| 摘要: |
| 目的 分析并比较Q-BoxTM Trace和Q-BoxTM两种剪切波弹性成像（SWE）测量方法对ACR TI-RADS 4类甲状腺结节良恶性的诊断价值。方法 选取超声报告提示ACR TI-RADS 4类的甲状腺结节患者79例，共95个结节，均行SWE检查。使用描记感兴趣区程序（即Q-BoxTM Trace）测量整个结节的杨氏模量最大值、最小值及标准差（Emax、Emean及Esd）：使用直径为2 mm的调整圆形感兴趣区程序（即Q-BoxTM）测量局部结节的Emax、Emean及Esd，绘制受试者工作特征（ROC）曲线分析两种方法对甲状腺结节的诊断效能。应用SPSS统计软件计算组内相关系数（ICC），Bland-Altman图计算95%一致性界限，分析并比较两种方法在操作者间及操作者内的重复性及一致性。结果 通过Q-BoxTM和Q-BoxTM Trace测得恶性结节Emax、Emean、Esd均大于良性结节，差异均有统计学意义（均P＜0.05）。ROC曲线分析显示，Q-BoxTM Trace测得Emax诊断甲状腺恶性结节的曲线下面积（AUC）、灵敏度、特异度分别为0.786、75.0%、76.9%，Q-BoxTM的AUC、灵敏度、特异度分别为0.699、72.9%、66.7%，两种方法的AUC比较差异有统计学意义（P＜0.05）。SPSS统计显示，Q-BoxTM Trace在操作者A、操作者B及操作者间的变异系数均低于Q-BoxTM，差异有统计学意义（P＜0.05）；二者在操作者内及操作者间的ICC均＞0.96，且Q-BoxTM Trace在操作者内及操作者间的ICC均高于Q-BoxTM，差异是有统计学意义（P＜0.05）；Bland-Altman图结果显示，Q-BoxTM Trace、Q-BoxTM 95%一致性界限外的点数分别为2%、6%，表明Q-BoxTM Trace的重复性及一致性均优于Q-BoxTM。结论 Q-BoxTM和Q-BoxTM Trace对ACR TI-RADS 4类甲状腺结节良恶性的诊断均有一定临床价值，但Q-BoxTM Trac重复性更高，变异性更小，提示其可能是一种受外界客观原因影响较小的标准化SWE的测量方法。 |
| 关键词: 超声检查 剪切波弹性成像 Q-BoxTM Q-BoxTM Trace 重复性 甲状腺结节，良恶性 |
| DOI： |
| 投稿时间：2022-08-12修订日期：2023-02-16 |
| 基金项目:无 |
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| A preliminary study of the diagnostic value of different shear wave elastometry methods for the diagnosis of benign and malignant thyroid nodules in ACR TI-RADS class 4 |
| LI Xu,ZHOU Li,LU Min |
| (Department of Ultrasound，Bishan Hospital of Chongqing，Bishan hospital of Chongqing medical university) |
| Abstract: |
| Objective To analyze and compare the diagnostic value of Q-BoxTM Trace and Q-BoxTM shear wave elastography measurement methods for benign and malignant ACR TI-RADS 4 thyroid nodules.Methods Seventy-nine patients with ultrasound-reported ACR TI-RADS classification 4 thyroid nodules，with a total of 95 nodules were examined by SWE. Young 's modulus maximum, minimum, and standard deviation of the entire nodule were measured using a traced interest program (i.e., Q-BoxTM Trace); Emax, Emean, and Esd of the local nodule were measured using a circular region of interest program with a diameter of 2 mm (i.e., Q-BoxTM), and receiver operating characteristic curves were plotted to analyze the diagnostic efficacy of the two methods for thyroid nodules.Bland-Altman plots were used to calculate the number of points beyond the 95% confidence interval，and SPSS statistical software was applied to compare the intra-group correlation coefficients and to compare the inter- and intra-evaluator repeatability differences between the two methods.Results Malignant nodules Emax, Emean, and Esd measured by Q-BoxTM and Q-BoxTM Trace were greater than benign nodules, and the differences were statistically significant （P＜0.05）. ROC curve analysis showed that the area under the curve , sensitivity, and specificity of Emax measured by Q-BoxTM Trace for the diagnosis of malignant thyroid nodules were 0.786, 75.0%, and 76.9%, respectively, and the AUC, sensitivity, and specificity of Q-BoxTM were 0.699, 72.9%, and 66.7%, respectively, and there was a significant difference between the two methods （P＜0.05）. SPSS statistics showed that the coefficient of variation of Q-BoxTM Trace between operator A，operator B and inter-operator were lower than those of Q-BoxTM, and the difference was statistically significant（P＜0.05）;The intra-operator and inter-operator the ICCs of two measurement methods were ＞0.96, and the ICCs of Q-BoxTM Trace were higher than those of Q-BoxTM, and the difference was statistically significant（P＜0.05）. The results of Bland-Altman plots showed that the number of points outside the 95% confidence interval for Q-BoxTM Trace and Q-BoxTM were 2% and 6%，respectively, indicating that the repeatability and consistency of Q-BoxTM Trace were superior to Q-BoxTM Trace.Conclusion Both Q-BoxTM and Q-BoxTM Trace have certain clinical value in the diagnosis of benign and malignant ACR TI-RADS classification 4 thyroid nodules.but Q-BoxTM Trace has higher repeatability and less variability, suggesting that it may be a standardized SWE measurement method that is less affected by external objective reasons. |
| Key words: ultrasound,shear wave elasticity,Q-BoxTM Trace,Q-BoxTM,repeatability,thyroid nodules,benign and malignant |
