声触诊组织量化与声触诊组织定量技术对甲状腺结节良恶性的鉴别诊断

doi:10.3877/cma.j.issn.1672-6448.2017.10.007

目的

比较声触诊组织量化（VTIQ）与声触诊组织定量（VTQ）技术在甲状腺结节良恶性鉴别诊断中的应用价值。

方法

选取2016年8月至11月在哈尔滨医科大学附属第一医院就诊并经手术病理证实的182例患者共186个甲状腺结节，行常规超声与VTIQ及VTQ检查。测量良恶性结节的剪切波速度（SWV），采用t检验比较良性结节与恶性结节之间SWV测值的差异。绘制受试者工作特征（ROC）曲线，计算VTIQ与VTQ技术鉴别诊断甲状腺良恶性结节的敏感度、特异度、准确性、阳性预测值和阴性预测值。采用Z检验分析曲线下面积（AUC）进行组间比较，比较两种弹性技术对甲状腺结节的诊断效能。

结果

186个甲状腺结节中，82个结节为良性，104个结节为恶性。VTIQ SWV平均值、VTIQ SWV中位数、VTQ SWV平均值、VTQ SWV中位数测量甲状腺结节良恶性曲线下面积分别为0.848、0.790、0.759、0.717。在VTIQ与VTQ技术中，SWV平均值均较SWV中位数诊断效能高，差异均有统计学意义（VTIQ技术：Z=2.104，P=0.0354；VTQ技术：Z=2.190，P=0.0285），VTIQ SWV平均值与VTQ SWV平均值鉴别甲状腺结节良恶性的比较，差异有统计学意义（Z=2.115，P=0.0344），以VTIQ SWV平均值诊断效能最佳，鉴别结节良恶性的截断值为2.91 cm/s，敏感度、特异度、准确性、阳性预测值、阴性预测值分别为72.12%、87.80%、79.03%、88.24%、71.29%。

结论

VTQ与VTIQ弹性成像技术对甲状腺结节良恶性的鉴别诊断均有较好的应用价值。VTIQ SWV平均值较VTQ SWV平均值对良恶性的鉴别诊断有一定的优势。

关键词: 甲状腺结节, 超声检查, 弹性成像技术

Objective

To compare the diagnostic performances of two elastography techniques, virtual touch tissue imaging quantification (VTIQ) and virtual touch tissue quantification (VTQ), in differentiating between benign and malignant thyroid nodules.

Methods

A total of 182 patients with 186 nodules evaluated by VTQ and VTIQ were enrolled in this study. Shear wave velocities (SWV) of benign and malignant nodules were measured and compared between different groups by t test . The receiver operating characteristic curve (ROC) was used to assess the value of VTIQ and VTQ in differentiating benign and malignant nodules. And the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of VTIQ and VTQ were calculated. According to areas under the curve (AUC), the diagnostic values of these two elastography techniques for thyroid nodules′ qualitative diagnosis were compared by Z test.

Results

In pathology, 104 thyroid nodules were benign and 82 were malignant. AUC of VTIQ SWV mean, VTIQ SWV median, VTQ SWV mean, VTQ SWV median were 0.848, 0.790, 0.759, 0.717, respectively. In the VTIQ and VTQ techniques, the SWV mean had higher diagnostic efficacy than the SWV median (VTIQ techniques: Z=2.104, P=0.0354; VTQ techniques: Z=2.190, P=0.0285). There were statistical differences in the diagnosis performance between VTIQ SWV mean and VTQ SWV mean (Z =2.115, P=0.0344). The VTIQ SWV mean value in the nodule had the best diagnostic value in comparison with other SWV values. The cut-off value of VTIQ SWV mean was 2.91 m/s. According to ROC curve analysis, the sensitivity, specificity, accuracy, PPV and NPV for VTIQ SWV mean were 72.12%, 87.80%, 79.03%, 88.24%, 71.29%, respectively.

Conclusions

The results demonstrated that VTQ and VTIQ have good diagnostic performance on distinguishing malignant from benign thyroid nodules. VTIQ SWV mean shows a better diagnostic performance than VTQ SWV mean.

