【摘要】：目的 聲觸診組織定量(VTQ)技術(shù)是聲輻射力脈沖成像技術(shù)(ARFI)新的測(cè)量組織硬度的一種定量技術(shù)，探究它對(duì)甲狀腺良惡性結(jié)節(jié)鑒別診斷的價(jià)值并把它與二維超聲成像相比較。 資料與方法 本研究包括128例患者136個(gè)結(jié)節(jié)，均經(jīng)病理證實(shí)，且所有結(jié)節(jié)都首先行常規(guī)超聲檢查，然后行ARFI的VTQ技術(shù)檢查。記錄每一個(gè)結(jié)節(jié)二維超聲特征，再將VTQ技術(shù)檢查的組織硬度以剪切波速度(SWV)和剪切波速度比值(SWR)記錄下來(lái)。受試者操作特性曲線(xiàn)(ROC)分析用來(lái)評(píng)價(jià)二維超聲及SWV和SWR在良惡性結(jié)節(jié)之間的鑒別診斷。二維超聲和VTQ技術(shù)ROC曲線(xiàn)下的面積被計(jì)算，它們之間的面積比較用Z檢驗(yàn)，p0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.102個(gè)良性結(jié)節(jié)中，14(13.7%)個(gè)病灶周邊有聲暈；41(40%)個(gè)病灶有微鈣化；97(95.1%)個(gè)病灶呈低回聲；7(6.8%)個(gè)病灶縱橫比1；37(36.2%)個(gè)病灶內(nèi)部有血流信號(hào)。32個(gè)惡性結(jié)節(jié)中，3(8.8%)個(gè)病灶周邊有聲暈；12(35.4%)個(gè)病灶有微鈣化；33(97.9%)個(gè)病灶呈低回聲；19(55.8%)個(gè)病灶縱橫比1；21(61.7%)個(gè)病灶內(nèi)部有血流信號(hào)。 根據(jù)超聲各評(píng)分診斷點(diǎn)作為檢驗(yàn)變量，以病理診斷為狀態(tài)變量，作ROC曲線(xiàn)，診斷甲狀腺良、惡性結(jié)節(jié)的曲線(xiàn)下的面積為0.725，診斷臨界點(diǎn)≥4分，二維超聲診斷良惡性結(jié)節(jié)的ROC曲線(xiàn)下面積最大(0.716)，約登指數(shù)為：0.441，其敏感性、特異性分別為62.8%、81.3%。 2.甲狀腺良、惡性結(jié)節(jié)的SWV分別為：(2.37±0.38)m/s、(3.93±1.96) m/s(t=4.907，p值=0.000)；甲狀腺良、惡性病灶SWR分別為：1.15±0.28、1.77±0.69(t=4.512，p值=0.000)；SWV大于2.75m/s作為診斷甲狀腺結(jié)節(jié)敏感性81.4%，特異性82.1%，準(zhǔn)確性80.8%，，陽(yáng)性預(yù)測(cè)值58.6%,陰性預(yù)測(cè)值92.2%；SWR大于1.32診斷甲狀腺結(jié)節(jié)的敏感性69.8%，特異性89.3%，準(zhǔn)確性83.8%，陽(yáng)性預(yù)測(cè)值67.6%,陰性預(yù)測(cè)值89.2%，SWV的ROC曲線(xiàn)下的面積0.868(95%CI:0.762,0.941)(p=0.000)和SWR的ROC曲線(xiàn)下的面積0.813(95%CI:0.687,0.901)(p=0.000)之間無(wú)統(tǒng)計(jì)學(xué)差異(p0.20)。 3.把各個(gè)SWV作為檢驗(yàn)變量，以病理診斷為狀態(tài)變量制作ROC曲線(xiàn)，ROC曲線(xiàn)下的面積為0.868，p值0.000，標(biāo)準(zhǔn)誤0.040；把超聲各評(píng)分診斷點(diǎn)作為檢驗(yàn)變量，以病理診斷為狀態(tài)變量制作ROC曲線(xiàn)，ROC曲線(xiàn)下的面積為:0.725，p值0.001，標(biāo)準(zhǔn)誤0.045；兩者經(jīng)Z檢驗(yàn)，Z=2.897，p0.004，兩者比較差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論 ARFI的VTQ成像對(duì)組織的硬度提供一種量化和可重復(fù)的信息，在鑒別甲狀腺良惡性結(jié)節(jié)方面是一種有用的技術(shù)，VTQ的診斷準(zhǔn)確性高于二維超聲，被認(rèn)為是常規(guī)超聲成像的一個(gè)有益補(bǔ)充。
[Abstract]:Objective the technique of acoustic palpation tissue quantitative (VTQ) (VTQ) is a new quantitative technique for measuring tissue hardness by acoustic radiation pulse imaging (ARFI). To explore its value in differential diagnosis of benign and malignant thyroid nodules and compare it with two-dimensional ultrasound imaging. Materials and methods this study included 136 nodules in 128 patients, all of which were confirmed by pathology, and all nodules were examined by conventional ultrasound first, then by VTQ technique of ARFI. The two-dimensional ultrasonic characteristics of each node were recorded and the tissue hardness measured by VTQ technique was recorded with shear wave velocity (SWV) and shear wave velocity ratio (SWR). (ROC) analysis was used to evaluate the differential diagnosis between benign and malignant nodules by two dimensional ultrasound, SWV and SWR. The area under the ROC curve of two-dimensional ultrasound and VTQ technique was calculated and the difference between them was statistically significant by Z test. Results 1.14 (13.7%) of 102 benign nodules had microcalcification around 41 (40%) lesions, 97 (95.1%) had hypoechoic lesions and 7 (6.8%) had a aspect ratio of 1. In 37 (36.2%) lesions, there was blood flow signal in 37 (36.2%) lesions, and in 3 (8.8%) of 32 malignant nodules, 12 (35.4%) lesions had microcalcification. 33 (97.9%) lesions showed hypoechoic lesions. The aspect ratio of 19 (55.8%) lesions to 121 (61.7%) lesions had blood flow signals. According to the diagnostic points of ultrasound scores as test variables and pathological diagnosis as state variables, the ROC curve was used to diagnose benign and malignant thyroid nodules. The area under the curve was 0.725, and the critical point of diagnosis was 鈮

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