不同ROI和弹性模量值对剪切波弹性成像诊断颈部良恶性淋巴结效能的影响
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摘要
目的探讨剪切波弹性成像(SWE)中,不同ROI和弹性模量值的选择对诊断颈部良恶性淋巴结的影响。方法选取经穿刺活检或手术病理证实的143枚颈部肿大淋巴结,于术前行常规超声及SWE检查,设置3种不同ROI:直径2mm的小圆形ROI(ROI-1)、不超出淋巴结边缘的最大切圆ROI(ROI-2)及手动勾勒整个淋巴结边缘的ROI(ROI-3),均包含淋巴结的最硬区域,分别测量最大弹性值(E_(max))、平均弹性值(E_(mean))和弹性标准差(SD)并进行对比分析,构建ROC曲线获得各弹性值诊断颈部良恶性淋巴结的AUC,并进行比较。结果恶性淋巴结3种ROI测量的E_(max)、E_(mean)和SD均高于良性淋巴结(P均<0.001)。3种ROI测量的良性淋巴结、恶性淋巴结及总淋巴结E_(max)总体差异无统计学意义(P均>0.05),E_(mean)和SD总体差异均有统计学意义(P均<0.001)。ROC曲线结果显示,3种ROI测量的E_(max)诊断良恶性淋巴结的AUC差异均无统计学意义(P均>0.05),ROI-1测量的E_(mean)的AUC高于ROI-2和ROI-3(P均<0.05),SD低于ROI-2和ROI-3(P均<0.05),而后两者比较差异无统计学意义(P均>0.05)。结论 SWE能够对颈部良恶性淋巴结进行鉴别,但其诊断效能随ROI及弹性模量值的选择而不同。选择较小ROI时,建议使用E_(max)和E_(mean);选择较大ROI时,建议使用E_(max)和SD。
Objective To investigate the impact of different ROI and modulus of elasticity in shear wave elastography(SWE)for diagnosis of benign and malignant cervical lymph nodes.Methods Totally 143 enlarged cervical lymph nodes confirmed by puncture biopsy or surgical pathology were examined with routine ultrasound and SWE before operation.Three different ROI,including the small circular ROI(ROI-1)with diameter 2 mm,the maximum circle ROI(ROI-2)not exceeding the edge of the lymph node,and the manual delineation of the entire lymph node-marginal ROI(ROI-3)were used,all containing the hardest region of lymph nodes.The maximum elastic value(E_(max)),the mean elastic value(E_(mean))and the elastic standard deviation(SD)were measured and compared,respectively.ROC curve was constructed to obtain the AUC of each elasticity value for the diagnosis of benign and malignant lymph nodes in the neck.Results E_(max),E_(mean) and SD measured with 3 ROI in malignant lymph nodes were higher than those in benign lymph nodes(all P<0.001).There was no significant difference of E_(max)in benign lymph nodes,malignant lymph nodes nor total lymph nodes measured with 3 ROI(all P>0.05),but there was significant difference of E_(mean)and SD(both P<0.001).The results of ROC curve showed that there was no significant difference among AUC of E_(max) measured with 3 ROI in diagnosis of benign and malignant lymph nodes(all P>0.05).AUC of E_(mean) measured with ROI-1 was higher than those of ROI-2 and ROI-3(both P<0.05),while SD was lower than those of ROI-2 and ROI-3(both P<0.05),while there was no significant difference between the latter two(both P>0.05).Conclusion SWE could differentiate benign and malignant cervical lymph nodes,but its diagnostic efficacy varies with the choice of ROI and modulus of elasticity.When selecting a smaller ROI,it is recommended to use E_(max)and E_(mean),while E_(max)and SD are recommended when larger ROI is selected.
Objective To investigate the impact of different ROI and modulus of elasticity in shear wave elastography(SWE)for diagnosis of benign and malignant cervical lymph nodes.Methods Totally 143 enlarged cervical lymph nodes confirmed by puncture biopsy or surgical pathology were examined with routine ultrasound and SWE before operation.Three different ROI,including the small circular ROI(ROI-1)with diameter 2 mm,the maximum circle ROI(ROI-2)not exceeding the edge of the lymph node,and the manual delineation of the entire lymph node-marginal ROI(ROI-3)were used,all containing the hardest region of lymph nodes.The maximum elastic value(E_(max)),the mean elastic value(E_(mean))and the elastic standard deviation(SD)were measured and compared,respectively.ROC curve was constructed to obtain the AUC of each elasticity value for the diagnosis of benign and malignant lymph nodes in the neck.Results E_(max),E_(mean) and SD measured with 3 ROI in malignant lymph nodes were higher than those in benign lymph nodes(all P<0.001).There was no significant difference of E_(max)in benign lymph nodes,malignant lymph nodes nor total lymph nodes measured with 3 ROI(all P>0.05),but there was significant difference of E_(mean)and SD(both P<0.001).The results of ROC curve showed that there was no significant difference among AUC of E_(max) measured with 3 ROI in diagnosis of benign and malignant lymph nodes(all P>0.05).AUC of E_(mean) measured with ROI-1 was higher than those of ROI-2 and ROI-3(both P<0.05),while SD was lower than those of ROI-2 and ROI-3(both P<0.05),while there was no significant difference between the latter two(both P>0.05).Conclusion SWE could differentiate benign and malignant cervical lymph nodes,but its diagnostic efficacy varies with the choice of ROI and modulus of elasticity.When selecting a smaller ROI,it is recommended to use E_(max)and E_(mean),while E_(max)and SD are recommended when larger ROI is selected.
