CAJ | 학술논문

目的：探讨声脉冲辐射力成像（ARFI）声触诊组织定量（VTQ）技术在甲状腺良、恶性结节鉴别诊断中的应用价值，并进一步探索不同切面对甲状腺VTQ值的影响。方法应用VTQ技术对210例共240枚甲状腺结节进行检测，分别进行横切面和纵切面扫查，记录结节及周边甲状腺组织的横向剪切波速度（SWV）。利用ROC曲线对测量结果进行分析，评价VTQ技术的诊断价值并确定诊断界值，并采用Z检验比较两种方法的诊断效能差异。结果横、纵切面甲状腺良性结节及周边甲状腺组织的SWV平均值分别为（2.34±1.41）m/s、（1.95±0.47）m/s 和（2.41±1.36）m/s、（2.07±0.41）m/s，恶性结节及周边甲状腺组织的SWV平均值分别为（4.97±2.97）m/s、（1.97±0.50）m/s和（5.02±2.94）m/s、（2.09±0.46）m/s。恶性结节的SWV值明显高于良性结节，两者比较差异有统计学意义（P＜0.0001）；恶性结节与其周边甲状腺组织比较，差异有统计学意义（P＜0.0001）；而良性结节与其周边甲状腺组织无明显统计学差异（P＞0.05）。横、纵切面ROC曲线下面积分别为0.840、0.842，以2.61 m/s诊断界值点时，对应的敏感度、特异度分别为70.5%、76.3%，特异度为77.6%、80.6%。结论 VTQ技术可以定量评价不同甲状腺组织的硬度，在鉴别甲状腺良恶性结节方面具有较高的临床应用价值。横、纵扫查切面不是甲状腺结节VTQ弹性成像的影响因素。
목적：탐토성맥충복사력성상（ARFI）성촉진조직정량（VTQ）기술재갑상선량、악성결절감별진단중적응용개치，병진일보탐색불동절면대갑상선VTQ치적영향。방법응용VTQ기술대210례공240매갑상선결절진행검측，분별진행횡절면화종절면소사，기록결절급주변갑상선조직적횡향전절파속도（SWV）。이용ROC곡선대측량결과진행분석，평개VTQ기술적진단개치병학정진단계치，병채용Z검험비교량충방법적진단효능차이。결과횡、종절면갑상선량성결절급주변갑상선조직적SWV평균치분별위（2.34±1.41）m/s、（1.95±0.47）m/s 화（2.41±1.36）m/s、（2.07±0.41）m/s，악성결절급주변갑상선조직적SWV평균치분별위（4.97±2.97）m/s、（1.97±0.50）m/s화（5.02±2.94）m/s、（2.09±0.46）m/s。악성결절적SWV치명현고우량성결절，량자비교차이유통계학의의（P＜0.0001）；악성결절여기주변갑상선조직비교，차이유통계학의의（P＜0.0001）；이량성결절여기주변갑상선조직무명현통계학차이（P＞0.05）。횡、종절면ROC곡선하면적분별위0.840、0.842，이2.61 m/s진단계치점시，대응적민감도、특이도분별위70.5%、76.3%，특이도위77.6%、80.6%。결론 VTQ기술가이정량평개불동갑상선조직적경도，재감별갑상선량악성결절방면구유교고적림상응용개치。횡、종소사절면불시갑상선결절VTQ탄성성상적영향인소。
Objective To investigate the clinical value of virtual touch tissue quantification(VTQ) technique of acoustic radiation force impulse imaging (ARFI) in differentiating malignant thyroid nodules from benign ones, and further to explore the influence of different sections of VTQ in the evaluation of thyroid nodules. Methods Totally 210 patients with 240 nodules were enrolled in this study. VTQ was used to determine the stiffness of the nodules and adjacent tissues of thyroid by measuring the value of shear wave velocities (SWV) at cross and longitudinal sections scanning. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of VTQ and to find the best cut-off point. Z test was used to compare the diagnostic performance of these two methods in diagnosis of thyroid nodules. Results At cross and longitudinal sections , the mean SWV in benign nodules and the adjacent thyroid tissues were (2.34±1.41) m/s, (1.95±0.47) m/s and (2.41±1.36) m/s, (2.07±0.41) m/s, respectively , while in malignant thyroid nodules and the adjacent thyroid tissues were (4.97 ± 2.97) m/s, (1.97 ± 0.50) m/s and (5.02 ± 2.94) m/s, (2.09 ± 0.46) m/s, respectively. A significant difference in mean SWV was found between malignant thyroid nodules on one hand and benign thyroid nodules(P<0.0001) or the adjacent thyroid tissues (P<0.0001) on the other hand, while no significant difference was found between benign thyroid nodules and the adjacent thyroid tissues(P>0.05). The area under ROC curve(AUC) was 0.840, 0.842, using 2.61 m/s was the cut-off point, the corresponding sensitivity and specificity of VTQ were70.5%, 76.3%and 77.6%, 80.6%, respectively. Conclusions VTQ provides quantitative information about the thyroid tissue stiffiness, which is highly valuable in the differentiation diagnosis of benign and malignant thyroid nodules. Cross or longitudinal sections is not the impact factor of VTQ elastography of thyroid nodules.