ARFI鉴别诊断TMC.doc

声脉冲辐射力弹性成像诊断甲状腺微小癌的价值 何勇 徐辉雄 张一峰 郭乐航 刘琳娜 刘畅 徐军妹 【摘要】目的 探讨声脉冲辐射力（acoustic radiation force impulse，ARFI）弹性成像技术诊断甲状腺微小癌（thyroid microcarcinoma，TMC）的价值。方法 回顾性分析经病理证实的14例患者的15个直径≤1cm甲状腺结节的ARFI弹性特征，包括声触诊组织定量成像（virtual touch tissue quantification, VTQ）及声触诊组织成像（virtual touch tissue imaging, VTI）。甲状腺结节评分应用VTQ定量法及VTI分级法，以病理结果为诊断金标准。分别绘制VTQ及VTI 诊断TMC的ROC曲线，比较曲线下面积。结果 VTQ诊断SWV≥2.87m/s结节8个，SWV＜2.87m/s结节7个，VTQ诊断TMC的敏感性、特异性及准确率分别为50%，43%，47%；VTI诊断VTI分级≥Ⅳ结节7个，VTI分级＜Ⅳ结节8个，VTI诊断TMC的敏感性、特异性及准确率分别为88%，100%，93%。VTQ及VTI的ROC曲线下面积分别为0.527 、0.938 （Z＞2.56,P＜0.01）。结论 ARFI弹性成像可用于鉴别诊断TMC，VTI与VTQ比较具有更高的诊断价值。 【关键词】声脉冲辐射力；弹性成像；甲状腺微小癌 Value of acoustic radiation force impulse imaging in the differential of thyroid microcarcinoma HE Yong, XU Hui-xiong, ZHANG Yi-feng, GUO Le-hang，LIU Lin-na，LIU Chang，XU Jun-mei. Department of Medical Ultrasound，Tenth People’s hospital of Tongji University, Medical Imaging Center of Tongji University, Shanghai 200072 【Abstract】 Objective To explore the value of acoustic radiation force impulse (ARFI) elastography in the differential of thyroid microcarcinoma. Methods The ARFI elastography characteristics of fifteen histologically proven thyroid sub-centimeter nodules in fourteen patients were retrospectively reviewed. Virtual touch tissue quantification (VTQ) and virtual touch tissue imaging （VTI） were used to evaluate the ARFI images. Two receiver operator characteristic (ROC) curves were drawn, one for the VTI，and one for the VTQ. The area under curve (AUC) of them made a comparison. Results The SWV values of 8 nodule greater then or equal to 2.87m/s，and 9 nodules less then 2.87m/s. The sensitivity, specificity and accuracy rate of VTQ were 50%，43% and 47%（p﹥0.05）， respectively. The numbers of VTI score greater then or equal to Ⅳ and less then Ⅳ were 7 and 9, respectively. The sensitivity, specificity and accuracy rate of VTI were 88%，100% and 93%（p﹤0.01）， respectively. The AUC of the VTQ was 0.527 and that of the VTI was 0.938. The difference between the