Usefulness of Real-Time Quantitative Microvascular Ultrasonography for Differentiation of Graves' Disease from Destructive Thyroiditis in Thyrotoxic Patients.
Usefulness of Real-Time Quantitative Microvascular Ultrasonography for Differentiation of Graves' Disease from Destructive Thyroiditis in Thyrotoxic Patients.
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DOI：
10.3803/enm.2022.1413
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发表时间：
2022-04
影响因子：
3.4
通讯作者：
Lim, Dong-Jun
中科院分区：
文献类型：
--
作者：
Baek, Han-Sang;Park, Ji-Yeon;Jeong, Chai-Ho;Ha, Jeonghoon;Kang, Moo Il;Lim, Dong-Jun
关键词：
微血管超声检查（MVUS）是第三代多普勒技术，与传统多普勒相比，其灵敏度更高。本研究的目的是比较MVUS与常规彩色多普勒（CD）和能量多普勒（PD）成像在鉴别Graves病（GD）和破坏性甲状腺炎（DT）中的作用。这项前瞻性研究包括2020年10月至2021年11月的101名受试者（46名GD，47名DT和8名正常对照）。所有超声检查均采用微血管血流技术（MV-Flow）进行。根据血流模式对CD、PD和MVUS图像进行半定量分级。在MVUS图像上，自动获得血管指数（维斯），即在定义的感兴趣区域中彩色像素占总灰度像素的比率（%）。通过受试者工作特征曲线分析验证MVUS的诊断性能。使用组间相关系数和Cohen's kappa分析来分析MVUS的可靠性（ClinicalTrials.gov：NCT 04879173）。CD、PD、MVUS和MVUS-VI的曲线下面积（AUC）分别为0.822、0.844、0.808和0.852。MVUS-VI鉴别GD和DT的最佳临界值为24.95%，敏感性为87%，特异性为80.9%。MVUS-VI与促甲状腺激素受体抗体（r=0.554）和甲状腺刺激性免疫球蛋白生物测定（r=0.841）呈显著正相关。MVUS显示了各种统计方法的高观察者内和观察者间可靠性。MVUS-VI以真实的时间和定量的方式有助于鉴别甲状腺功能亢进患者的GD和甲状腺炎，且观察者间变异性较小。
Microvascular ultrasonography (MVUS) is a third-generation Doppler technique that was developed to increase sensitivity compared to conventional Doppler. The purpose of this study was to compare MVUS with conventional color Doppler (CD) and power Doppler (PD) imaging to distinguish Graves’ disease (GD) from destructive thyroiditis (DT). This prospective study included 101 subjects (46 GDs, 47 DTs, and eight normal controls) from October 2020 to November 2021. All ultrasonography examinations were performed using microvascular flow technology (MV-Flow). The CD, PD, and MVUS images were semi-quantitatively graded according to blood flow patterns. On the MVUS images, vascularity indices (VIs), which were the ratio (%) of color pixels in the total grayscale pixels in a defined region of interest, were obtained automatically. Receiver operating characteristic curve analysis was performed to verify the diagnostic performance of MVUS. The interclass correlation coefficient and Cohen’s kappa analysis were used to analyze the reliability of MVUS (ClinicalTrials.gov:NCT04879173). The area under the curve (AUC) for CD, PD, MVUS, and MVUS-VI was 0.822, 0.844, 0.808, and 0.852 respectively. The optimal cutoff value of the MVUS-VI was 24.95% for distinguishing GD and DT with 87% sensitivity and 80.9% specificity. We found a significant positive correlation of MVUS-VI with thyrotropin receptor antibody (r=0.554) and with thyroid stimulating immunoglobulin bioassay (r=0.841). MVUS showed high intra- and inter-observer reliability from various statistical method. In a real time and quantitative manner, MVUS-VI could be helpful to differentiate GD from thyroiditis in thyrotoxic patients, with less inter-observer variability.