切换至 "中华医学电子期刊资源库"

中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (12) : 1185 -1190. doi: 10.3877/cma.j.issn.1672-6448.2021.12.011

浅表器官超声影像学

甲状腺结节杨氏模量最大值的影响因素及其对结节性质的鉴别诊断价值
李帅1, 樊秀齐2, 康春松1,(), 薛继平1, 苗俊旺1   
  1. 1. 030032 太原,山西医科大学附属白求恩医院超声科
    2. 030012 太原,山西省中医院超声科
  • 收稿日期:2020-12-08 出版日期:2021-12-01
  • 通信作者: 康春松
  • 基金资助:
    山西省重点研发计划项目(201803D31143)

Influencing factors of maximum Young's modulus of thyroid nodules and its value in differential diagnosis of the nature of thyroid nodules

Shuai Li1, Xiuqi Fan2, Chunsong Kang1,(), Jiping Xue1, Junwang Miao1   

  1. 1. Department of Ultrasound, Shanxi Bethune Hospital Affiliated to Shanxi Medical University, Taiyuan 030032, China
    2. Department of Ultrasound , Shanxi Hospital of Traditional Chinese Medicine, Taiyuan 030012, China
  • Received:2020-12-08 Published:2021-12-01
  • Corresponding author: Chunsong Kang
引用本文:

李帅, 樊秀齐, 康春松, 薛继平, 苗俊旺. 甲状腺结节杨氏模量最大值的影响因素及其对结节性质的鉴别诊断价值[J]. 中华医学超声杂志(电子版), 2021, 18(12): 1185-1190.

Shuai Li, Xiuqi Fan, Chunsong Kang, Jiping Xue, Junwang Miao. Influencing factors of maximum Young's modulus of thyroid nodules and its value in differential diagnosis of the nature of thyroid nodules[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(12): 1185-1190.

目的

分析测量甲状腺结节剪切波弹性成像(SWE)杨氏模量最大值(Emax)的影响因素,并探讨按最显著影响因素分组是否可提高Emax值对结节性质的鉴别诊断价值。

方法

回顾性选取2017年1月至2019年11月在山西医科大学附属白求恩医院行甲状腺结节手术并经术后病理证实的368例患者(共413个结节),术前均行二维超声及SWE检查。常规超声记录结节的大小、数量、纵横比、位置、内部成分、回声、边缘、钙化;SWE记录结节的Emax值及相对应的深度。应用Spearman秩相关筛选甲状腺恶性结节Emax值的相关因素,对相关因素行多元线性回归分析,依据最显著影响因素分组,采用ROC曲线进一步分析Emax值对结节性质的鉴别诊断价值。

结果

413个甲状腺结节中,良性106个,恶性307个。相关性分析结果表明:甲状腺恶性结节大小、边缘、钙化与Emax值呈正相关(r=0.477、0.244、0.256,P均<0.05),结节深度与Emax值呈负相关(r=-0.132,P<0.05);多元线性回归分析结果表明:结节大小对Emax值影响最显著(标准化偏回归系数为0.537)。按结节最大径将甲状腺结节分为A组(最大径≤1 cm)、B组(1 cm<最大径≤2 cm)、C组(2 cm<最大径≤3 cm)。未按结节大小分组Emax值诊断甲状腺恶性结节的截断值为36.0 kPa,ROC曲线下面积(AUC)为0.830,诊断敏感度、特异度分别为73.0%、81.1%;依据结节大小分组的A、B、C组Emax值诊断甲状腺恶性结节的截断值分别为33.7 kPa、37.8 kPa、57.1 kPa,AUC分别为0.832、0.889、0.952,A组诊断敏感度、特异度分别为68.0%、87.9%,B组诊断敏感度、特异度分别为89.0%、82.1%,C组诊断敏感度、特异度分别为94.7%、90.9%。与未按结节大小分组比较,A、B、C组的AUC均有不同程度增大,A组Emax值诊断的敏感度降低,特异度增加,B、C组Emax值诊断的敏感度及特异度均增加。

结论

甲状腺结节Emax值受结节大小的影响最为显著,按结节大小分组,可提高Emax值对结节最大径>1 cm的甲状腺结节的诊断价值,应用Emax值诊断甲状腺结节性质时,不同大小结节建议采用不同的截断值。

Objective

To analyze the influencing factors of maximum Young's modulus (Emax) of shear wave elastography (SWE) of thyroid nodules, and to explore whether grouping by the most significant influencing factors can improve the diagnostic value of Emax.

