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目的评价剪切波弹性成像(SWE)对桥本甲状腺炎(HT)背景下的甲状腺结节良恶性的鉴别诊断作用。方法回顾性分析2013年1月至2014年6月中山大学附属第一医院行甲状腺手术前超声检查发现可疑结节并行SWE检查的260例病人(297个结节)的临床资料,其中合并HT者73例(83个结节)。SWE定量测量甲状腺结节时,调节感兴趣区(ROI)大小为2 mm,并置于结节内最硬处,记录ROI内SWE值(表示硬度)。结果恶性结节的SWE值高于良性结节和周围实质,差异均有统计学意义[(64.4±42.8)k Pa vs.(26.8±15.3)k Pa vs.(17.7±5.3)k Pa,P<0.001];组内恶性结节SWE值高于良性结节和周围实质(P<0.05);组间同类结节的SWE值差异无统计学意义(P>0.05)。HT组结节周围甲状腺组织的SWE值高于非HT组(P<0.05),且其与血清TPO-Ab之间存在正相关关系[相关系数(r)=0.307,P<0.05]。当其SWE值为39.0 k Pa时,SWE技术诊断结节良恶性的敏感度、特异度及准确率分别为68.9%、91.7%和82.9%。结论 SWE值为39.0 k Pa时SWE技术(ROI大小为2 mm)对于HT病人的结节良恶性具有较高的诊断价值。
Objective To evaluate the differential diagnosis of benign and malignant thyroid nodules by shear wave elastography (SWE) in the context of Hashimoto’s thyroiditis (HT). Methods The clinical data of 260 patients (297 nodules) with suspicious nodules and SWE examinations were retrospectively analyzed from January 2013 to June 2014 in the First Affiliated Hospital of Sun Yat-sen University from January 2013 to June 2014. Among them, 73 cases (83 nodules). SWE quantitative measurement of thyroid nodules, the adjustment of interest area (ROI) size of 2 mm, and placed in the hardest nodules, recording SWE value within the ROI (hardness). Results The SWE of malignant nodules was higher than that of benign nodules and surrounding parenchyma ([(64.4 ± 42.8) kPa vs. (26.8 ± 15.3) kPa vs. (17.7 ± 5.3) kPa, P <0.001]. The SWE value of malignant nodules was higher than benign nodules and surrounding parenchyma (P <0.05). There was no significant difference in SWE between nodules (P> 0.05). The SWE of thyroid tissue around the nodules of HT group was higher than that of non-HT group (P <0.05), and there was a positive correlation between serum SWT and serum TPO-Ab [correlation coefficient (r) = 0.307, P <0.05]. When the SWE value was 39.0 kPa, the sensitivity, specificity and accuracy of the diagnosis of malignant and benign nodules of SWE were 68.9%, 91.7% and 82.9% respectively. Conclusion The SWE technique (ROI size of 2 mm) with a SWE value of 39.0 k Pa has a high diagnostic value for benign and malignant nodules in patients with HT.