应变弹性成像、声辐射力脉冲成像点剪切波弹性成像与二维剪切波弹性成像在甲状腺结节鉴别诊断中的比较。
Comparison of strain elastography, point shear wave elastography using acoustic radiation force impulse imaging and 2D-shear wave elastography for the differentiation of thyroid nodules.
机构信息
Department of Internal Medicine 1, J.W. Goethe-University Hospital, Frankfurt, Germany.
Institute of Biostatistics and Mathematical Modeling, Faculty of Medicine, J.W. Goethe-University, Frankfurt, Germany.
出版信息
PLoS One. 2018 Sep 17;13(9):e0204095. doi: 10.1371/journal.pone.0204095. eCollection 2018.
PURPOSE
The aim of the study was to compare three different elastography methods, namely Strain Elastography (SE), Point Shear-Wave Elastography (pSWE) using Acoustic Radiation Force Impulse (ARFI)-Imaging and 2D-Shear Wave Elastography (2D-SWE), in the same study population for the differentiation of thyroid nodules.
MATERIALS AND METHODS
All patients received a conventional ultrasound scan, SE and 2D-SWE, and all patients except for two received ARFI-Imaging. Cytology/histology of thyroid nodules was used as a reference method. SE measures the relative stiffness within the region of interest (ROI) using the surrounding tissue as reference tissue. ARFI mechanically excites the tissue at the ROI using acoustic pulses to generate localized tissue displacements. 2D-SWE measures tissue elasticity using the velocity of many shear waves as they propagate through the tissue.
RESULTS
84 nodules (73 benign and 11 malignant) in 62 patients were analyzed. Sensitivity, specificity and NPV of SE were 73%, 70% and 94%, respectively. Sensitivity, specificity and NPV of ARFI and 2D-SWE were 90%, 79%, 98% and 73%, 67%, 94% respectively, using a cut-off value of 1.98m/s for ARFI and 2.65m/s (21.07kPa) for 2D-SWE. The AUROC (Area under the Receiver Operating Characteristic) of SE, ARFI and 2D-SWE for the diagnosis of malignant thyroid nodules were 52%, 86% and 71%, respectively. A significant difference in AUROC was found between SE and ARFI (p = 0.008), while no significant difference was found between ARFI and SWE (86% vs. 71%, p = 0.31), or SWE and SE (71% vs. 52%, p = 0.26).
CONCLUSION
pSWE using ARFI and 2D-SWE showed comparable results for the differentiation of thyroid nodules. ARFI was superior to elastography using SE.
目的
本研究旨在比较三种不同的弹性成像方法，即应变弹性成像（SE）、声辐射力脉冲（ARFI）成像的点剪切波弹性成像（pSWE）和二维剪切波弹性成像（2D-SWE），在同一研究人群中用于甲状腺结节的鉴别诊断。
材料和方法
所有患者均接受常规超声扫描、SE 和 2D-SWE 检查，除 2 例患者外，所有患者均接受 ARFI-成像检查。甲状腺结节的细胞学/组织学检查作为参考方法。SE 通过使用周围组织作为参考组织来测量感兴趣区域（ROI）内的相对硬度。ARFI 使用声脉冲机械激发 ROI 中的组织，以产生局部组织位移。2D-SWE 使用许多剪切波在组织中传播时的速度来测量组织弹性。
结果
62 例患者的 84 个结节（73 个良性和 11 个恶性）进行了分析。SE 的灵敏度、特异性和 NPV 分别为 73%、70%和 94%。ARFI 和 2D-SWE 的灵敏度、特异性和 NPV 分别为 90%、79%、98%和 73%、67%、94%，ARFI 的截断值为 1.98m/s，2D-SWE 的截断值为 2.65m/s（21.07kPa）。SE、ARFI 和 2D-SWE 对恶性甲状腺结节诊断的 AUROC（受试者工作特征曲线下面积）分别为 52%、86%和 71%。SE 与 ARFI 之间的 AUROC 差异有统计学意义（p=0.008），而 ARFI 与 2D-SWE（86%比 71%，p=0.31）或 2D-SWE 与 SE（71%比 52%，p=0.26）之间的 AUROC 差异无统计学意义。
结论
ARFI 成像的 pSWE 和 2D-SWE 对甲状腺结节的鉴别诊断结果相当。ARFI 优于 SE 弹性成像。
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