Methods

A total of 368 patients (with 413 nodules in total) who underwent surgery for thyroid nodules at Bethune Hospital Affiliated to Shanxi Medical University from January 2017 to November 2019 were retrospectively selected. All patients underwent preoperative two-dimensional ultrasound and SWE examination. The size, number, shape, position, internal composition, echo, margin, and calcification of nodules were recorded by conventional ultrasound. Emax values and the depths of nodules were recorded by SWE. Spearman rank correlation was used to screen the influencing factors of Emax value of thyroid malignant nodules. Multiple linear regression analysis was performed on the related factors, and the diagnostic value of Emax value was further analyzed according to the grouping of the most significant influencing factors.

Results

Among 413 thyroid nodules, 106 were benign and 307 were malignant. The results of correlation analysis showed that the size, margin, and calcification of thyroid malignant nodules were positively correlated with Emax value (r=0.477, 0.244, and 0.256, respectively; P<0.05 for all), while the depth of thyroid nodules was negatively correlated with Emax value (r=-0.132, P<0.05). Multiple linear regression analysis showed that nodule size had the most significant effect on Emax value (standardized partial regression coefficient, 0.537). The nodules were divided into group A (maximum diameter ≤1 cm), group B (1 cm < maximum diameter ≤2 cm), and group C (2 cm < maximum diameter ≤3 cm) according to their maximum diameter. The cutoff value was 36.0 kPa, the area under the ROC curve (AUC) was 0.830, and the sensitivity and specificity were 73.0% and 81.1%, respectively, for the diagnosis of thyroid malignant nodules not grouped by Emax value. The cutoff value of Emax for diagnosis of thyroid malignant nodules in groups A, B, and C according to the size of nodules was 33.7 kPa, 37.8 kPa, and 57.1 kPa, and AUC was 0.832, 0.889, and 0.952, respectively. The diagnostic sensitivity and specificity in group A were 68.0% and 87.9% in group A, 89.0% and 82.1% in group B, and 94.7% and 90.9% in group C, respectively. Compared with the nodules not grouped by nodule size, the AUCs of groups A, B, and C increased to varying degrees, the diagnostic sensitivity and specificity of Emax value decreased in group A, and increased in groups B and C.

Conclusion

The Emax value of thyroid nodule is most significantly affected by the size of thyroid nodules. Grouping by the size of thyroid nodule can improve the diagnostic value of Emax value for thyroid nodules with the maximum diameter >1 cm. When using Emax value to diagnose the nature of thyroid nodules, it is recommended to use different cutoff values for different nodule sizes.

