【摘要】 目的观察病灶大小对剪切波弹性成像（SWE）鉴别诊断甲状腺良、恶性结节效能的影响。方法回顾性分析214例甲状腺结节患者,共215枚结节,良性93枚、恶性122枚,根据结节最大径分为小结节组（最大径<1.00 cm, 85枚）、中结节组（1.00 cm≤最大径<1.50 cm, 67枚）及大结节组（最大径≥1.50 cm, 63枚）;对比良、恶性结节及各组结节最大弹性模量(E_max)差异,采用受试者工作特征（ROC）曲线观察E_max诊断甲状腺良、恶性结节的截断值及曲线下面积（AUC）,评价结节横径、前后径及最大径与E_max的相关性。结果恶性结节E_max大于良性结节（P<0.01）。各组恶性结节E_max均大于良性（P均<0.01）。各组间恶性结节E_max差异有统计学意义（P<0.01）,且大结节组大于小结节及中结节组（P均<0.05）,小结节与中结节组差异无统计学意义（P>0.05）。各组间良性结节E_max差异无统计学意义（P>0.05）。E_max鉴别全部甲状腺结节、小结节组、中结节组及大结节组良、恶性病变的截断值分别为30.65、29.40、30.70及52.65 kPa, AUC分别为0.82、0.79、0.76及0.89,差异均无统计学意义（P均>0.05）;针对大结节组将截断值调整为52.65 kPa时,诊断特异度达100%。E_max与结节横径、前后径及最大径线均呈正相关（r=0.29、0.29、0.55,P均<0.05）。结论以SWE参数E_max判断甲状腺良、恶性结节时存在尺度效应;针对最大径≥1.50 cm的甲状腺结节,适当提高E_max截断值有助于改善诊断效能。更多还原

【Abstract】 Objective To explore the impact of scale effect on the efficacy of shear wave elastography(SWE)in diagnosing benign and malignant thyroid nodules.Methods A total of 214 patients with 215 thyroid lesions(93 benign and122 of malignant ones) were retrospectively analyzed.Lesions were divided into small nodules group(maximum diameter<1.00 cm,n=85),middle nodules group(1.00 cm ≤ maximum diameter<1.50 cm,n=67)and large nodules group(maximum diameter≥1.50 cm,n=63).The maximum elastic modulus(Emax)were compared between benign and malignant nodules,also among nodules with different sizes.The cut-off value and the area under the curve(AUC)of Emax in differential diagnosis of benign and malignant thyroid lesions were assessed by receiver operating characteristic(ROC)curves.The correlations between the transverse diameter,anterior diameter and maximum diameter of nodules and Emax were analyzed.Results Emaxof malignant nodules were greater than that of benign ones(P<0.01)among all 215 nodules and in small,medium and large nodule groups(all P<0.01).Emax of malignant nodules were different among small,medium and large nodules groups(P<0.01),of large nodules group was larger than that of small and medium nodules groups(both P<0.05),but not statistical different between small and medium nodules groups(P>0.05).There was no significant difference of Emax of benign nodules among small,medium and large nodule groups(P>0.05).The cut-off values of Emaxfor differential diagnosis of benign and malignant thyroid nodules in all nodules and small,medium and large nodules was 30.65,29.40,30.70,52.65 kPa,and AUC was 0.82,0.79,0.76,0.89,respectively.No significant difference of AUC of all nodules,nor of small,medium and large nodules groups(all P>0.05).When the cut-off value of Emax was adjusted from 30.65 kPa to 52.65 kPa,the diagnostic specificity increased from 87.88%to 100%in large nodules group.Emax was correlated with the transverse diameter,anteroposterior diameter and maximum diameter of nodules(r=0.29,0.29,0.55,all P<0.05).Conclusion There was a certain scale effect when using Emaxof SWE to evaluate benign and malignant thyroid nodules.For nodules with the maximum diameter≥1.50 cm,appropriate adjustment of the cut-off value of Emax might improve the diagnostic efficiency.更多还原