剪切波弹性成像杨氏模量最大值与ACR TI-RADS分类对甲状腺结节的诊断价值
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摘要
目的:探讨剪切波弹性成像(SWE)杨氏模量最大值(Emax)联合2017年美国放射协会(ACR)的甲状腺影像学报告及数据系统(TI-RADS)对甲状腺结节的诊断价值。方法:回顾性分析113个甲状腺结节的声像图资料。所有结节均行SWE及常规超声检查,记录Emax并按照2017年ACR TI-RADS分类。以病理为金标准,构建ROC曲线,选取最佳诊断切点。比较单独应用Emax、ACR TI-RADS以及两者联合应用诊断甲状腺良恶性结节的价值。结果:113个甲状腺结节中良性结节51个,恶性结节62个,SWE最佳分界点为Emax>40kPa,其诊断甲状腺结节良恶性的灵敏度、特异度及准确率分别为74.2%,76.5%,75.2%。ACR TI-RADS最佳分界点为TI-RADS分级>TR4,其诊断甲状腺结节良恶性的灵敏度、特异度及准确率分别为80.6%,78.4%,79.6%。2种方法联合诊断甲状腺结节良恶性的灵敏度、特异度及准确率分别为93.5%、68.6%、82.3%。2种方法联合应用较单独应用诊断甲状腺良恶性结节的灵敏度升高,差异有统计学意义(P<0.05),而特异度和准确率差异均无统计学意义(P>0.05)。结论:SWE及ACR TI-RADS分类系统对于鉴别甲状腺结节的良恶性具有重要的临床价值,2种方法联合应用较单独应用能提高诊断的灵敏度,特异度及准确率不变。
Objective:The aim of this study is to assess the application value of maximum Young's modulus of shear wave elastography in combination with Thyroid Imaging Reporting and Data System set by the American College of Radiology in the diagnosis of benign and malignant thyroid nodules.Method:A retrospective analysis of113 thyroid nodules with ultrasonographic imaging data was carried out.All nodules were subjected to SWE and conventional ultrasonography,and Emax was recorded and classified according to the 2017 ACR TI-RADS.With pathology as the gold standard,the ROC curve was drawn and the best diagnostic cut-off was selected for comparing their diagnostic performance.Result:Of the 113 thyroid nodules,51 were benign and 62 were malignant.Best cut-off point for diagnosing malignant by SWE was Emax>40 kPa.And at that point,the sensitivity,specificity and accuracy of the average value of it were 74.2%,76.5%and 75.2%.Best cut-off point for diagnosing malignant by ACR TI-RADS was>TR4.The sensitivity,specificity and accuracy of the average value of it were80.6%,78.4% and 79.6%.The sensitivity of the combination of the two examinations was significantly higher than that of simple application of each of them,while there was no significant difference in the specificity and accuracy between them.Conclusion:The SWE and ACR TI-RADS classification systems have important clinical value in identifying the benign and malignant thyroid nodules.The combination of the two methods can improve the sensitivity,specificity and accuracy of the diagnosis.
Objective:The aim of this study is to assess the application value of maximum Young's modulus of shear wave elastography in combination with Thyroid Imaging Reporting and Data System set by the American College of Radiology in the diagnosis of benign and malignant thyroid nodules.Method:A retrospective analysis of113 thyroid nodules with ultrasonographic imaging data was carried out.All nodules were subjected to SWE and conventional ultrasonography,and Emax was recorded and classified according to the 2017 ACR TI-RADS.With pathology as the gold standard,the ROC curve was drawn and the best diagnostic cut-off was selected for comparing their diagnostic performance.Result:Of the 113 thyroid nodules,51 were benign and 62 were malignant.Best cut-off point for diagnosing malignant by SWE was Emax>40 kPa.And at that point,the sensitivity,specificity and accuracy of the average value of it were 74.2%,76.5%and 75.2%.Best cut-off point for diagnosing malignant by ACR TI-RADS was>TR4.The sensitivity,specificity and accuracy of the average value of it were80.6%,78.4% and 79.6%.The sensitivity of the combination of the two examinations was significantly higher than that of simple application of each of them,while there was no significant difference in the specificity and accuracy between them.Conclusion:The SWE and ACR TI-RADS classification systems have important clinical value in identifying the benign and malignant thyroid nodules.The combination of the two methods can improve the sensitivity,specificity and accuracy of the diagnosis.
引文
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[4]那子悦,乔强,王秋程,等.甲状腺剪切波弹性成像假性结果二维超声特点的分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(15):1191-1195.
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[6]董芬,张彪,单广良.中国甲状腺癌的流行现状和影响因素[J].中国癌症杂志,2016,26(1):47-52.
