Dobruch-Sobczak Katarzyna, Gumińska Anna, Bakuła-Zalewska Elwira, Mlosek Krzysztof, Słapa Rafał Z, Wareluk Paweł, Krauze Agnieszka, Ziemiecka Agnieszka, Migda Bartosz, Jakubowski Wiesław, Dedecjus Marek
Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Science, Warsaw, Poland; Department of Radiology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
Department of Endocrine Oncology and Nuclear Medicine, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
J Ultrason. 2015 Dec;15(63):358-67. doi: 10.15557/JoU.2015.0033. Epub 2015 Dec 28.
Shear wave elastography (SWE) is a modern method for the assessment of tissue stiffness. There has been a growing interest in the use of this technique for characterizing thyroid focal lesions, including preoperative diagnostics.
The aim of the study was to assess the clinical usefulness of SWE in medullary thyroid carcinoma (MTC) diagnostics.
A total of 169 focal lesions were identified in the study group (139 patients), including 6 MTCs in 4 patients (mean age: 45 years). B-mode ultrasound and SWE were performed using Aixplorer (SuperSonic, Aix-en-Provence), with a 4-15 MHz linear probe. The ultrasound was performed to assess the echogenicity and echostructure of the lesions, their margin, the halo sign, the height/width ratio (H/W ratio), the presence of calcifications and the vascularization pattern. This was followed by an analysis of maximum and mean Young's (E) modulus values for MTC (EmaxLR, EmeanLR) and the surrounding thyroid tissues (EmaxSR, EmeanSR), as well as mean E-values (EmeanLRz) for 2 mm region of interest in the stiffest zone of the lesion. The lesions were subject to pathological and/or cytological evaluation.
The B-mode assessment showed that all MTCs were hypoechogenic, with no halo sign, and they contained micro- and/ or macrocalcifications. Ill-defined lesion margin were found in 4 out of 6 cancers; 4 out of 6 cancers had a H/W ratio > 1. Heterogeneous echostructure and type III vascularity were found in 5 out of 6 lesions. In the SWE, the mean value of EmaxLR for all of the MTCs was 89.5 kPa and (the mean value of EmaxSR for all surrounding tissues was) 39.7 kPa Mean values of EmeanLR and EmeanSR were 34.7 kPa and 24.4 kPa, respectively. The mean value of EmeanLRz was 49.2 kPa.
SWE showed MTCs as stiffer lesions compared to the surrounding tissues. The lesions were qualified for fine needle aspiration biopsy based on B-mode assessment. However, the diagnostic algorithm for MTC is based on the measurement of serum calcitonin levels, B-mode ultrasound and FNAB.
剪切波弹性成像（SWE）是一种评估组织硬度的现代方法。人们对使用该技术来表征甲状腺局灶性病变（包括术前诊断）的兴趣日益浓厚。
本研究的目的是评估SWE在甲状腺髓样癌（MTC）诊断中的临床实用性。
研究组（139例患者）共识别出169个局灶性病变，其中4例患者有6个MTC（平均年龄：45岁）。使用Aixplorer（SuperSonic，普罗旺斯地区艾克斯）和4-15 MHz线性探头进行B超和SWE检查。进行超声检查以评估病变的回声性和回声结构、边缘、晕圈征、高/宽比（H/W比）、钙化情况和血管分布模式。随后分析MTC（EmaxLR、EmeanLR）和周围甲状腺组织（EmaxSR、EmeanSR）的最大和平均杨氏模量值，以及病变最硬区域2 mm感兴趣区的平均E值（EmeanLRz）。对病变进行病理和/或细胞学评估。
B超评估显示，所有MTC均为低回声，无晕圈征，且含有微钙化和/或大钙化。6例癌症中有4例边界不清；6例癌症中有4例H/W比>1。6个病变中有5个具有不均匀回声结构和III型血管分布。在SWE中，所有MTC的EmaxLR平均值为89.5 kPa，所有周围组织的EmaxSR平均值为39.7 kPa。EmeanLR和EmeanSR的平均值分别为34.7 kPa和24.4 kPa。EmeanLRz的平均值为49.2 kPa。
与周围组织相比，SWE显示MTC为更硬的病变。根据B超评估，这些病变适合进行细针穿刺活检。然而，MTC的诊断算法基于血清降钙素水平测量、B超和细针穿刺抽吸活检。