Key words: Thyroid nodule, Ultrasonography, Elasticity imaging techniques

图1~4 甲状腺良性结节的VTQ与VTIQ检测图。图1为甲状腺结节的普通超声声像图；图2为该结节VTQ SWV值为2.38 m/s；图3为该结节VTIQ的质量图；图4为该结节VTIQ SWV值为2.40 m/s、2.57 m/s、2.02 m/s、2.10 m/s、2.14 m/s

图5~8 甲状腺恶性结节的VTQ与VTIQ检测图。图5为甲状腺结节的普通超声声像图；图6为该结节VTQ SWV值为3.3 m/s；图7为该结节VTIQ的质量图；图8为该结节VTIQ SWV值为4.05 m/s，4.01 m/s，3.91 m/s，3.96 m/s，3.86 m/s

表1 甲状腺良恶性结节SWV值

组别	个数	VTIQ				VTQ
组别	个数	SWV最大值	SWV最小值	SWV中位数	SWV平均数	SWV中位数	SWV平均数
良性结节	82	3.06±0.69	2.21±0.46	2.51±0.46	2.51±0.42	2.44±1.43	2.45±1.41
恶性结节	104	3.68±1.25	2.57±0.67	3.15±0.79	3.18±0.71	3.05±1.47	3.18±1.44
t值	?	4.274	4.254	6.916	7.584	2.859	3.449
P值	?	<0.001	<0.001	<0.001	<0.001	0.005	0.001

表1 甲状腺良恶性结节SWV值

组别	个数	VTIQ				VTQ
组别	个数	SWV最大值	SWV最小值	SWV中位数	SWV平均数	SWV中位数	SWV平均数
良性结节	82	3.06±0.69	2.21±0.46	2.51±0.46	2.51±0.42	2.44±1.43	2.45±1.41
恶性结节	104	3.68±1.25	2.57±0.67	3.15±0.79	3.18±0.71	3.05±1.47	3.18±1.44
t值	?	4.274	4.254	6.916	7.584	2.859	3.449
P值	?	<0.001	<0.001	<0.001	<0.001	0.005	0.001

表2 VTIQ与VTQ技术鉴别甲状腺结节良恶性诊断效能

SWV值	弹性	AUC	95%CI	截断值	敏感度（%）	特异度（%）	Youden指数	PPV（%）	NPV（%）	准确性（%）
SWV平均数	VTIQ	0.848	0.791~0.905	2.91	72.12	87.80	0.5992	88.24	71.29	79.03
?	VTQ	0.759	0.688~0.829	2.73	62.50	80.49	0.4299	80.25	62.86	70.43
SWV中位数	VTIQ	0.790	0.725~0.855	2.87	64.42	87.80	0.5223	87.01	66.06	74.73
?	VTQ	0.717	0.642~0.792	2.72	52.88	81.71	0.3459	78.57	57.76	65.59

表2 VTIQ与VTQ技术鉴别甲状腺结节良恶性诊断效能

SWV值	弹性	AUC	95%CI	截断值	敏感度（%）	特异度（%）	Youden指数	PPV（%）	NPV（%）	准确性（%）
SWV平均数	VTIQ	0.848	0.791~0.905	2.91	72.12	87.80	0.5992	88.24	71.29	79.03
?	VTQ	0.759	0.688~0.829	2.73	62.50	80.49	0.4299	80.25	62.86	70.43
SWV中位数	VTIQ	0.790	0.725~0.855	2.87	64.42	87.80	0.5223	87.01	66.06	74.73
?	VTQ	0.717	0.642~0.792	2.72	52.88	81.71	0.3459	78.57	57.76	65.59

表3 VTIQ与VTQ曲线下面积比较

超声技术	SWV平均值AUC	SWV中位数AUC	Z值	P值
VTIQ	0.848	0.790	2.104	0.0354
VTQ	0.759	0.717	2.190	0.0285
Z值	2.115	1.591	?	?
P值	0.0344	0.1115	?	?

表3 VTIQ与VTQ曲线下面积比较

超声技术	SWV平均值AUC	SWV中位数AUC	Z值	P值
VTIQ	0.848	0.790	2.104	0.0354
VTQ	0.759	0.717	2.190	0.0285
Z值	2.115	1.591	?	?
P值	0.0344	0.1115	?	?

图9 VTIQ SWV平均数和VTQ SWV平均数鉴别甲状腺结节良恶性的ROC曲线

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Study on the diagnostic values of virtual touch tissue imaging quantification and virtual touch tissue quantification techniques in differentiating thyroid benign and malignant nodules

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Study on the diagnostic values of virtual touch tissue imaging quantification and virtual touch tissue quantification techniques in differentiating thyroid benign and malignant nodules