甲状腺结节良恶性评估中 TIRADS、SRE 和 SWE：哪种方法的诊断性能更好？
TIRADS, SRE and SWE in INDETERMINATE thyroid nodule characterization: Which has better diagnostic performance?
机构信息
Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
出版信息
Radiol Med. 2021 Sep;126(9):1189-1200. doi: 10.1007/s11547-021-01349-5. Epub 2021 Jun 15.
PURPOSE
To assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) accuracy alone and with TIRADS classification, for the risk stratification of indeterminate thyroid nodules.
MATERIALS AND METHODS
128 Patients with 128 indeterminate nodules candidates for thyroidectomy underwent preoperative staging neck ultrasound and were classified according to K-TIRADS score. After TIRADS evaluation, semi-quantitative (SRE) and quantitative (SWE expressed in kPa) elastosonography were performed and relative diagnostic performances, alone and in combination, were compared through ROC curves analysis. In order to maximize the SRE and SWE sensitivity and specificity, their cut-off values were calculated using the Liu test. Bonferroni test was used to evaluate statistically significant differences with a p value < 0.05.
RESULTS
Sensitivity, specificity, PPV and NPV were, respectively, 71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, 85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa expressed). SRE evaluation showed the best diagnostic accuracy compared to the SWE (kPa expressed) (p < 0.05) and to the K-TIRADS (p > 0.05). The association of SRE with conventional ultrasound with K-TIRADS score increased sensitivity (92.9% vs 71.4%) but decreased the specificity than conventional US alone (76.5% vs 82.4%).
CONCLUSION
Strain Elastosonography can be associated with K-TIRADS US examination in the thyroid nodule characterization with indeterminate cytology; in fact, adding the SRE to K-TIRADS assessment significantly increases its sensitivity and negative predictive value. However, further multicenter studies on larger population are warranted.
目的
评估应变比（SRE）和剪切波弹性成像（SWE）单独及联合 TIRADS 分类在甲状腺结节不确定患者中的风险分层中的准确性。
材料和方法
对 128 例 128 个有甲状腺切除术适应证的不确定甲状腺结节患者进行术前颈部超声分期，并根据 K-TIRADS 评分进行分类。在 TIRADS 评估后，进行半定量（SRE）和定量（SWE 以 kPa 表示）弹性成像，并通过 ROC 曲线分析比较单独及联合使用时的相对诊断性能。为了最大化 SRE 和 SWE 的灵敏度和特异性，使用 Liu 检验计算其截止值。Bonferroni 检验用于评估具有统计学意义的差异，p 值<0.05。
结果
K-TIRADS 基线 US 的灵敏度、特异性、PPV 和 NPV 分别为 71.4%、82.4%、62.5%、87.5%，SRE 为 85.7%、94.1%、85.7%、94.1%，SWE（以 kPa 表示）为 57.1%、79.4%、53.3%、81.8%。与 SWE（以 kPa 表示）相比，SRE 评估显示出最佳的诊断准确性（p<0.05），与 K-TIRADS 相比（p>0.05）也是如此。与 K-TIRADS 评分联合的 SRE 与常规超声联合使用时提高了灵敏度（92.9% vs 71.4%），但特异性低于常规 US 单独使用（76.5% vs 82.4%）。
结论
应变弹性成像可与甲状腺结节细胞学不确定的 K-TIRADS 超声检查联合使用进行特征描述；事实上，将 SRE 加入到 K-TIRADS 评估中可显著提高其敏感性和阴性预测值。然而，需要进一步进行更大规模人群的多中心研究。
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