Value of Shear Wave Elastography in the Diagnosis of Thyroid Nodules
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摘要:
目的 分析剪切波弹性成像技术（shear wave elastography ，SWE）在甲状腺TI-RADS4类结节中，特别是4A类甲状腺结节的良恶性诊断中的价值。 方法 回顾性连续纳入云南省肿瘤医院2024年07月至2025年08月收治的200例甲状腺结节患者的临床病例资料及剪切波弹性成像数据，经ICC验证数据一致性后，运用二分类Logistics回归分析恶性甲状腺结节的危险因素，进一步绘制ROC曲线进行分析，联合诊断应用效能用NRI和IDI进行分析。 结果 （1）甲状腺结节的横切面杨氏模量最小值（minimum of Young’ s modulus，Emin）、横切面剪切波速度最小值（minimum of shear wave velocity，Csmin）、纵切面杨氏模量平均值（mean of Young’ s modulus，Emean）、纵切面Emin、纵切面剪切波速度平均值（mean of shear wave velocity，Csmean）、纵切面Csmin为恶性甲状腺结节的危险因素（P < 0.05）；（2）在甲状腺影像报告与数据系统（thyroid imaging reporting and data system ，TI-RADS）为4类的甲状腺结节中，各切面的杨氏模量最小值（Emin）与剪切波最小速度（Csmin）为恶性结节的危险因素（P < 0.05），在TI-RADS 4A类结节中也是如此；（3）SWE参数与TI-RADS分类联合诊断后对恶性甲状腺结节的诊断效能提升（AUC=0.819，NRI=45.455%，IDI=0.097）。 结论 剪切波弹性成像可作为TI-RADS4类甲状腺结节良恶性诊断的辅助检查，特别是在TI-RADS 4A类患者中有诊断价值，SWE与TI-RADS联合诊断恶性甲状腺结节效果较好。 -
关键词:
- 剪切波弹性成像技术 /
- 甲状腺结节 /
- 甲状腺影像报告与数据系统
Abstract:Objective To analyze the value of shear wave elastography （SWE） in the diagnosis of benign and malignant thyroid nodules classified as TI-RADS category 4, particularly category 4A thyroid nodules. Methods A retrospective consecutive cohort of 200 patients with thyroid nodules admitted to Yunnan Cancer Hospital between July 2024 and August 2025 was enrolled, and their clinical case data and shear wave elastography data were collected. After the data consistency was verified using the intraclass correlation coefficient （ICC）, binary logistic regression analysis was performed to identify risk factors for malignant thyroid nodules. ROC curves were then plotted for further analysis, and the diagnostic performance of the combined approach was evaluated using the net reclassification improvement （NRI） and integrated discrimination improvement （IDI）. Results The minimum of Young's modulus （Emin） in the transverse plane, the minimum of shear wave velocity （Csmin） in the transverse plane, the mean of Young's modulus （Emean） in the longitudinal plane, Emin in the longitudinal plane, the mean of shear wave velocity （Csmean） in the longitudinal plane, and Csmin in the longitudinal plane were risk factors for malignant thyroid nodules （P < 0.05）. In thyroid nodules classified as category 4 according to the Thyroid Imaging Reporting and Data System （TI-RADS）, Emin and Csmin in each plane were risk factors for malignant nodules （P < 0.05）, and the same was true for TI-RADS category 4A nodules. The combined diagnosis of SWE parameters and TI-RADS classification improved the diagnostic performance for malignant thyroid nodules （AUC = 0.819, NRI = 45.455%, IDI = 0.097）. Conclusion Shear wave elastography can serve as an auxiliary examination for the diagnosis of benign and malignant TI-RADS category 4 thyroid nodules, and it is of diagnostic value especially in patients with TI-RADS category 4A nodules. The combined use of SWE and TI-RADS yields good diagnostic performance for malignant thyroid nodules. -
