Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Korean J Radiol. 2018 Sep-Oct;19(5):992-999. doi: 10.3348/kjr.2018.19.5.992. Epub 2018 Aug 6.
The aim of this study was to evaluate the diagnostic performance of gray-scale ultrasonography (US), Doppler scan, and elastography using carotid artery pulsation in the diagnosis of thyroid nodules and to find a complementary role of elastography.
A total 197 thyroid nodules with 91 malignant and 106 benign pathologic results from 187 patients (41 males and 146 females; age range, 20-83 years; mean age, 49.4 years) were included in this prospective study. The gray-scale, Doppler US images, elastography with elasticity contrast index (ECI), and stiffness color were assessed. The diagnostic performances of each dataset were assessed in order to differentiate benign from malignant thyroid nodules.
The optimal cut-off value of the ECI was 1.71. The area under receiver operating characteristic curve (Az value) was 0.821 for gray-scale US, 0.661 for the ECI, 0.592 for stiffness color, and 0.539 for Doppler US. The Az value for a combined assessment of gray-scale US and the ECI was higher than that for the gray-scale US alone; however, there was no statistical difference between the two ( = 0.219). The median ECI values of follicular thyroid carcinoma (FTC) and follicular variant of papillary thyroid carcinoma (FVPTC) were significantly lower than those of the other malignant lesions ( = 0.005). Meanwhile, the diffuse sclerosing variant of PTC and a metastatic nodule showed the two highest median values of the ECI.
For differentiating thyroid nodules, the diagnostic performances of the combination of gray-scale US and elastography with the ECI were similar to, but not superior, to those of gray-scale US alone. FVPTC and FTC have a significantly lower ECI value than those of the other malignant lesions.
本研究旨在评估灰阶超声（US）、多普勒扫描和颈动脉搏动弹性成像在甲状腺结节诊断中的诊断性能，并寻找弹性成像的互补作用。
本前瞻性研究共纳入 187 例患者（41 名男性和 146 名女性；年龄 20-83 岁；平均年龄 49.4 岁）的 197 个甲状腺结节，其中 91 个为恶性，106 个为良性病理结果。评估了灰阶、多普勒 US 图像、弹性成像的弹性对比指数（ECI）和硬度颜色，并评估了每个数据集的诊断性能，以区分良性和恶性甲状腺结节。
ECI 的最佳截断值为 1.71。灰阶 US、ECI、硬度颜色和多普勒 US 的受试者工作特征曲线（Az 值）的曲线下面积分别为 0.821、0.661、0.592 和 0.539。灰阶 US 和 ECI 联合评估的 Az 值高于灰阶 US 单独评估，但差异无统计学意义（=0.219）。滤泡状甲状腺癌（FTC）和滤泡状甲状腺癌变异型（FVPTC）的 ECI 中位数明显低于其他恶性病变（=0.005）。同时，弥漫硬化型 PTC 和转移性结节的 ECI 中位数最高。
对于甲状腺结节的鉴别诊断，灰阶 US 联合 ECI 弹性成像的诊断性能与灰阶 US 单独诊断相似，但并不优于灰阶 US 单独诊断。FVPTC 和 FTC 的 ECI 值明显低于其他恶性病变。