表1 甲状腺恶性结节Emax值相关因素的多元线性回归分析
图1 甲状腺结节剪切波弹性成像图。图a示良性结节杨氏模量最大值(Emax)=25.0 kPa;图b示恶性结节Emax=55.4 kPa
图2 杨氏模量最大值(Emax)诊断甲状腺结节良恶性的ROC曲线。图a为未按结节大小分组的ROC曲线;图b为按结节大小分组A组(最大径≤1 cm)的ROC曲线;图c为按结节大小分组B组(1 cm<最大径≤2 cm)的ROC曲线;图d为按结节大小分组C组(2 cm<最大径≤3 cm)的ROC曲线
表2 按结节大小分组与未按结节大小分组的Emax值对甲状腺结节良恶性的诊断价值
1
Bhatia KS, Tong CS, Cho CC, et al. Shear wave elastography of thyroid nodules in routine clinical practice:preliminary observations and utility for detecting malignancy [J]. Eur Radiol, 2012, 22(11): 2397-2406.
2
Xu HX, Yan K, Liu BJ, et al. Guidelines and recommendations on the clinical use of shear wave elastography for evaluating thyroid nodule1 [J]. Clin Hemorheol Microcirc, 2019, 72(1): 39-60.
3
Kim H, Kim JA, Son EJ, et al. Quantitative assessment of shear-wave ultrasound elastography in thyroid nodules: diagnostic performance for predicting malignancy [J]. Eur Radiol, 2013, 23(9): 2532-2537.
4
Nattabi HA, Sharif NM, Yahya N, et al. Is diagnostic performance of quantitative 2D-shear wave elastography optimal for clinical classification of benign and malignant thyroid nodules?: A systematic review and meta-analysis [J]. Acad Radiol, 2017, S1076-6332(17)30369-0.
5
Park AY, Son EJ, Han K, et al. Shear wave elastography of thyroid nodules for the prediction of malignancy in a large scale study [J]. Eur J Radiol, 2015, 84(3): 407-412.
6
Cosgrove D, Barr R, Bojunga J, et al. WFUMB guidelines and recommendations on the clinical use of ultrasound elastography: part 4. Thyroid [J]. Ultrasound Med Biol, 2017, 43(1): 4-26.
7
Dobruch-Sobczak K, Zalewska EB, Gumińska A, et al. Diagnostic performance of shear wave elastography parameters alone and in combination with conventional B-mode ultrasound parameters for the characterization of thyroid nodules: a prospective, dual-center study [J]. Ultrasound Med Biol, 2016, 42(12): 2803-2811.
8
Swan KZ, Nielsen VE, Bibby BM, et al. Is the reproducibility of shear wave elastography of thyroid nodules high enough for clinical use? A methodological study [J]. Clin Endocrinol (Oxf), 2017, 86(4): 606-613.
9
Szczepanek-Parulska E, Woliński K, Stangierski A, et al. Biochemical and ultrasonographic parameters influencing thyroid nodules elasticity [J]. Endocrine, 2014, 47(2): 519-527.
10
Kim HG, Moon HJ, Kwak JY, et al. Diagnostic accuracy of the ultrasonographic features for subcentimeter thyroid nodules suggested by the revised American Thyroid Association guidelines [J]. Thyroid, 2013, 23(12): 1583-1589.
11
Evans A, Whelehan P, Thomson K, et al. Quantitative shear wave ultrasound elastography: initial experience in solid breast masses [J]. Breast Cancer Res, 2010, 12(6): R104.
12
Veyrieres JB, Albarel F, Lombard JV, et al. A threshold value in shear wave elastography to rule out malignant thyroid nodules: a reality? [J]. Eur J Radiol, 2012, 81(12): 3965-3972.
