Value of Acoustic Radiation Force Impulse Imaging in The Differential Diagnosis Between Benign and Malignant Thyroid Nodules_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANGHui ,  NANCai-ling , MASu-mei , YAOYa-ning

Department of Ultrasound, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China;

Corresponding?author：

NANCai-ling, Email: cailingnan@live.Cn

Keywords：

Virtual touch tissue quantification; Elastography imaging; Ultrasound; Thyroid nodule; Differential diagnosis

DOI：

10.7507/1007-9424.20140262

Video：

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Objective To explore the value of virtual touch tissue quantification(VTQ) of acoustic radiation force impulse (ARFI) in the differential diagnosis between benign and malignant thyroid nodules. Methods The ultrasound (US), elastography imaging(EI), and VTQ of ARFI were performed to determine the characteristics and features of 63 thyroid nodules. The pathological diagnosis was the gold standard. According to the receiver operating characteristic curve (ROC) of US, EI, and VTQ, the critical points and diagnostic values of US, EI, and VTQ in diag-nosis of malignant thyroid nodules were achieved. Results Of the 63 nodules, 45 were benign and 18 were malignant. The area under curves of US, EI, and shear wave velocity(SWV) were 0.837(95% CI:0.712-0.962), 0.863(95% CI:0.751-0.974), and 0.900 (95% CI:0.810-0.990) respectively, and all the 3 kinds of technique had diagnostic value(P=0.001), but there were no significant difference among the 3 kinds of technique on the area under curve(P > 0.05). According to the receiver operating characteristic(ROC) curve, the critical point of US in distinguishing benign nodules with malignant nodules was 3 conventional ultrasonography, which displayed a sensitivity of 83.3%, a specificity of 86.7%, and a accuracy of 85.7%. The critical point of EI grades in distinguishing benign nodules with malignant nodules was gradeⅣ, which displayed a sensitivity of 94.1%, a specificity of 82.6%, and a accuracy of 87.3%. The critical value of SWV in distinguishing benign nodules with malignant nodules was 3.39 m/s, which displayed a sensiti-vity of 88.9%, a specificity of 91.1%, and a accuracy of 90.5%. Conclusion US, EI, and VTQ techniques all have diagnostic values in the differential diagnosis between benign and malignant thyroid nodules, and we should make combination with all of the 3 kinds of technique when performing differential diagnosis.

Citation： WANGHui, NANCai-ling, MASu-mei, YAOYa-ning. Value of Acoustic Radiation Force Impulse Imaging in The Differential Diagnosis Between Benign and Malignant Thyroid Nodules. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(9): 1087-1091. doi: 10.7507/1007-9424.20140262 Copy

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2.	Tan GH, Gharib H. Thyroid incidentalomas:management approaches to nonpalpable nodules discovered incidentally on thyroid imaging[J]. Ann Intern Med, 1997, 126(3):226-231.
3.	D'onofrio M, Gallotti A, Salvia R, et al. Acoustic radiation force impulse (ARFI) ultrasound imaging of pancreatic cystic lesions[J]. Eur J Radiol, 2011, 80(2):241-244.
4.	黃炎, 李俊來, 王知力, 等. 實時剪切波彈性成像定量評價乳腺良惡性病變[J]. 中國醫學影像技術, 2011, 27(3):561-564.
5.	Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis[J]. Radiology, 2006, 239(2):341-350.
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8.	俞清, 王文平, 李超倫, 等. 超聲彈性成像技術診斷甲狀腺結節的影響因素探討[J]. 上海醫學影像, 2010, 19(3):165-167.
9.	Meng W, Zhang G, Wu C, et al. Preliminary results of acoustic radiation force impulse (ARFI) ultrasound imaging of breast lesions[J]. Ultrasound Med Biol, 2011, 37(9):1436-1443.
10.	智慧, 羅葆明, 歐冰, 等. 對乳腺彈性成像5分評分法的進一步探討[J]. 中國超聲醫學雜志, 2007, 23(5):349-351.
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13.	Stavros AT, Thickman D, Rapp CL, et al. Solid breast nodules:use of sonography to distinguish between benign and malignant lesions[J]. Radiology, 1995, 196(1):123-134.
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15.	劉暢, 徐輝雄, 張一峰, 等. 甲狀腺癌聲脈沖輻射力彈性成像特征分析[J/CD]. 中華醫學超聲雜志:電子版, 2012, 9(8):735-739.
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18.	Friedrich-Rust M, Wunder K, Kriener S, et al. Liver fibrosis in viral hepatitis:noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography[J]. Radiology, 2009, 252(2):595-604.
19.	Fahey BJ, Nightingale KR, Nelson RC, et al. Acoustic radiation force impulse imaging of the abdomen:demonstration of feasibility and utility[J]. Ultrasound Med Biol, 2005, 31(9):1185-1198.
20.	李蔚, 項飛翔, 李玲, 等. 超聲實時組織彈性成像技術定量評價甲狀腺腫塊的應用價值[J]. 中華超聲影像學雜志, 2010, 19(3):219-222.
21.	Vorl?nder C, Wolff J, Saalabian S, et al. Real-time ultrasound elastography-a noninvasive diagnostic procedure for evaluating dominant thyroid nodules[J]. Langenbecks Arch Surg, 2010, 395(7):865-871.
22.	Gietka-Czernel M, Kochman M, Bujalska K, et al. Real-time ultrasound elastography-a new tool for diagnosing thyroid nodules[J]. Endokrynol Pol, 2010, 61(6):652-657.
23.	Sporea I, Vlad M, Bota S, et al. Thyroid stiffness assessment by acoustic radiation force impulse elastography (ARFI)[J]. Ultraschall Med, 2011, 32(3):281-285.
24.	宇傳華, 鄭迎東, 毛宗福, 等. SPSS與統計分析[M]. 北京:電子工業出版社, 2007:319-323.

1. Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening[J]. Endocrinol Metab Clin North Am, 1997, 26(1):189-218.
2. Tan GH, Gharib H. Thyroid incidentalomas:management approaches to nonpalpable nodules discovered incidentally on thyroid imaging[J]. Ann Intern Med, 1997, 126(3):226-231.
3. D'onofrio M, Gallotti A, Salvia R, et al. Acoustic radiation force impulse (ARFI) ultrasound imaging of pancreatic cystic lesions[J]. Eur J Radiol, 2011, 80(2):241-244.
4. 黃炎, 李俊來, 王知力, 等. 實時剪切波彈性成像定量評價乳腺良惡性病變[J]. 中國醫學影像技術, 2011, 27(3):561-564.
5. Itoh A, Ueno E, Tohno E, et al. Breast disease:clinical application of US elastography for diagnosis[J]. Radiology, 2006, 239(2):341-350.
6. 羅葆明, 歐冰, 馮霞, 等. 乳腺疾病實時組織彈性成像與病理對照的初步探討[J]. 中國超聲醫學雜志, 2005, 21(9):662-664.
7. 張艷, 唐杰. 超聲彈性成像技術在前列腺的應用進展[J/CD]. 中華醫學超聲雜志:電子版, 2010, 7(9):1548-1553.
8. 俞清, 王文平, 李超倫, 等. 超聲彈性成像技術診斷甲狀腺結節的影響因素探討[J]. 上海醫學影像, 2010, 19(3):165-167.
9. Meng W, Zhang G, Wu C, et al. Preliminary results of acoustic radiation force impulse (ARFI) ultrasound imaging of breast lesions[J]. Ultrasound Med Biol, 2011, 37(9):1436-1443.
10. 智慧, 羅葆明, 歐冰, 等. 對乳腺彈性成像5分評分法的進一步探討[J]. 中國超聲醫學雜志, 2007, 23(5):349-351.
11. 劉芳, 肖螢. 超聲彈性成像鑒別良惡性甲狀腺結節[J]. 中國醫學影像技術, 2010, 26(6):1028-1030.
12. 李開林, 聶紅蓮, 方北, 等. 實時組織彈性成像對甲狀腺結節良惡性的鑒別診斷[J]. 臨床超聲醫學雜志, 2011, 13(4):220-222.
13. Stavros AT, Thickman D, Rapp CL, et al. Solid breast nodules:use of sonography to distinguish between benign and malignant lesions[J]. Radiology, 1995, 196(1):123-134.
14. 李苗, 劉娜, 白亞蓮, 等. 超聲造影和超聲彈性成像對甲狀腺良惡性結節的鑒別診斷價值[J]. 臨床超聲醫學雜志, 2011, 30(8):516-520.
15. 劉暢, 徐輝雄, 張一峰, 等. 甲狀腺癌聲脈沖輻射力彈性成像特征分析[J/CD]. 中華醫學超聲雜志:電子版, 2012, 9(8):735-739.
16. 何勇, 徐輝雄, 張一峰, 等. 聲觸診組織彈性成像鑒別診斷甲狀腺結節良惡性的價值[J]. 中華超聲影像學雜志, 2012, 21(4):320-323.
17. 丹海俊, 王燕, 丹海永, 等. 實時超聲彈性成像診斷甲狀腺單發實性小結節[J]. 中國醫學影像技術, 2010, 26(1):63-65.
18. Friedrich-Rust M, Wunder K, Kriener S, et al. Liver fibrosis in viral hepatitis:noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography[J]. Radiology, 2009, 252(2):595-604.
19. Fahey BJ, Nightingale KR, Nelson RC, et al. Acoustic radiation force impulse imaging of the abdomen:demonstration of feasibility and utility[J]. Ultrasound Med Biol, 2005, 31(9):1185-1198.
20. 李蔚, 項飛翔, 李玲, 等. 超聲實時組織彈性成像技術定量評價甲狀腺腫塊的應用價值[J]. 中華超聲影像學雜志, 2010, 19(3):219-222.
21. Vorl?nder C, Wolff J, Saalabian S, et al. Real-time ultrasound elastography-a noninvasive diagnostic procedure for evaluating dominant thyroid nodules[J]. Langenbecks Arch Surg, 2010, 395(7):865-871.
22. Gietka-Czernel M, Kochman M, Bujalska K, et al. Real-time ultrasound elastography-a new tool for diagnosing thyroid nodules[J]. Endokrynol Pol, 2010, 61(6):652-657.
23. Sporea I, Vlad M, Bota S, et al. Thyroid stiffness assessment by acoustic radiation force impulse elastography (ARFI)[J]. Ultraschall Med, 2011, 32(3):281-285.
24. 宇傳華, 鄭迎東, 毛宗福, 等. SPSS與統計分析[M]. 北京:電子工業出版社, 2007:319-323.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of Acoustic Radiation Force Impulse Imaging in The Differential Diagnosis Between Benign and Malignant Thyroid Nodules

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