图 1 200例甲状腺结节患者的6项SWE参数的ROC曲线
Figure 1. ROC curves of 6 SWE parameters in 200 patients with thyroid nodules
图 2 111例TI-RADS 4A类甲状腺结节患者的4项SWE参数的 ROC曲线
Figure 2. ROC curves of 4 SWE parameters in 111 patients with TI-RADS 4A thyroid nodules
图 3 SWE参数联合TI-RADS分类诊断的ROC曲线
Figure 3. ROC curve of SWE parameter combined with TI-RADS classification for diagnosis
表 1 甲状腺结节患者的一般情况及病理结果
Table 1. General characteristics and pathological results of patients with thyroid nodules
项目 良性（n=46） 恶性（n=154） χ2 P 年龄（岁） 5.688 0.017* ≥55 16 28 <55 30 126 性别 0.306 0.580 男 11 31 女 35 123 超声下表现 位置 0.113 0.737 左 24 76 右 22 78 血流信号 0.751 0.386 有 29 86 无 17 68 TI-RADS分类 <0.001* 3类 7 0 4A类 35 76 4B类 4 59 4C类 0 12 5类 0 3 6类 0 4 *P < 0.05。 
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表 2 20例甲状腺结节患者SWE数据的一致性检验
Table 2. Consistency test of SWE data in 20 thyroid nodule patients
SWE参数 ICC P 95%CI 横切面Emean 0.931 <0.01* 0.662 ～ 0.916 横切面Emax 0.878 <0.01* 0.490 ～ 0.858 横切面Emin 0.760 <0.01* 0.250 ～ 0.743 横切面Esd 0.893 <0.01* 0.535～ 0.874 横切面Csmean 0.929 <0.01* 0.656～ 0.913 横切面Csmax 0.881 <0.01* 0.501～ 0.862 横切面Csmin 0.780 <0.01* 0.277～ 0.763 横切面Cssd 0.740 <0.01* 0.224～ 0.725 纵切面Emean 0.926 <0.01* 0.647～ 0.911 纵切面Emax 0.893 <0.01* 0.539～ 0.874 纵切面Emin 0.806 <0.01* 0.327～ 0.787 纵切面Esd 0.917 <0.01* 0.612～ 0.900 纵切面Csmean 0.910 <0.01* 0.592～ 0.893 纵切面Csmax 0.911 <0.01* 0.594～ 0.894 纵切面Csmin 0.750 <0.01* 0.232～ 0.736 纵切面Cssd 0.914 <0.01* 0.604～ 0.898 *P < 0.05。
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表 3 甲状腺结节患者SWE参数与病理结果的单因素二分类Logistics回归分析
Table 3. Univariate binary logistic regression analysis of SWE parameters and pathological results in patients with thyroid nodules
SWE参数 B SE Wals χ2 P OR 95%CI 横切面Emean 0.024 0.015 2.475 0.116 1.024 0.994～1.055 横切面Emax −0.002 0.006 0.085 0.771 0.998 0.988～1.009 横切面Emin 0.059 0.020 8.325 0.004* 1.061 1.019～1.104 横切面Esd −0.021 0.031 0.460 0.498 0.979 0.922～1.040 横切面Csmean 0.538 0.285 3.560 0.059 1.712 0.979～2.993 横切面Csmax −0.004 0.149 0.001 0.980 0.996 0.744～1.334 横切面Csmin 0.657 0.224 8.616 0.003* 1.929 1.244～2.991 横切面Cssd −0.836 0.722 1.342 0.247 0.433 0.105～1.783 纵切面Emean 0.028 0.014 4.181 0.041* 1.029 1.001～1.057 纵切面Emax 0.002 0.005 0.265 0.607 1.002 0.993～1.011 纵切面Emin 0.053 0.019 7.824 0.005* 1.055 1.016～1.095 纵切面Esd 0.009 0.026 0.134 0.714 1.009 0.960～1.062 纵切面Csmean 0.604 0.282 4.573 0.032* 1.829 1.052～3.181 纵切面Csmax 0.043 0.143 0.090 0.764 1.044 0.789～1.382 纵切面Csmin 0.813 0.237 11.746 <0.001* 2.254 1.416～3.587 纵切面Cssd −0.588 0.701 0.703 0.402 0.555 0.141～2.196 *P < 0.05。
