李虎莎,
车颖^,
大连医科大学附属第一医院 超声科, 辽宁 大连 116011

基金项目: 辽宁省自然科学基金项目（201602221）


详细信息 作者简介: 李虎莎(1992-), 女, 硕士研究生。E-mail:lihusha1636@163.com


通讯作者: 车颖, 教授。E-mail:yche1964@163.com 中图分类号: R445.1


摘要:目的探讨二维剪切波弹性成像（2D-SWE）定量参数在甲状腺微小良性结节与微小乳头状癌（PTMC）中的差异及其在预测PTMC被膜侵犯中的应用价值。方法收集行细针穿刺（FNAB）或手术切除的63例患者的73枚甲状腺微小结节（最大径≤1 cm），二维高频超声观察并记录结节与甲状腺被膜的关系，2D-SWE测量并记录结节的SWE-E值（KPa）。以细胞或组织病理为金标准，将结节分为良性结节组和PTMC组，构建SWE-E的ROC曲线，评估2D-SWE鉴别甲状腺微小结节良恶性的能力。进一步将PTMC分为侵犯被膜组和未侵犯被膜组，构建SWE-E的ROC曲线，评估2D-SWE对PTMC被膜侵犯的预测价值。结果PTMC的SWE-E值（78.54±22.56）KPa明显高于良性微小结节的SWE-E值（34.92±13.65）KPa，差异有统计学意义（P < 0.01）。SWE-E诊断PTMC的最佳截断值为44.27 KPa，诊断的敏感性为96.1%，特异性为90.9%。二维高频超声预测被膜侵犯的敏感性为76.0%，特异性为84.6%。侵犯被膜组的SWE-E值（92.97±20.80）KPa明显高于未侵犯被膜组的SWE-E值（64.66±13.93）KPa，差异有统计学意义（P < 0.01）。SWE-E预测被膜侵犯的最佳截断值为72.76 KPa，诊断的敏感性为96.0%，特异性为73.1%。结论2D-SWE定量成像提供量化的组织硬度信息，在诊断PTMC中可作为常规二维高频超声的有力补充；2D-SWE定量成像对PTMC被膜侵犯具有良好的预测价值。
关键词: 甲状腺结节/
剪切波弹性成像/
甲状腺被膜侵犯/
病理诊断


Abstract:ObjectiveTo evaluate the diagnostic value of two-dimensional shear wave elastography (2D-SWE) for papillary thyroid microcarcinoma (PTMC) and to investigate its application in the prediction of extrathyroidal extension (ETE).MethodsSixty-three patients with 73 thyroid nodules (≤1 cm) were included in this study who received conventional grayscale ultrasound (US) and 2D-SWE before fine-needle aspiration or surgery. The relationship between malignant lesions and the thyroid capsule was observed by US. And Young's modulus value (KPa) was analyzed and recorded with 2D-SWE. The thyroid nodules were divided into benign nodule group and PTMC group according to the cytopathology and surgical pathology results. Receiver-operating characteristic (ROC) curve analysis was performed to assess the performance of 2D-SWE in diagnosing PTMC. The patients with PTMC were furhter divided into ETE group and non-ETE group according to the surgical pathology results. Conventional US findings were analyzed and compared between the ETE group and non-ETE group. ROC curve analysis was performed to assess the performance of 2D-SWE in predicting pathologic ETE.ResultsThe value of SWE-E in PTMCs (78.54±22.56)KPa was significantly higher than that in benign nodules (34.92±13.65)KPa, and the difference was statistically significant (P < 0.01). The optimal cut-off value of SWE-E for predicting malignancy was 44.27 KPa, with a sensitivity and specificity of 96.1% and 90.9%, respectively. The sensitivity and specificity of conventional US to predict pathologic ETE were 76.0% and 84.6%, respectively. The value of SWE-E in PTMC ETE group (92.97±20.80)KPa was significantly higher than that in non-ETE group (64.66±13.93)KPa, and the difference was statistically significant (P < 0.01). The optimal cut-off value of SWE-E for predicting pathologic ETE was 72.76 KPa, with a sensitivity and specificity of 96.0% and 73.1% respectively.Conclusions2D-SWE can be used as a powerful supplement to conventional grayscale US in diagnosing PTMC, providing quantitative stiffness information when conventional US cannot give a definite result. 2D-SWE has a good performance in predicting pathologic ETE in PTMC.
Keywords:thyroid nodule/
shear wave elastography/
extrathyroidal extension/
pathologic diagnosis

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