中国实用外科杂志

中国实用外科杂志

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剪切波弹性成像在并存桥本甲状腺炎的甲状腺结节良恶性鉴别诊断中价值研究

blank">梁瑾瑜a，blank">刘保娴a，王    伟a，blank">谢晓燕a，blank">吕明德a，b   

  1. 中山大学附属第一医院 a.超声科 中山大学超声诊断与介入超声研究所b.肝胆外科，广东广州510080
  • 出版日期:2016-05-01 发布日期:2016-04-28

  • Online:2016-05-01 Published:2016-04-28

摘要：

目的    评价剪切波弹性成像（SWE）对桥本甲状腺炎（HT）背景下的甲状腺结节良恶性的鉴别诊断作用。方法    回顾性分析2013年1月至2014年6月中山大学附属第一医院行甲状腺手术前超声检查发现可疑结节并行SWE检查的260例病人（297个结节）的临床资料，其中合并HT者73例（83个结节）。SWE定量测量甲状腺结节时，调节感兴趣区（ROI）大小为2 mm，并置于结节内最硬处，记录ROI内SWE值（表示硬度）。结果    恶性结节的SWE值高于良性结节和周围实质，差异均有统计学意义［（64.4±42.8）kPa vs. （26.8±15.3）kPa vs. （17.7±5.3）kPa，P < 0.001］；组内恶性结节SWE值高于良性结节和周围实质（P<0.05）；组间同类结节的SWE值差异无统计学意义（P>0.05）。HT组结节周围甲状腺组织的SWE值高于非HT组（P<0.05），且其与血清TPO-Ab之间存在正相关关系［相关系数（r）=0.307，P<0.05］。当其SWE值为39.0 kPa时，SWE技术诊断结节良恶性的敏感度、特异度及准确率分别为68.9%、91.7%和82.9%。结论    SWE值为39.0 kPa时SWE技术（ROI大小为2 mm）对于HT病人的结节良恶性具有较高的诊断价值。

关键词: 弹性成像, 超声检查, 桥本甲状腺炎, 甲状腺结节

Abstract:

Diagnosis in thyroid nodules with coexistent chronic autoimmune Hashimoto thyroiditis by shear wave elastography        LIANG Jin-yu*，LIU Bao-xian，WANG Wei，et al. *Department of Medical Ultrasonics，Institute of Diagnostic and Interventional Ultrasound，the First Affiliated Hospital of Sun Yat-sen University，Guangzhou 510080,China
Corresponding author: WANG Wei，E-mail：wangw73@mail.sysu.edu.cn
Abstract    Objective    To assess the diagnostic performance of shear wave elastography (SWE) in the differentiation of thyroid nodules with coexistent Hashimoto thyroiditis（HT）. Methods    From January 2013 to June 2014，conventional ultrasound (US) and SWE were performed on 297 suspicious thyroid nodules of 260 patients with histological confirmation. 73 patients with 83 nodules were included in the HT group. Results    SWE value in the maglignant nodule was significant higher than that in the benign one and surrounding parenchyma (64.4±42.8）kPa vs（26.8±15.3）kPa vs（17.7±5.3）kPa, P<0.05). SWE value in HT group of malignant module was significantly higher than that of benign one and surrounding parenchyma. In the benign and malignant nodules，SWE value between HT and non-HT groups showed no significant differences (P>0.05). SWE value of surrounding parenchyma in HT group was higher than that in non-HT group and had positive correlation with TPO-Ab(r=0.307, P<0.05). Optimal value of SWE to diagnose malignancy was 39.1kPa with sensitivity, specificity and accuracy 68.9%,91.7% and 82.9%, respectively.  Conclusions    39.0 kPa of SWE value showed good diagnostic performance in the differentiation of malignant and benign thyroid nodules with coexistent HT.

Key words: elastography, ultrasonography, Hashimoto thyroiditis, thyroid nodule