[7]CLARK T J,POKHAREL S,MEIER J,et al.Thyroid Nodule Doubling Time is Not a Reliable Indicator of Benign or Malignant Nature[J].Ultrasound Q,2016,32:132-135.
[8]刘如玉,张波.美国放射学会甲状腺结节影像报告系统和影像偶发甲状腺结节管理系列白皮书解读[J].中国癌症杂志,2018,28(2):88-97.
[9]刘红,胡正明,罗海愉,等.ACR TI-RADS分类在诊断甲状腺结节中的应用价值探究[J].中国超声医学杂志,2018,34(8):673-675.
[10]刘保娴,梁瑾瑜,谢晓燕,等.剪切波弹性成像与实时组织弹性成像技术在甲状腺结节良恶性鉴别诊断中的应用价值[J].中华医学超声杂志(电子版),2014,11(11):57-62.
[11]BHATIA K S,TONG C S,CHO C C,et al.Shear wave elastography of thyroid nodules in routine clinical practice:preliminary observationsand utility for detecting malignancy[J].Eur Radiol,2012,22:2397-2406.
[12]乐坚,常才,范亦武,等.剪切波弹性成像对甲状腺病灶的鉴别诊断价值初探[J].中华超声影像学杂志,2014,23(3):263-264.
[13]王涛,王学梅,张义侠,等.实时剪切波弹性成像鉴别甲状腺结节良恶性的定量分析[J].中国医学影像学杂志,2012,20(9):684-687.
[14]崔智飞,张波涛,李蒙迪,等.超声探头压力对甲状腺实时剪切波弹性成像杨氏模量值的影响[J].放射学实践,2018,33(5):86-90.
[15]RAGO T,SANTINI F,SCUTARI M,et al.Elastography:new developments in ultrasound for predicting malignancy in thyroid nodules[J].J Clin Endocrinol Metab,2007,92:2917-2922.
[2]SAMIR A E.The role and value of ultrasound elastography in the evaluation of thyroid nodules[J].Cancer Cytopathol,2016,124:765-766.
[3]TESSLER F N,MIDDLETON W D,GRANT E G,et al.ACR Thyroid Imaging,Reporting and Data System(TI-RADS):White Paper of the ACR TI-RADS Committee[J].J Am Coll Radiol,2017,14:587-595.
[4]那子悦,乔强,王秋程,等.甲状腺剪切波弹性成像假性结果二维超声特点的分析[J].临床耳鼻咽喉头颈外科杂志,2017,31(15):1191-1195.
[5]王伟,甲状腺结节的临床、病理特点及其甲状腺癌发病风险分析[J].中国实用医药,2018,34(1):51-52.
[6]董芬,张彪,单广良.中国甲状腺癌的流行现状和影响因素[J].中国癌症杂志,2016,26(1):47-52.
[7]CLARK T J,POKHAREL S,MEIER J,et al.Thyroid Nodule Doubling Time is Not a Reliable Indicator of Benign or Malignant Nature[J].Ultrasound Q,2016,32:132-135.
[8]刘如玉,张波.美国放射学会甲状腺结节影像报告系统和影像偶发甲状腺结节管理系列白皮书解读[J].中国癌症杂志,2018,28(2):88-97.
[9]刘红,胡正明,罗海愉,等.ACR TI-RADS分类在诊断甲状腺结节中的应用价值探究[J].中国超声医学杂志,2018,34(8):673-675.
[10]刘保娴,梁瑾瑜,谢晓燕,等.剪切波弹性成像与实时组织弹性成像技术在甲状腺结节良恶性鉴别诊断中的应用价值[J].中华医学超声杂志(电子版),2014,11(11):57-62.
[11]BHATIA K S,TONG C S,CHO C C,et al.Shear wave elastography of thyroid nodules in routine clinical practice:preliminary observationsand utility for detecting malignancy[J].Eur Radiol,2012,22:2397-2406.
[12]乐坚,常才,范亦武,等.剪切波弹性成像对甲状腺病灶的鉴别诊断价值初探[J].中华超声影像学杂志,2014,23(3):263-264.
[13]王涛,王学梅,张义侠,等.实时剪切波弹性成像鉴别甲状腺结节良恶性的定量分析[J].中国医学影像学杂志,2012,20(9):684-687.
[14]崔智飞,张波涛,李蒙迪,等.超声探头压力对甲状腺实时剪切波弹性成像杨氏模量值的影响[J].放射学实践,2018,33(5):86-90.
[15]RAGO T,SANTINI F,SCUTARI M,et al.Elastography:new developments in ultrasound for predicting malignancy in thyroid nodules[J].J Clin Endocrinol Metab,2007,92:2917-2922.