目的 探讨剪切波弹性成像对桥本甲状腺炎患者合并甲状腺结节良恶性的鉴别诊断价值.方法 收集经穿刺活检或术后病理证实的桥本甲状腺炎患者54例,根据结节良恶性分为良性结节组和恶性结节组,良性结节组又分为假结节组和真结节组.测量并比较分析甲状腺结节的杨氏模量值,绘制ROC曲线以评价其诊断效能.结果 54例桥本甲状腺炎患者共检出162个结节,其中良性结节131个(真结节93个,假结节38个)、恶性结节31个.桥本甲状腺炎合并良性结节、恶性结节、真结节及假结节的杨氏模量均值分别为(33.04±10.95)kPa、(66.15±19.17)kPa、(35.95±9.74) kPa、(30.13±11.87)kPa.良性结节与恶性结节杨氏模量值差异有统计学意义(t=12.91,P＜0.01);假结节组、真结节组与恶性结节组的杨氏模量值总体差异有统计学意义(F=36.20,P＜0.01),且恶性结节组杨氏模量值高于其他2组(P均＜0.01).通过ROC曲线确定杨氏模量值的诊断临界点为43.65 kPa,其诊断良恶性甲状腺结节的敏感度为90.63％、特异度为81.25％、阳性似然比为4.83、阴性似然比为0.12.结论 剪切波弹性成像技术可以对桥本甲状腺炎及其结节进行定量分析,有助于结节性质的判定.%Objective To evaluate the differential diagnosis value of shear wave elastography for Hashimoto's disease with benign or malignant thyroid nodules.Methods Fifty four patients of Hashimoto's disease confirmed by biopsy or pathology were enrolled.Based on benign or malignant of nodules,patients were divided into benign nodules group and malignant nodules group.And the benign group were divided into true nodules and sham nodules.Young's modulus values were measured and compared among different groups.The ROC curve was drawn to evaluate the diagnostic efficency.Results There were tatol 162 nodules in 54 cases with Hashimoto's disease,including 131 of benign nodules (93 of true nodules,38 of sham nodules) and 31 of malignant nodules.The values of Young's modulus for benign,malignant,ture nodules and sham nodules were (33.04±10.95)kPa,(66.15±19.17)kPa,(35.95±9.74)kPa and (30.13±11.87)kPa.For mean values of Young's modulus,there was significantly statistical difference between benign and malignant nodules (t=12.91,P＜0.01).There was significant statistical difference of the Young's modulus among sham nodule group,true nodule group and malignant nodule group (F 36.20,P＜0.01).Compared with the other two groups,the value of Young's modulus in malignant nodules was significantly higher than that in the other two groups (both P＜0.01).Taking 43.65 kPa as the diagnostic point,the sensitivity,specificity,positive likelihood ratio,and negative likelihood ratio of Youngs modulus in diagnosis of benign and malignat nodules were 90.63％,81.25％,4.83,and 0.12.Conclusion Shear wave elastography technique can quantitative analysis the Hashimoto's disease and complicated nodules,which is helpful to determine the essence of the nodules.
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