Zhang Yi-Feng, He Yong, Xu Hui-Xiong, Xu Xiao-Hong, Liu Chang, Guo Le-Hang, Liu Lin-Na, Xu Jun-Mei
Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, 301 Yanchangzhong Rd, 200072 Shanghai, China.
J Ultrasound Med. 2014 Apr;33(4):585-95. doi: 10.7863/ultra.33.4.585.
Objectives- Acoustic radiation force impulse elastography is a newly developed ultrasound elasticity imaging technique that included both Virtual Touch tissue quantification and Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA). This study aimed to evaluate the usefulness of VTI in differentiating malignant from benign thyroid nodules. Methods- This study included 192 consecutive patients with thyroid nodules (n = 219) who underwent surgery for compressive symptoms or suspicion of malignancy. Tissue stiffness on VTI elastography was scored from 1 (soft) to 6 (hard). The VTI scores between malignant and benign thyroid nodules were compared. The intraobserver and interobserver agreement for VTI elastography was also assessed. Results- On VTI elastography: score 1 was found in 84 nodules (all benign); score 2 in 37 nodules (3 papillary carcinomas and 34 benign nodules); score 3 in 25 nodules (1 medullary carcinoma, 6 papillary carcinomas, and 18 benign nodules); score 4 in 53 nodules (50 papillary carcinomas and 3 benign nodules); score 5 in 17 nodules (14 papillary carcinomas and 3 benign nodules); and score 6 in 3 nodules (all papillary carcinomas). A VTI elasticity score of 4 or greater was highly predictive of malignancy (P< .01), and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.0% (67 of 77), 95.8% (136 of 142), 91.8% (67 of 73), 93.1% (136 of 146), and 92.7% (203 of 219), respectively. The κ values were 0.69 for intraobserver agreement and 0.85 for interobserver agreement. Conclusions- Virtual Touch tissue elasticity imaging has great potential as an adjunctive tool combined with conventional sonography for differential diagnosis between benign and malignant thyroid nodules.
目的——声辐射力脉冲弹性成像是一种新开发的超声弹性成像技术，包括虚拟触诊组织定量和虚拟触诊组织成像（VTI；西门子医疗解决方案公司，加利福尼亚州山景城）。本研究旨在评估VTI在鉴别甲状腺良恶性结节中的作用。方法——本研究纳入了192例连续的甲状腺结节患者（共219个结节），这些患者因出现压迫症状或怀疑为恶性而接受手术。VTI弹性成像的组织硬度评分为1（软）至6（硬）。比较了甲状腺良恶性结节的VTI评分。还评估了VTI弹性成像的观察者内和观察者间一致性。结果——在VTI弹性成像中：84个结节评分为1分（均为良性）；37个结节评分为2分（3个乳头状癌和34个良性结节）；25个结节评分为3分（1个髓样癌、6个乳头状癌和18个良性结节）；53个结节评分为4分（50个乳头状癌和3个良性结节）；17个结节评分为5分（14个乳头状癌和3个良性结节）；3个结节评分为6分（均为乳头状癌）。VTI弹性评分4分及以上高度提示为恶性（P<0.01），敏感性、特异性、阳性预测值、阴性预测值和准确性分别为87.0%（77个中的67个）、95.8%（142个中的136个）、91.8%（73个中的67个）、93.1%（146个中的136个）和92.7%（219个中的203个）。观察者内一致性的κ值为0.69，观察者间一致性的κ值为0.85。结论——虚拟触诊组织弹性成像作为一种辅助工具，与传统超声检查相结合，在甲状腺良恶性结节的鉴别诊断中具有巨大潜力。
