目的探讨声脉冲辐射力弹性成像(ARFI)技术对伴有钙化的甲状腺结节良恶性的鉴别诊断价值。方法对52例患者共54个伴有钙化的甲状腺结节进行术前常规超声(US)及ARFI弹性技术检查,ARFI弹性技术包括声触诊组织定量成像(VTQ)及声触诊组织成像(VTI)。以术后病理结果为金标准,比较常规超声、ARFI弹性技术及常规超声+VTI/VTQ诊断的敏感性、特异性及准确性,及钙化特征对于甲状腺结节良恶性诊断结果的影响。结果 52例患者54个结节中包括恶性结节34个,良性结节20个;34个甲状腺恶性结节中普通超声有3项及以上恶性表现的有27个,少于3项的有7个;而20个甲状腺良性结节中有3项及以上恶性表现的有5个,少于3项的有15个(P<0.005)。34个甲状腺恶性结节中,32个结节VTI分级≥Ⅳ级,2个结节VTI分级<Ⅳ级;而20个甲状腺良性结节中,13个结节VTI分级≥Ⅳ级,7个结节VTI分级<Ⅳ级(P<0.01)。34个甲状腺恶性结节VTQ横向剪切波速度(SWV)值为1.36~9.00 m/s,平均(5.18±3.82)m/s,其中SWV值≥2.87 m/s的结节23个;20个甲状腺良性结节SWV值为0.78~8.15 m/s,平均(4.465±3.685)m/s,其中SWV值≥2.87 m/s的结节6个。甲状腺恶性结节SWV值略高于甲状腺良性结节,差异不具有统计学意义(t=1.86,P=0.068)。常规超声、VTI、VTQ及常规超声+VTI/VTQ对甲状腺恶性结节的诊断价值比较:常规超声诊断的敏感性为79.4%,特异性为75%,准确性为77.7%,单独VTI诊断的敏感性为94.1%,特异性为35%,准确性为72.2%,而单独VTQ诊断的敏感性为67.6%,特异性为70%,准确性为68.5%,联合应用常规超声及VTI/VTQ诊断的敏感性为97.0%,特异性为75%,准确性为88.8%。结论 ARFI技术对于伴有钙化的甲状腺结节良恶性的诊断能力并不优于常规超声,但是两者联合应用可提高甲状腺结节的诊断水平。 Objective To investigate the differential diagnosis of benign and malignant thyroid nodules associated with acoustic pulse radiation elastography (ARFI). Methods A total of 54 calcified thyroid nodules from 52 patients were examined by conventional US and ARFI techniques. The ARFI technique included acoustic palpation (VTQ) and acoustic palpation (VTI) ). The postoperative pathological results were taken as the gold standard to compare the sensitivity, specificity and accuracy of routine ultrasound, ARFI and conventional ultrasound + VTI / VTQ in diagnosis of benign and malignant thyroid nodules. Results Of 52 patients, 34 of 54 patients had malignant nodules and 20 benign nodules. Of the 34 patients with malignant thyroid nodules, 27 had 3 or more malignant lesions and 7 had less than 3 lesions There were 5 malignant thyroid benign nodules in 3 and above, and 15 in 3 benign thyroid nodules (P <0.005). Of the 34 thyroid malignant nodules, VTI grade of 32 nodules was ≥ Ⅳ grade and VTI grade of 2 nodules was <Ⅳ grade. Of the 20 thyroid benign nodules, 13 nodules had VTI grade of ≥ Ⅳ grade and 7 knots Day VTI grading