13
李泉水, 熊华花, 陈胜华, 等. 甲状腺结节VTI成像与纤维含量的相关性研究 [J]. 中国超声医学杂志, 2014, 30(11): 96l-963.
14
Liu B, Liang J, Zhou L, et al. Shear wave elastography in the diagnosis of thyroid nodules with coexistent chronic autoimmune Hashimoto's thyroiditis [J]. Otolaryngol Head Neck Surg, 2015, 153(5): 779-785.
15
Liu B, Liang J, Zheng Y, et al. Two-dimensional shear wave elastography as promising diagnostic tool for predicting malignant thyroid nodules: a prospective single-centre experience [J]. Eur Radiol, 2015, 25(3): 624-634.
16
Duan SB, Yu J, Li X, et al. Diagnostic value of two-dimensional shear wave elastography in papillary thyroid microcarcinoma [J]. Onco Targets Ther, 2016, 9: 1311-1317.
17
Moon HJ, Sung JM, Kim EK, et al. Diagnostic performance of gray-scale US and elastography in solid thyroid nodules [J]. Radiology, 2012, 262(3): 1002-1013.
18
Cantisani V, Grazhdani H, Drakonaki E, et al. Strain US elastography for the characterization of thyroid nodules: advantages and limitation [J]. Int J Endocrinol, 2015, 2015: 908575.
[1] 张茜, 陈佳慧, 高雪萌, 赵傲雪, 黄瑛. 基于高帧频超声造影的影像组学特征鉴别诊断甲状腺结节良恶性的价值[J]. 中华医学超声杂志(电子版), 2023, 20(09): 895-903.
[2] 丁雷, 罗文, 杨晓, 庞丽娜, 张佩蒂, 刘海静, 袁佳妮, 刘瑾. 高帧频超声造影在评价C-TIRADS 4-5类甲状腺结节成像特征中的应用[J]. 中华医学超声杂志(电子版), 2023, 20(09): 887-894.
[3] 李卫民, 陈军民, 黄艳丽, 范晓芳, 韩文, 贾磊, 张俊超, 瞿辰. 基于中国甲状腺超声报告与数据系统分析超声在不同大小甲状腺结节中的诊断价值[J]. 中华医学超声杂志(电子版), 2023, 20(07): 743-748.
[4] 王珏, 陈赛君, 贲志飞, 詹锦勇, 徐开颖. 剪切波弹性成像联合极速脉搏波技术评估颈动脉弹性对糖尿病性视网膜病变的预测价值[J]. 中华医学超声杂志(电子版), 2023, 20(06): 636-641.
[5] 付泽辉, 王思齐, 卢叶君, 张剑, 贺烨, 陈卉. 超声对易误诊的等回声、高回声甲状腺结节良恶性的鉴别[J]. 中华医学超声杂志(电子版), 2023, 20(05): 517-523.
[6] 郭云云, 解翔, 彭梅, 姜凡, 毕玉, 何年安, 胡蕾, 杨杨, 王涛, 石玉洁, 陈冬冬. ACR-TIRADS与C-TIRADS分类分别联合二维剪切波弹性成像对甲状腺结节分类的诊断效能——多中心回顾性研究[J]. 中华医学超声杂志(电子版), 2023, 20(05): 511-516.
[7] 黄珈瑶, 林满霞, 田文硕, 何璟怡, 赖佳明, 谢晓燕, 龙海怡. 健康成人胰腺剪切波弹性成像的可行性和测量值及其影响因素[J]. 中华医学超声杂志(电子版), 2023, 20(05): 524-529.
[8] 程广文, 丁红, 陈坤, 张祯, 黄翀, 张继明. 实时双幅联合弹性成像在慢性肝病肝纤维化与炎症分层诊断中的价值[J]. 中华医学超声杂志(电子版), 2023, 20(01): 63-69.
[9] 郭东, 姚春, 庞海苏, 单悦. 超声微血流成像联合弹性成像评分对甲状腺TI-RADS 4类结节良恶性的鉴别诊断价值[J]. 中华医学超声杂志(电子版), 2022, 19(10): 1098-1102.
[10] 付泽辉, 卢叶君, 张剑, 莫晓民, 贺烨, 张晓青, 陶楚楚, 陈卉. 常规超声特征联合内部粗大钙化特征鉴别甲状腺结节良恶性的价值[J]. 中华医学超声杂志(电子版), 2022, 19(08): 767-773.
[11] 李盈盈, 李欣洋, 阎琳, 肖静, 张明博, 罗渝昆. S-detect技术辅助住院医师诊断甲状腺影像报告和数据系统4类≤1 cm甲状腺结节的应用价值[J]. 中华医学超声杂志(电子版), 2022, 19(07): 682-687.
[12] 壮健, 潘昌杰, 李晓琴, 于梦霞, 张超, 朱韦文. 剪切波弹性成像技术评估子痫前期胎盘弹性的临床价值[J]. 中华医学超声杂志(电子版), 2022, 19(07): 660-666.
[13] 强坤坤, 罗红. 杜氏肌营养不良症患儿的高频超声与剪切波弹性成像诊断研究现状及前景[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 162-167.
[14] 李俊, 彭健韵, 邱婉冰, 窦倩怡, 潘福顺, 梁瑾瑜. 甲状腺结节恶性风险分层(指南):ACR TI-RADS与C-TIRADS诊断效能及不同医师使用指南一致性的多中心回顾性比较研究[J]. 中华普通外科学文献(电子版), 2023, 17(06): 401-407.
[15] 柴吉鑫, 张雪, 何时知, 齐艳涛, 王婧婧, 敖亚洲, 陈泳. 不同穿刺方法对甲状腺结节细胞学检查的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(03): 315-318.
阅读次数
全文


摘要