CAJ | 학술논문

目的初步探讨超声弹性成像应变率比值(SR)对鉴别诊断甲状腺良恶性结节的影响因素.方法回顾性分析171例患者共171枚甲状腺结节的二维、彩色多普勒及弹性图像,记录甲状腺结节的常规超声特征(结节最大径、内部成分、形态、边界、深度、钙化、内部血流)及纵切面上SR值.以手术或活检病理结果作为金标准,采用ROC曲线方法评价SR值诊断甲状腺结节良恶性的效能.以恶性结节为研究对象,采用相关分析初步筛选与SR值相关的常规超声特征,并以全部结节为研究对象,采用多元线性逐步回归方法分析初筛相关的因素及病理性质对SR值的影响.结果以SR=3.67作为最佳诊断临界点,SR值鉴别诊断甲状腺结节良恶性的灵敏性、特异性及ROC曲线下面积分别为85.6％、81.1％、0.891.相关分析结果表明:结节最大径、钙化与SR值相关(r值分别为0.345、0.261,P＜0.05),其他特征与SR值的相关性无统计学意义(P≥0.05).进一步多元线性回归分析结果显示:结节最大径、钙化及病理类型进入回归方程(P＜0.05),其中病理类型对结节SR值影响最大(标准化回归系数是0.494).结论 SR值是鉴别甲状腺良恶性结节的有效指标,病理类型是SR值最显著的影响因素,此外SR值还与结节的最大径及钙化相关,与结节内部成分、形态、边界、所处深度及内部血流关系不大.
목적 초보탐토초성탄성성상응변솔비치(SR)대감별진단갑상선량악성결절적영향인소.방법 회고성분석171례환자공171매갑상선결절적이유、채색다보륵급탄성도상,기록갑상선결절적상규초성특정(결절최대경、내부성분、형태、변계、심도、개화、내부혈류)급종절면상SR치.이수술혹활검병리결과작위금표준,채용ROC곡선방법평개SR치진단갑상선결절량악성적효능.이악성결절위연구대상,채용상관분석초보사선여SR치상관적상규초성특정,병이전부결절위연구대상,채용다원선성축보회귀방법분석초사상관적인소급병이성질대SR치적영향.결과 이SR=3.67작위최가진단림계점,SR치감별진단갑상선결절량악성적령민성、특이성급ROC곡선하면적분별위85.6％、81.1％、0.891.상관분석결과표명:결절최대경、개화여SR치상관(r치분별위0.345、0.261,P＜0.05),기타특정여SR치적상관성무통계학의의(P≥0.05).진일보다원선성회귀분석결과현시:결절최대경、개화급병리류형진입회귀방정(P＜0.05),기중병리류형대결절SR치영향최대(표준화회귀계수시0.494).결론 SR치시감별갑상선량악성결절적유효지표,병리류형시SR치최현저적영향인소,차외SR치환여결절적최대경급개화상관,여결절내부성분、형태、변계、소처심도급내부혈류관계불대.
Objective To investigate the influencing factors of strain ratio(SR) value in differential diagnosis of benign and malignant thyroid nodules by using real-time tissue elastosonography (RTE).Methods One hundred and seventy-one patients with a total of 171 thyroid nodules were analyzed retrospectively.Their images,including 2D ultrasound,color Doppler flow imaging (CDFI) and RTE were reviewed and conventional ultrasonic features (including the maximum diameter,composition,shape,magin,calcification,intranodular blood flow,depth) and SR value were recorded.Receiver-operating characteristic (ROC) curve was employed to assess the diagnostic efficiency of SR value in differentiating malignant nodules from benign ones.Firstly,the correlation between the aforementioned factors and SR value was assessed by using malignant lesions as the research subjects.And then,the multiple linear regressions (MLR) was employed to evaluate the influence of particular features which turned out to be an important disturbing factor affecting SR value of the lesion in the first step of analysis and pathological type in all nodules (benign and malignant) on SR value.Results With a cut-off point of SR value 3.67,the sensitivity and specificity of SR value in differential diagnosis of benign and malignant thyroid nodules was 85.6％ and 81.1 ％,respectively,and the area under ROC curve was 0.891.Correlation between the maximum diameter and calcification and SR value was significant(r =0.345 and 0.261 respectively,P ＜0.05).However,there was no significant correlation between other features(5 factors) and SR value(P ≥0.05).MLR indicated that the maximum diameter,calcification and the type of pathology of the nodule were associated with SR value (P ＜ 0.05).Among them,pathological nature was the most significant impact factor with a standardized coefficient 0.494).Conclusions SR value can be used to evaluate the hardness of thyroid nodules semi-quantitatively.Its value mainly depends on the pathological nature of the nodules.The maximum diameter and calcification are also the influencing factors of SR value.However,the composition,shape,margin,intranodular blood flow and depth have no obvious effect on SR value.