引文
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[4]Skerl K,Vinnicombe S,Giannotti E,et al.Influence of region of interest size and ultrasound lesion size on the performance of 2Dshear wave elastography(SWE)in solid breast masses.Clin Radiol,2015,70(12):1421-1427.
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[7]Liu B,Liang J,Zheng Y,et al.Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules:A prospective single-centre experience.Eur Radiol,2015,25(3):624-634.
[8]Kot BC,Zhang ZJ,Lee AW,et al.Elastic modulus of muscle and tendon with shear wave ultrasound elastography:Variations with different technical settings.PLoS One,2012,7(8):e44348.
[9]Jung WS,Kim JA,Son EJ,et al.Shear wave elastography in evaluation of cervical lymph node metastasis of papillary thyroid carcinoma:Elasticity index as a prognostic implication.Ann Surg Oncol,2015,22(1):111-116.
[10]Desmots F,Fakhry N,Mancini J,et al.Shear wave elastography in head and neck lymph node assessment:Image quality and diagnostic impact compared with B-mode and Doppler ultrasonography.Ultrasound Med Biol,2016,42(2):387-398.
[11]程慧芳,王学梅,李银燕,等.实时剪切波弹性成像评价颈部及腋窝淋巴结硬度.中国医学影像技术,2015,31(3):363-366.
[12]郑宝群,覃业志,陈晓霞,等.声辐射力脉冲弹性成像技术对浅表肿大淋巴结良恶性的鉴别诊断.中华医学超声杂志(电子版),2015,12(7):568-573.
[2]You J,Chen J,Xiang F,et al.The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules.J Med Ultrason(2001),2018,45(2):251-259.
[3]Suh CH,Choi YJ,Baek JH.The diagnostic performance of shear wave elastography for malignant cervical lymph nodes:Asystematic review and meta-analysis.Eur Radiol,2017,27(1):222-230.
[4]Skerl K,Vinnicombe S,Giannotti E,et al.Influence of region of interest size and ultrasound lesion size on the performance of 2Dshear wave elastography(SWE)in solid breast masses.Clin Radiol,2015,70(12):1421-1427.
[5]Youk JH,Son EJ,Han K,et al.Performance of shear-wave elastography for breast masses using different region-of-interest(ROI)settings.Acta Radiol,2018,59(7):789-797.
[6]Moon JH,Hwang JY,Park JS,et al.Impact of region of interest(ROI)size on the diagnostic performance of shear wave elastography in differentiating solid breast lesions.Acta Radiol,2018,59(6):657-663.
[7]Liu B,Liang J,Zheng Y,et al.Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules:A prospective single-centre experience.Eur Radiol,2015,25(3):624-634.
[8]Kot BC,Zhang ZJ,Lee AW,et al.Elastic modulus of muscle and tendon with shear wave ultrasound elastography:Variations with different technical settings.PLoS One,2012,7(8):e44348.
[9]Jung WS,Kim JA,Son EJ,et al.Shear wave elastography in evaluation of cervical lymph node metastasis of papillary thyroid carcinoma:Elasticity index as a prognostic implication.Ann Surg Oncol,2015,22(1):111-116.
[10]Desmots F,Fakhry N,Mancini J,et al.Shear wave elastography in head and neck lymph node assessment:Image quality and diagnostic impact compared with B-mode and Doppler ultrasonography.Ultrasound Med Biol,2016,42(2):387-398.
[11]程慧芳,王学梅,李银燕,等.实时剪切波弹性成像评价颈部及腋窝淋巴结硬度.中国医学影像技术,2015,31(3):363-366.
[12]郑宝群,覃业志,陈晓霞,等.声辐射力脉冲弹性成像技术对浅表肿大淋巴结良恶性的鉴别诊断.中华医学超声杂志(电子版),2015,12(7):568-573.