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目的 评估横切面和纵切面对剪切波弹性成像（shear wave elastography，SWE）测量甲状腺结节硬度的影响。 方法 选取2022年2月至2022年11月在betway必威登陆网址 第一附属医院行SWE检查的67例甲状腺结节患者（79枚结节），所有患者均经穿刺活检或手术取得病理结果，依据病理结果将结节分为良性和恶性。比较良恶性结节横纵两切面的弹性模量最大值（maximum elastic modulus，Emax）、弹性模量平均值（mean elastic modulus，Emean），构建受试者工作特征（receiver operating characteristic，ROC）曲线，并应用曲线下面积（area under the curve，AUC）分析不同切面方向的SWE对甲状腺结节良恶性的诊断效能；采用Cronbach信度和Bland-Altman图分析SWE横切面和纵切面2个方向对诊断甲状腺结节的可靠性和一致性。 结果 甲状腺恶性结节的横切面和纵切面弹性模量值均高于良性结节。对于良性结节，横切面及纵切面的Emax值、Emean值的差异均无统计学意义（P > 0.05）；对于恶性结节，横切面及纵切面的Emax值均大于Emean值，2个值的差异有统计学意义（P < 0.05）。ROC曲线分析表明，纵向SWE的Emax、Emean，横向SWE的Emax、Emean的AUC分别为0.955、0.939、0.942、0.930，2个指标的AUC的诊断性能差异无统计学意义（P > 0.05）。79枚甲状腺结节横切面和纵切面SWE的Emax和Emean的Cronbach信度分析表明具有良好的相关关系（信度系数值为0.941，0.943），Bland-Altman图直观表明，横切面和纵切面的弹性模量值在很大范围内几乎没有偏差，说明数据具有良好的一致性水平。 结论 切面方向（横切面和纵切面）对SWE测量甲状腺结节Emax和Emean具有良好的一致性和可靠性。2种成像方向的相似表现为有解剖或生理限制的患者成像提供了检查灵活性。
","endNoteUrl_en":"http://xuebao.sdfmu.edu.cn/EN/article/getTxtFile.do?fileType=EndNote&id=575","reference":"| 1 | Cabanillas ME， McFadden DG， Durante C. Thyroid cancer［J］. Lancet， 2016， 388（10061）： 2783. |
| 2 | Haugen BR， Alexander EK， Bible KC， et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer： the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer［J］. Thyroid， 2016， 26（1）： 1. |
| 3 | Liao LJ， Chen HW， Hsu WL， et al. Comparison of strain elastography， shear wave elastography， and conventional ultrasound in diagnosing thyroid nodules［J］. J Med Ultrasound， 2019， 27（1）： 26. |
| 4 | Chen Y， Dong B， Jiang Z， et al. SuperSonic shear imaging for the differentiation between benign and malignant thyroid nodules： a meta-analysis［J］. J Endocrinol Invest， 2022， 45（7）： 1327. |
| 5 | Filho RHC， Pereira FL， Iared W. Diagnostic accuracy evaluation of two-dimensional shear wave elastography in the differentiation between benign and malignant thyroid nodules： systematic review and meta-analysis［J］. J Ultrasound Med， 2020， 39（9）： 1729. |
| 6 | Swan KZ， Nielsen VE， Bonnema SJ. Evaluation of thyroid nodules by shear wave elastography： a review of current knowledge［J］. J Endocrinol Invest， 2021， 44（10）： 2043. |
| 7 | 李健明， 胡向东， 张岩峰， 等. 剪切波弹性成像的影响因素分析［J］. 中华医学超声杂志（电子版）， 2019， 16（8）： 565. |
| 8 | Sigrist RMS， Liau J， Kaffas AE， et al. Ultrasound elastography： review of techniques and clinical applications［J］. Theranostics， 2017， 7（5）： 1303. |
| 9 | Taljanovic MS， Gimber LH， Becker GW， et al. Shear-wave elastography： basic physics and musculoskeletal applications［J］. Radiographics， 2017， 37（3）： 855. |
| 10 | Shiina T， Nightingale KR， Palmeri ML， et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography： part 1： basic principles and terminology［J］. Ultrasound Med Biol， 2015， 41（5）： 1126. |
| 11 | Kim JK， Baek JH， Lee JH， et al. Ultrasound elastography for thyroid nodules： a reliable study？［J］. Ultrasound Med Biol， 2012， 38（9）： 1508. |
| 12 | Barbone PE， Bamber JC. Quantitative elasticity imaging： what can and cannot be inferred from strain images［J］. Physics in Medicine & Biology， 2002， 47（12）： 2147. |
| 13 | Lin P， Chen M， Liu B， et al. Diagnostic performance of shear wave elastography in the identification of malignant thyroid nodules： a meta-analysis［J］. European radiology， 2014， 24： 2729. |
| 14 | 王艳春， 肖沪生， 徐芳， 等. 实时剪切波弹性成像在骨骼肌系统中的应用［J］. 中国医学影像学杂志， 2016， 24（3）： 238. |
