Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography: A Preliminary Two-plane View Study
Differentiation of Benign and Malignant Thyroid Nodules by Using Comb-push Ultrasound Shear Elastography: A Preliminary Two-plane View Study
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DOI：
10.1016/j.acra.2018.02.025
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发表时间：
2018-11-01
影响因子：
4.8
通讯作者：
Alizad, Azra
中科院分区：
文献类型：
--
作者：
Gregory, Adriana;Bayat, Mandi;Alizad, Azra
基本原理和目标：传统超声在区分甲状腺结节良恶性方面的低特异性导致大量不必要的（即良性）细针穿刺活检，这给患者带来了巨大的经济和身体负担。超声剪切波弹性成像是一种能够提供与组织刚度相关的附加信息的技术。在这项研究中，定量刚度值获得超声剪切波弹性成像在两个不同的成像平面进行了评估，预测甲状腺结节的恶性。此外，弹性测量与甲状腺和结节的超声特征的关联。材料和方法：共计155名患者（106名女性和49名男性）（平均年龄57.48 ± 14.44岁），173个甲状腺结节（平均尺寸24.89 ± 15.41 mm，范围5-68 mm），计划于2015年3月至2017年5月进行细针抽吸活检。在纵向和横向解剖平面进行梳推剪切弹性成像。结果：纵切面测量值明显高于横切面测量值。伴有钙化的结节与弹性增加相关，而含有血管成分或甲状腺肿大（甲状腺肿）内的结节与弹性值较低相关。对每个成像平面的E-mean和E-max以及两个平面的平均值进行受试者工作特征曲线分析。两个平面的E-mean和E-max参数的平均值的敏感性为95.45%，特异性为86.61%，阳性预测值为0.58，阴性预测值为0.99，曲线下面积分别为92%和93%，截断值分别为49.09 kPa和105.61 kPa。甲状腺结节的弹性性质在良恶性结节之间有很好的相似性（P <0.0001）。然而，探头方向和内部特征（如钙化、血管成分和甲状腺肿）可能会影响最终的弹性成像测量结果。大量的恶性结节需要研究，以进一步验证我们的结果。
Rationale and Objectives: Low specificity of traditional ultrasound in differentiating benign from malignant thyroid nodules leads to a great number of unnecessary (ie, benign) fine-needle aspiration biopsies that causes a significant financial and physical burden to the patients. Ultrasound shear wave elastography is a technology capable of providing additional information related to the stiffness of tissues. In this study, quantitative stiffness values acquired by ultrasound shear wave elastography in two different imaging planes were evaluated for the prediction of malignancy in thyroid nodules. In addition, the association of elasticity measurements with sonographic characteristics of thyroid gland and nodules is presented.Materials and Methods: A total number of 155 patients (106 female and 49 male) (average age 57.48 +/- 14.44 years) with 173 thyroid nodules (average size 24.89 +/- 15.41 mm, range 5-68 mm) scheduled for fine-needle aspiration biopsy were recruited from March 2015 to May 2017. Comb-push shear elastography imaging was performed at longitudinal and transverse anatomic planes. Mean (E-mean) and maximum (E-max) elasticity values were obtained.Results: Measurements at longitudinal view were statistically significantly higher than measurements at transverse view. Nodules with calcifications were associated with increased elasticity, and nodules with a vascular component or within an enlarged thyroid gland (goiter) were associated with a lower elasticity value. Receiver operating characteristic curve analysis was performed for E-mean and E-max at each imaging plane and for the average of both planes. Sensitivity of 95.45%, specificity of 86.61%, 0.58 positive predictive value, and 0.99 negative predictive value were achieved by the average of the two planes for each E-mean and E-max parameters, with area under the curve of 92% and 93%, and a cutoff value of 49.09 kPa and 105.61 kPa, respectively.Conclusions: The elastic properties of thyroid nodules showed promise to be a good discriminator between malignant and benign nodules (P < .0001). However, probe orientation and internal features such as calcifications, vascular component, and goiter may influence the final elastography measurements. A larger number of malignant nodules need to be studied to further validate our results.