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目的应用剪切波弹性成像测定甲状腺微小乳头状癌的杨氏模量值及实时剪切波速度值,探讨其在甲状腺微小癌诊断中的价值。方法对83例共134个甲状腺实性结节(最大径线均≤1 cm)进行检查,采用剪切波组织弹性成像技术测量剪切波速度最大值(V_(max))、平均值(V_(mean))及杨氏模量最大值(E_(max))、平均值(E_(mean)),以病理结果为诊断金标准,构建ROC曲线,评价SWE定量测值在甲状腺微小癌诊断方面的价值。结果恶性结节E_(max)为(45.07±10.68)kPa,E_(mean)为(30.66±8.16)kPa,V_(max)为(3.79±0.61)m/s,V_(mean)(3.13±0.45)m/s;良性结节E_(max)为(25.03±5.37)kPa,E_(mean)为(18.62±5.06)kPa,V_(max)为(2.87±0.31)m/s,V_(mean)为(2.45±0.37)m/s。甲状腺微小癌的E_(max)、E_(mean)、V_(max)、V_(mean)均高于甲状腺良性微小结节,差异均有统计学意义(E_(max) t=10.120、P<0.001,E_(mean) t=6.151、P<0.001,V_(max) t=7.895、P<0.001,V_(mean) t=1.687、P<0.001)。甲状腺微小结节以E_(max)=35 kPa为临界值时,诊断良恶性病变的敏感度为90.9%,特异度为98.2%;以E_(mean)=26 kPa为临界值,诊断良恶性病变的敏感度为79.7%,特异度为94.5%;以V_(max)=3.35 m/s为临界值时,诊断良恶性病变的敏感度为84.8%,特异度为96.4%;以V_(mean)=2.95 m/s为临界值时,诊断良恶性病变的敏感度为76.7%,特异度为94.5%。受试者工作特征曲线下面积分别为0.952、0.896、0.900、0.876(P<0.05)。结论通过剪切波弹性成像测定甲状腺微小结节的杨式模量值和实时剪切波速度值,有助于甲状腺微小癌的鉴别诊断。
Objective To evaluate the value of Young’s modulus and real-time shear wave velocity of thyroid papillary carcinoma by shear-wave elastography and to explore its value in the diagnosis of thyroid microcarcinoma. Methods Totally 134 thyroid solid nodules (maximal radial diameter≤1 cm) were examined in 83 cases. The maximum shear wave velocity (V_ (max)), mean (V_ (mean) and maximum Young’s modulus (E max) and mean (E mean). The pathological results were used as the gold standard for diagnosis, and the ROC curve was constructed to evaluate the quantitative value of SWE in the diagnosis of thyroid microcarcinoma the value of. Results Emax of 45.07 ± 10.68 kPa, mean E 30.66 ± 8.16 kPa, V max 3.79 ± 0.61 m / s, V mean 3.13 ± 0.45, ) m / s, the mean value of Emax for benign nodules was (25.03 ± 5.37) kPa, the mean E mean was (18.62 ± 5.06) kPa, and the V max was (2.87 ± 0.31) m / (2.45 ± 0.37) m / s. The E_ (max), E mean (mean), V_ (max) and V_ (mean) of thyroid microcarcinoma were all higher than those of benign thyroid nodules (E max = 10.120, P <0.001 , E mean t = 6.151, P <0.001, V max = 7.895, P <0.001, V mean t = 1.687, P <0.001). The sensitivity and specificity of the diagnosis of benign and malignant lesions were 90.9% and 98.2%, respectively. The mean value of E = (mean) = 26 kPa was used to diagnose benign and malignant lesions The sensitivity and specificity were 79.7% and 94.5%, respectively. The sensitivity and specificity of 84.8% and 96.4% for the diagnosis of benign and malignant lesions at V max = 3.35 m / = 2.95 m / s as the critical value, the sensitivity of benign and malignant lesions was 76.7% and the specificity was 94.5%. The area under the receiver operating characteristic curve was 0.952,0.896,0.900,0.876 (P <0.05). Conclusions Young’s modulus and real-time shear wave velocity of thyroid nodules measured by shear wave elastography are helpful to the differential diagnosis of thyroid microcarcinoma.