VueBox® 灌注分析在诊断甲状腺小结节中的应用

VueBox® perfusion analysis of dynamic contrast enhanced ultrasound provides added value in the diagnosis of small thyroid nodules.

机构信息

Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.

Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.

出版信息

Clin Hemorheol Microcirc. 2023;83(4):409-420. doi: 10.3233/CH-221681.

DOI:10.3233/CH-221681

PMID:36683500

Abstract

OBJECTIVES

To explore the potential added value of dynamic contrast enhanced ultrasound (DCE-US) using VueBox® software for the diagnosis of small solid thyroid nodules (≤1.0 cm).

PATIENTS AND METHODS

This prospective study was approved by the institutional review board and it was performed at two hospitals from January 2020 to October 2020. B mode ultrasound and contrast enhanced ultrasound (CEUS) images were obtained for 79 small solid thyroid nodules (≤1.0 cm) confirmed by ultrasound-guided fine needle aspiration cytology results in 79 consecutive patients (55 women and 24 men, median age: 41 years). The CEUS time-intensity curves (TICs) of thyroid nodules and surrounding parenchyma were created by VueBox® software (Bracco, Italy). The CEUS quantitative parameters were obtained after curve fitting. The diagnostic performance of CEUS and DCE-US was evaluated and compared. The weighted kappa statistic (κ) was performed to assess the interobserver agreement and consistency between the diagnosis of CEUS and DCE-US.

RESULTS

Among the 79 thyroid nodules, 56 (70.9 %) were malignant and 23 (29.1 %) were benign lesions. Hypoenhancement during the arterial phase of CEUS was associated with malignancy (P < 0.001), with an AUC of 0.705 (sensitivity 71.4 %, specificity 69.6 %). Among all CEUS quantitative parameters, the peak enhancement (PE), wash-in rate (WiR), and wash-out rate (WoR) of DCE-US in malignancies were significantly lower than those in benign nodules (P = 0.049, P = 0.046, and P = 0.020, respectively). The area under the receiver operating characteristic curves (AUCs) of PE, WiR, and WoR were 0.642 (sensitivity 65.2 %, specificity 67.9 %), 0.643 (sensitivity 43.5 %, specificity 91.1 %), and 0.667 (sensitivity 69.6 %, specificity 69.6 %) in differentiation between benign and malignant small solid thyroid nodules (≤1.0 cm), respectively. Comparing the quantitative parameters of DCE-US between small solid thyroid nodules and surrounding normal thyroid parenchyma, the PE, WiAUC, WiR, wash-in perfusion index (WiPI), WoAUC, WiWoAUC, and WoR of the nodules were significantly lower than those of normal thyroid tissue (P = 0.008, P < 0.001, P = 0.037, P = 0.009, P = 0.003, P = 0.002, P = 0.049, respectively). A total of 16 (20.3 %) nodules showed isoenhancement during the arterial phase of CEUS, while the median PE ratio of surrounding tissue and thyroid nodules was 1.70 (IQR: 1.33-1.89).

CONCLUSIONS

VueBox® is a helpful tool for the evaluation of dynamic microvascularization of thyroid nodules, and DCE-US using VueBox® perfusion analysis could provide added values for differential diagnosis of small solid thyroid nodules (≤1.0 cm).

摘要

目的

探讨 VueBox®软件在诊断直径≤1.0cm 甲状腺小实性结节中的应用，探讨其对常规超声造影（CEUS）的补充诊断价值。

方法

本前瞻性研究经机构审查委员会批准，于 2020 年 1 月至 2020 年 10 月在两家医院进行。共纳入 79 例经超声引导下细针穿刺细胞学证实的直径≤1.0cm 的甲状腺小实性结节患者（55 例女性，24 例男性；中位年龄 41 岁），对其进行常规超声和 CEUS 检查。采用 VueBox®软件（Bracco，意大利）获得甲状腺结节及周围实质的时间-强度曲线（TIC），并进行曲线拟合获得 CEUS 定量参数。评估和比较 CEUS 和 DCE-US 的诊断效能，采用加权κ 检验评估 CEUS 和 DCE-US 诊断结果的一致性和观察者间的一致性。

结果

79 个甲状腺结节中，56 个（70.9%）为恶性，23 个（29.1%）为良性。CEUS 动脉期低增强与恶性肿瘤相关（P<0.001），其 AUC 为 0.705（灵敏度 71.4%，特异度 69.6%）。在所有的 CEUS 定量参数中，DCE-US 的峰值增强（PE）、上升斜率（WiR）和下降斜率（WoR）在恶性结节中明显低于良性结节（P=0.049、P=0.046 和 P=0.020）。PE、WiR 和 WoR 的受试者工作特征曲线（ROC）曲线下面积（AUC）分别为 0.642（灵敏度 65.2%，特异度 67.9%）、0.643（灵敏度 43.5%，特异度 91.1%）和 0.667（灵敏度 69.6%，特异度 69.6%），用于区分直径≤1.0cm 的甲状腺良恶性小实性结节。比较甲状腺小实性结节与周围正常甲状腺组织的 DCE-US 定量参数，结节的 PE、WiAUC、WiR、WiPI、WoAUC、WiWoAUC 和 WoR 均明显低于正常甲状腺组织（P=0.008、P<0.001、P=0.037、P=0.009、P=0.003、P=0.002、P=0.049，分别）。16 个（20.3%）结节在 CEUS 动脉期呈等增强，周围组织与甲状腺结节的中位 PE 比值为 1.70（IQR：1.33-1.89）。