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.	黄炎, 李俊来, 王知力, 等. 实时剪切波弹性成像定量评价乳腺良恶性病变[J]. 中国医学影像技术, 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.	罗葆明, 欧冰, 冯霞, 等. 乳腺疾病实时组织弹性成像与病理对照的初步探讨[J]. 中国超声医学杂志, 2005, 21(9):662-664.
7.	张艳, 唐杰. 超声弹性成像技术在前列腺的应用进展[J/CD]. 中华医学超声杂志:电子版, 2010, 7(9):1548-1553.
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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.
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12.	李开林, 聂红莲, 方北, 等. 实时组织弹性成像对甲状腺结节良恶性的鉴别诊断[J]. 临床超声医学杂志, 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, 刘娜, 白亚莲, 等. 超声造影和超声弹性成像对甲状腺良恶性结节的鉴别诊断价值[J]. 临床超声医学杂志, 2011, 30(8):516-520.
15.	刘畅, 徐辉雄, 张一峰, 等. 甲状腺癌声脉冲辐射力弹性成像特征分析[J/CD]. 中华医学超声杂志:电子版, 2012, 9(8):735-739.
16.	何勇, 徐辉雄, 张一峰, 等. 声触诊组织弹性成像鉴别诊断甲状腺结节良恶性的价值[J]. 中华超声影像学杂志, 2012, 21(4):320-323.
17.	丹海俊, 王燕, 丹海永, 等. 实时超声弹性成像诊断甲状腺单发实性小结节[J]. 中国医学影像技术, 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, 项飞翔, 李玲, 等. 超声实时组织弹性成像技术定量评价甲状腺肿块的应用价值[J]. 中华超声影像学杂志, 2010, 19(3):219-222.
21.	Vorländer 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.	宇传华, 郑迎东, 毛宗福, 等. SPSS与统计分析[M]. 北京:电子工业出版社, 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. 黄炎, 李俊来, 王知力, 等. 实时剪切波弹性成像定量评价乳腺良恶性病变[J]. 中国医学影像技术, 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. 罗葆明, 欧冰, 冯霞, 等. 乳腺疾病实时组织弹性成像与病理对照的初步探讨[J]. 中国超声医学杂志, 2005, 21(9):662-664.
7. 张艳, 唐杰. 超声弹性成像技术在前列腺的应用进展[J/CD]. 中华医学超声杂志:电子版, 2010, 7(9):1548-1553.
8. 俞清, 王文平, 李超伦, 等. 超声弹性成像技术诊断甲状腺结节的影响因素探讨[J]. 上海医学影像, 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, 罗葆明, 欧冰, 等. 对乳腺弹性成像5分评分法的进一步探讨[J]. 中国超声医学杂志, 2007, 23(5):349-351.
11. 刘芳, 肖萤. 超声弹性成像鉴别良恶性甲状腺结节[J]. 中国医学影像技术, 2010, 26(6):1028-1030.
12. 李开林, 聂红莲, 方北, 等. 实时组织弹性成像对甲状腺结节良恶性的鉴别诊断[J]. 临床超声医学杂志, 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, 刘娜, 白亚莲, 等. 超声造影和超声弹性成像对甲状腺良恶性结节的鉴别诊断价值[J]. 临床超声医学杂志, 2011, 30(8):516-520.
15. 刘畅, 徐辉雄, 张一峰, 等. 甲状腺癌声脉冲辐射力弹性成像特征分析[J/CD]. 中华医学超声杂志:电子版, 2012, 9(8):735-739.
16. 何勇, 徐辉雄, 张一峰, 等. 声触诊组织弹性成像鉴别诊断甲状腺结节良恶性的价值[J]. 中华超声影像学杂志, 2012, 21(4):320-323.
17. 丹海俊, 王燕, 丹海永, 等. 实时超声弹性成像诊断甲状腺单发实性小结节[J]. 中国医学影像技术, 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, 项飞翔, 李玲, 等. 超声实时组织弹性成像技术定量评价甲状腺肿块的应用价值[J]. 中华超声影像学杂志, 2010, 19(3):219-222.
21. Vorländer 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. 宇传华, 郑迎东, 毛宗福, 等. SPSS与统计分析[M]. 北京:电子工业出版社, 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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