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表 4 200例甲状腺结节患者的6项SWE参数的ROC曲线分析
Table 4. ROC curve analysis of 6 SWE parameters in 200 patients with thyroid nodules
SWE参数 AUC 95%CI 截断值 灵敏度（%） 特异度（%） 横切面Emin 0.644 0.574～0.710 12.71 70.8 54.3 横切面Csmin 0.643 0.572～0.709 1.91 74.7 50.0 纵切面Emean 0.594 0.523～0.663 35.92 64.9 54.3 纵切面Emin 0.625 0.554～0.693 9.39 87.7 34.8 纵切面Csmean 0.603 0.532～0.672 3.41 66.9 54.3 纵切面Csmin 0.650 0.580～0.716 1.80 87.7 39.1
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表 5 111例TI-RADS 4A类甲状腺结节患者SWE参数与病理结果的单因素二分类Logistics回归分析
Table 5. Univariate binary logistic regression analysis of SWE parameters and pathological results in 111 patients with TI-RADS 4A thyroid nodules
SWE参数 B SE Wals χ2 P OR 95%CI 横切面Emean 0.008 0.015 0.266 0.606 1.008 0.978～1.039 横切面Emax −0.011 0.007 2.152 0.142 0.990 0.976～1.004 横切面Emin 0.071 0.027 6.937 0.008* 1.074 1.018～1.133 横切面Esd −0.046 0.036 1.617 0.204 0.955 0.889～1.025 横切面Csmean 0.182 0.325 0.314 0.575 1.200 0.635～2.268 横切面Csmax −0.410 0.225 3.323 0.068 0.663 0.427～1.031 横切面Csmin 0.860 0.319 7.254 0.007* 2.363 1.264～4.419 横切面Cssd −2.324 1.071 4.707 0.030* 0.098 0.012～0.799 纵切面Emean 0.019 0.017 1.349 0.246 1.019 0.987～1.053 纵切面Emax −0.010 0.007 2.075 0.150 0.990 0.976～1.004 纵切面Emin 0.063 0.024 6.898 0.009* 1.065 1.016～1.116 纵切面Esd −0.038 0.037 1.039 0.308 0.963 0.894～1.036 纵切面Csmean 0.407 0.348 1.368 0.242 1.503 0.759～2.975 纵切面Csmax −0.359 0.222 2.620 0.106 0.698 0.452～1.079 纵切面Csmin 1.028 0.324 10.053 0.002* 2.795 1.481～5.277 纵切面Cssd −2.152 1.068 4.059 0.044* 0.116 0.014～0.943 *P < 0.05。
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表 6 111例TI-RADS 4A类甲状腺结节患者的4项SWE参数的 ROC曲线分析
Table 6. ROC curve analysis of 4 SWE parameters in 111 patients with TI-RADS 4A thyroid nodules
SWE参数 AUC 95%CI 截断值 灵敏度（%） 特异度（%） 横切面Emin 0.666 0.570～0.752 14.10 62.9 67.1 横切面Csmin 0.666 0.570～0.753 12.20 60.5 68.6 纵切面Emin 0.651 0.555～0.739 18.64 60.5 65.7 纵切面Csmin 0.685 0.590～0.770 2.54 59.2 74.3
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表 7 SWE参数联合TI-RADS分类诊断较TI-RADS分类单独诊断的NRI和IDI结果
Table 7. NRI and IDI results of SWE parameter combined with TI-RADS compared classification for diagnosis compared with TI-RADS classification alone
指标 NRI/IDI值 标准误 z P 95%CI NRI 45.455% 0.164 2.772 0.006 0.133 ～ 0.775 NRI（金标准=阳性1） 45.455% 0.072 6.333 0.000 0.314 ～ 0.595 NRI（金标准=阴性0） 0.000% 0.147 0.000 1.000 −0.289 ～ 0.289 IDI 0.097 0.027 3.579 0.000 0.044 ～ 0.150
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