参数，后行 CEUS检查，并对结节动态造影图像进行定量参数分析，获取造影时间 -强度曲线( TIC)图及相关 CEUS参数。比较 SWE参数 Еmax、Еmin、Еmean与 CEUS参数 PI、TTP、MTT、超声造影 TIC曲线下面积( AUC)及联合参数在鉴别甲状腺结节良恶性中的诊断价值。结果 106例甲状腺结节中，甲状腺良性结节(TBN)组 60例和恶性结节( TMN)组 46例；两组结节一般资料比较中，病人年龄平均值 TBN组( 42.37±5.54)岁与 TMN组( 39.56±4.69)岁相比差异有统计学意义( P<0.05)结节血流分布差异有统计学意义( P<0.05)；两组结节 SWE杨氏模量 Emax、Emin、Emean平均值中， TBN组平均值分别为( 39.29，±12.59)Kp、(14.19±4.60)Kp、(23.01±7.93)Kp，TMN组平均值分别为( 104.35±35.62)Kp、(35.09±17.53)Kp、(62.13±22.94)Kp，两组相比差异有统计学意义( P <0.05)；两组结节 CEUS定性及定量各参数 PI、TTP、AUC平均值中， TBN组各参数平均值分别为( 45.88±4.22)dB、(22.02±1.97) s、(4177.58±426.29)dB·s，TMN组各参数平均值分别为( 35.64±4.16)dB、(24.98±3.91)s、(3280.94±315.76)dB·s，TMN组 PI、AUC均低于 TBN组，而 TMN组 TTP长于 TBN组，两组相比差异有统计学意义( P<0.05)； SWE及 CEUS参数联合诊断受试者操作特征(ROC)曲线下面积( AUC)、准确性及对应的灵敏度、特异度均高于各参数单独诊断，且均差异有统计学意义(P<0.05)。 SWE各参数单独及联合诊断 ROC曲线成对比较， Еmax比 Еmin、Еmean比 Еmin成对比较差异有统计学意义( Z=2.60、3.00，P<0.05)。 CEUS各参数单独及联合诊断 ROC曲线成对比较， TTP与联合诊断成对比较差异有统计学意义( Z=2.35，P<0.05)。 Emean截断值为 32.21 KPa时， SWE-Emean联合 CEUS特征鉴别甲状腺结节良恶性的诊断效能均优于 SWE-Emean或 CEUS单独诊断。结论 SWE杨氏模量联合 CEUS参数可提高甲状腺结节诊断准确性。 |
| 英文摘要: |
| Objective To evaluate the diagnostic value of real-time shear-wave elastography (SWE) combined with Young's modulus and contrast-enhanced ultrasound (CEUS) parameters in differentiating benign and malignant thyroid nodules.Methods The patients with thyroid nodules confirmed by fine-needle aspiration biopsy or surgical pathology, who were admitted to Baoji People's Hospitalfrom June 2020 to November 2022, were chosen as the research subjects, and 106 patients (106 nodules) were finally included in thestudy according to the inclusion/exclusion criteria set by the research goal. Routine ultrasound and SWE examinations were performedto record the ultrasonic characteristics and elastic parameters of nodules, followed by CEUS examination. Quantitative parameter analy?sis was performed on the dynamic angiography images of nodules, and the angiographic time-intensity curve(TIC) and related CEUS pa?rameters were obtained. The diagnostic values of SWE parameters Еmax, Еmin and Еmean, CEUS parameters PI, TTP, MTT, and AUCand the combination of the two kinds of parameters were compared in the differentiation of benign and malignant thyroid nodules.Re? sults Among 106 cases of thyroid nodules, 60 cases were benign thyroid nodules (TBN group) and 46 cases were malignant thyroid nodules (TMN group). The comparison results of the baseline information of nodules between the two groups showed that the mean agesof patients between the TBN group and the TMN group were significantly different [(42.37±5.54) vs. (39.56±4.69), P<0.05], and the nodular blood flow distributions were also significantly different (P<0.05). Emax, Emin and Emean mean values of Young's modulus ofnodular SWE in the two groups were (39.29±12.59) Kp, (14.19±4.60) Kp and (23.01±7.93) Kp in the TBN group, and (104.35±35.62)Kp, (35.09±17.53) Kp and (62.13±22.94) Kp in the TMN group, with statistically significant differences between the two groups (P< 0.05). The mean values of qualitative and quantitative CEUS parameters PI, TTP and AUC were (45.88±4.22) dB, (22.02±1.97) s and (4 177.58±426.29) dB·s in the TBN group and (35.64±4.16) dB, (24.98±3.91) s and (3 280.94± 315.76) dB·s in the TMN group, re?spectively. Both PI and AUC in the TMN group were lower than those in the TBN group, while TTP in the TMN group was longer thanthat in the TBN group. There were statistically significant differences between the two groups (P<0.05). The areas under ROC curve(AUC), accuracies, corresponding sensitivities and specificities of diagnosis by combined parameters of SWE and CEUS were higherthan those of separate-parameter diagnosis, and the differences were statistically significant (P < 0.05). For pair-wise comparisons ofROC curves diagnosed by each parameter of SWE alone and in combination, there were statistically significant differences in the pair-wise comparison of Emax/Emin and Emean/Emin (Z=2.60, 3.00, P<0.05). For pair-wise comparisons of ROC curves of diagnosis byeach parameter of CEUS alone and in combination, there were statistically significant differences between TTP and the combined diag?nosis (Z=2.35, P<0.05). When the Emean cut-off value was 32.21 KPa, the diagnostic efficacy of SWE-Emean combined with CEUS in differentiating benign and malignant thyroid nodules was superior to that of SWE-Emean or CEUS alone.Conclusion SWE Young's modulus combined with CEUS parameters can improve the diagnostic accuracy of thyroid nodules. |
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