超声实时剪切波弹性成像杨氏模量最大值在甲状腺实性结节良恶性鉴别诊断中的应用

发布时间：2018-04-18 04:33

  本文选题：甲状腺结节 + 剪切波弹性成像(SWE)　； 参考：《南京医科大学》2017年硕士论文

【摘要】：[目的]探讨超声实时剪切波弹性成像(shearwaveelastography,SWE)杨氏模量最大值(Emax)在甲状腺实性结节良恶性鉴别诊断中的应用价值。[方法]采用Supersonic Imagine Aixplorer型彩色多普勒超声诊断仪(法国),线阵探头L15-4(频率为4-15MZ)。常规超声观察并详细记录252例患者的297个甲状腺结节的大小、形态、内部回声、边界、纵横比、是否有钙化、周边及内部血流及有无淋巴结转移等。依据甲状腺影像数据报告及评分系统(TI-RADS)对甲状腺结节进行分类,所有结节进行剪切波弹性成像并记录杨氏模量值,以病理为金标准,采用对数正态分布统计模型对甲状腺结节Emax值进行拟合。根据Emax值的期望值和95%概率值的统计学意义,提出了鉴别诊断甲状腺结节病变良恶性性质的Emax值的界值范围,并计算出界值范围对甲状腺结节良恶性诊断的特异性和敏感性。将其中TI-RADS3-4类的186个甲状腺结节分为两组,Ⅰ组:结节直径≤1Omm组,共74个结节;Ⅱ组:直径10mm组,共112个结节。以病理结果为金标准,绘制ROC曲线,计算甲状腺结节Emax值最佳界值,并计算出SWE在不同大小的TI-RADS3-4类甲状腺结节以及合并桥本甲状腺炎的甲状腺结节鉴别诊断中的敏感性、特异性和准确性。[结果]当甲状腺结节杨氏模量最大值Emax45kPa,甲状腺结节良性概率大于恶性概率,此区间内良性结节的可能性大于50%;45kPa≤Emax70kPa,甲状腺结节可疑异常病变,此区间内良恶性结节概率各占50%左右;70kPa≤Emax120 kPa,甲状腺恶性结节可能性大于良性,此区间内恶性结节的概率大于50%;Emax≥120kPa,甲状腺结节高度可疑恶性,结节为良性的可能性小于5%;其中,31%甲状腺良性结节和37%恶性结节中不能采用Emax值直接判断结节性质;在可以判别性质的结节中:甲状腺良性结节的特异性78%,假阴性率22%;甲状腺恶性结节的敏感性76%,假阳性率24%。甲状腺结节Emax值最佳诊断界值为52.5kPa,Ⅰ组和Ⅱ组的敏感性、准确性及特异性分别为57.4%、66.2%及90%和87.5%、79.5%及68.8%。合并桥本甲状腺炎的甲状腺结节Emax值最佳诊断界值为54.4kPa,其敏感性、特异性及准确性分别为64.4%、68.4%及65.62%。[结论]实时剪切波弹性成像杨氏模量最大值Emax值对甲状腺结节的良恶性鉴别有统计学意义,同时在评估甲状腺结节良恶性的风险中具有较高的临床意义。在Ⅰ、Ⅱ组中,SWE对Ⅱ组(10mm)甲状腺结节更有鉴别诊断价值;对Ⅰ组(≤10mm)及合并桥本甲状腺炎的甲状腺结节诊断价值有限,对此类患者建议应联合其他相关检查,尽早明确诊断。
[Abstract]:[objective] to evaluate the value of Emax in differential diagnosis of benign and malignant solid thyroid nodules.[methods] using Supersonic Imagine Aixplorer color Doppler ultrasound diagnostic instrument (France), linear array probe L15-4 (frequency 4-15 MZD).The size, shape, internal echo, boundary, aspect ratio, calcification, peripheral and internal blood flow and lymph node metastasis of 297 thyroid nodules were observed and recorded by conventional ultrasound.Thyroid nodules were classified according to the thyroid imaging data reporting and scoring system (TI-RADS). All the nodules were examined with shear wave elastic imaging and the Young's modulus was recorded.The logarithmic normal distribution statistical model was used to fit the Emax value of thyroid nodules.According to the statistical significance of the expected value of Emax value and 95% probability value, the boundary value range of Emax value for differential diagnosis of benign and malignant nature of thyroid nodule disease was put forward, and the specificity and sensitivity of the range of Emax value for the diagnosis of benign and malignant thyroid nodule were calculated.One hundred and eighty-six thyroid nodules of TI-RADS3-4 type were divided into two groups: group 鈪，

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