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目的探讨声辐射力脉冲(acoustic radiation force impulse,ARFI)的声触诊组织定量(virtual touch tissue quantification,VTQ)技术鉴别诊断甲状腺良恶性结节的价值。方法对63个甲状腺结节行常规超声检查,并采用超声弹性成像(EI)技术对病灶组织进行EI分级,采用VTQ技术检测病灶组织的剪切波速度(shear wave velocity,SWV)。以术后病理学检查结果作为金标准,采用受试者工作特征曲线(ROC曲线)评估常规超声、EI及VTQ技术诊断甲状腺结节性质的最佳诊断界点及诊断价值。结果 63个甲状腺结节中有良性结节45个,恶性结节18个。常规超声检查、EI及VTQ技术的受试者工作特征(ROC)曲线下面积分别为0.837(95%CI:0.712~0.962)、0.863(95%CI:0.751~0.974)及0.900(95%CI:0.810~0.990),与0.5比较差异均有统计学意义(P=0.001),但三者间曲线下面积比较差异无统计学意义(P>0.05)。常规超声检查的最佳诊断界点为具有3项恶性表现,相应的灵敏度、特异度及准确率分别为83.3%,86.7%及85.7%。EI的最佳诊断界点为Ⅳ级,相应的灵敏度、特异度及准确率分别为94.1%、82.6%及87.3%。VTQ技术的最佳诊断界点为3.39 m/s,相应的灵敏度、特异度及准确率分别为88.9%,91.1%及90.5%。结论常规超声检查、EI及ARFI的VTQ技术对甲状腺实性结节的良恶性鉴别诊断均有诊断价值,在鉴别诊断时需相互结合,综合考虑。
Objective To investigate the value of virtual touch tissue quantification (VTQ) in differential diagnosis of benign and malignant thyroid nodules by acoustic radiation force impulse (ARFI). Methods Thirty-six thyroid nodules were examined by routine sonography. The lesions were graded by EI and the shear wave velocity (SWV) was measured by VTQ. The postoperative pathological examination was taken as the gold standard, and the receiver operating characteristic curve (ROC curve) was used to evaluate the diagnostic threshold and the diagnostic value of routine ultrasound, EI and VTQ in the diagnosis of thyroid nodules. Results There were 45 benign nodules and 18 malignant nodules in 63 thyroid nodules. The area under the receiver operating characteristic (ROC) curves of conventional ultrasonography, EI and VTQ were 0.837 (95% CI: 0.712-0.962), 0.863 (95% CI 0.751-0.974) and 0.900 (95% CI: 0.810 ~ 0.990). There was a significant difference between them (P = 0.001) and 0.5, but there was no significant difference in the area under the curve between the three groups (P> 0.05). The best diagnostic endpoint for routine ultrasonography was 3 malignant, with corresponding sensitivity, specificity, and accuracy of 83.3%, 86.7%, and 85.7%, respectively. The best diagnostic endpoint for EI was grade IV, with corresponding sensitivity, specificity and accuracy of 94.1%, 82.6% and 87.3%, respectively. The best endpoint of VTQ is 3.39 m / s, and the corresponding sensitivity, specificity and accuracy are 88.9%, 91.1% and 90.5% respectively. Conclusion Conventional ultrasonography, EI and ARFI VTQ techniques have diagnostic value in the differential diagnosis of benign and malignant thyroid nodules, and should be combined with each other in the differential diagnosis.