Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong c/o Prince of Wales Hospital, Shatin, New Territories, Hong Kong S.A.R., China.
Eur Radiol. 2012 Nov;22(11):2397-406. doi: 10.1007/s00330-012-2495-1. Epub 2012 May 30.
To evaluate real-time shear wave ultrasound elastography (SWE) for characterizing focal thyroid lesions in routine clinical practice.
Seventy-four patients with 81 focal thyroid lesions undergoing conventional US with needle cytology also underwent SWE. Absolute and relative SWE stiffness measurements on colour-coded elastograms were correlated with cytology and their discriminatory performances assessed.
Seventeen nodules were malignant (13 papillary, 4 other cancers), 45 benign (43 hyperplastic nodules, 2 focal thyroiditis), 5 indeterminate ("follicular lesions"), and 5 had inadequate cytology. SWE results were higher in malignant than benign nodules (P values 0.02-0.05) although their discriminatory performances were mediocre (AUCs 0.58-0.74). The most accurate SWE cut-off, 34.5 kPa for a 2-mm region of interest, achieved 76.9 % sensitivity and 71.1 % specificity for discriminating papillary cancer from benign nodules. No thresholds produced high sensitivity without lowering specificity appreciably, and vice versa. Nodule size correlated with SWE for benign nodules (P < 0.01). Intranodular cystic change or calcification did not influence SWE. Qualitatively, elastographic artefacts and foci lacking colour elasticity signal occurred in some solid nodules.
Although malignant nodules are generally stiffer than benign nodules, the precision results do not suggest a definitive role for SWE, at present, in identifying or excluding thyroid malignancy.
• Shear wave ultrasound elastography (SWE) offers new insight into thyroid disease. • Papillary cancers have higher SWE indices (equating to higher stiffness) than benign nodules. • SWE appears limited in terms of identifying or excluding thyroid malignancy accurately. • Vertically aligned elastographic artefacts can occur in thyroid SWE. • Areas lacking SWE colour signal can occur in some solid thyroid nodules.
评估实时剪切波超声弹性成像（SWE）在常规临床实践中对甲状腺局灶性病变的特征描述能力。
74 例 81 个甲状腺局灶性病变患者行常规超声检查及细针穿刺细胞学检查，同时行 SWE。对彩色弹性图上的绝对和相对 SWE 硬度测量值与细胞学结果进行相关性分析，并评估其鉴别诊断性能。
17 个结节为恶性（13 个为乳头状癌，4 个为其他癌症），45 个为良性（43 个为增生性结节，2 个为局灶性甲状腺炎），5 个为不确定（“滤泡性病变”），5 个为细胞学不充分。恶性结节的 SWE 结果高于良性结节（P 值为 0.02-0.05），但鉴别诊断性能一般（AUC 为 0.58-0.74）。最准确的 SWE 截断值为 34.5kPa（感兴趣区 2mm 直径），用于鉴别甲状腺乳头状癌与良性结节时，灵敏度为 76.9%，特异性为 71.1%。没有一个截断值能在不明显降低特异性的情况下显著提高灵敏度，反之亦然。结节大小与良性结节的 SWE 相关（P<0.01）。结节内囊性变或钙化不影响 SWE。在一些实性结节中，弹性成像存在伪像和缺乏彩色弹性信号的区域。
虽然恶性结节通常比良性结节更硬，但精细的结果并不表明 SWE 目前在识别或排除甲状腺恶性肿瘤方面具有明确作用。
• 剪切波超声弹性成像（SWE）为甲状腺疾病提供了新的认识。• 甲状腺乳头状癌的 SWE 指数（代表更高的硬度）高于良性结节。• SWE 在准确识别或排除甲状腺恶性肿瘤方面似乎有限。• 甲状腺 SWE 中可出现垂直排列的弹性成像伪像。• 一些实性甲状腺结节中可出现缺乏 SWE 彩色信号的区域。