| 15 | Lee HY， Lee JH， Shin JH， et al. Shear wave elastography using ultrasound： effects of anisotropy and stretch stress on a tissue phantom and in vivo reactive lymph nodes in the neck［J］. Ultrasonography， 2017， 36（1）： 25. |
| 16 | Gennisson JL， Deffieux T， Macé E， et al. Viscoelastic and anisotropic mechanical properties of in vivo muscle tissue assessed by supersonic shear imaging［J］. Ultrasound Med Biol， 2010， 36（5）： 789. |
), 马喆(), 徐帅娅, 巴晨曦, 孙萌","risUrl_cn":"//www.pitakata.com/xuebao/CN/article/getTxtFile.do?fileType=Ris&id=575","title_cn":"切面方向对剪切波弹性成像测量甲状腺结节硬度的影响","doi":"10.3969/j.issn.2097-0005.2023.12.004","jieShuYe":"903","keywordList_en":["thyroid nodule","SWE","section orientation","elastic modulus value"],"endNoteUrl_cn":"//www.pitakata.com/xuebao/CN/article/getTxtFile.do?fileType=EndNote&id=575","zhaiyao_en":"Objective To assess the effect of transverse and longitudinal sections on shear wave elastography （SWE） measurements of thyroid nodule stiffness. Methods A total of 67 patients （79 nodules） who underwent thyroid ultrasound examination in our hospital from February 2022 to November 2022 and underwent SWE examination for all nodules were included in this study. All patients had pathological results obtained through either fine-needle aspiration or surgical biopsy， which allowed the nodules to be classified as benign or malignant. The study aimed to compare the maximum elastic modulus （Emax） and mean elastic modulus （Emean） between benign and malignant nodules in both transverse and longitudinal shear wave elastography. Receiver operating characteristic （ROC） curves were constructed， and the area under the curve （AUC） was calculated to assess the diagnostic performance of SWE in different directions for distinguishing benign and malignant thyroid nodules. The Cronbach reliability coefficient and Bland-Altman plot were used to analyze the reliability and consistency of SWE in both transverse and longitudinal directions for diagnosing thyroid nodules. Results The transverse and longitudinal elastic modulus values of malignant thyroid nodules were higher than those of benign nodules. The differences in Emax and Emean values in transverse and longitudinal sections were not statistically significant for benign nodules， but they were statistically significant for malignant nodules. The ROC analysis showed that the AUC values for Emax and Emean in longitudinal shear wave elastography were 0.955 and 0.939， respectively， while the AUC values for Emax and Emean in transverse shear wave elastography were 0.942 and 0.930， respectively. There was no statistically significant difference in the diagnostic performance （AUC） between these two measurements. Cronbach's reliability analysis of Emax and Emean for SWE in cross-sectional and longitudinal sections of 79 thyroid nodules showed a good correlation （reliability coefficient values of 0.941， 0.943）. The Bland-Altman plots visually showed that the values of the elastic modulus in the transverse and longitudinal sections had almost no deviation over a wide range， indicating a good level of agreement in the data. Conclusion The section orientation （transverse and longitudinal sections） shows good agreement and reliability for SWE measurements of maximum and mean modulus values of thyroid nodules. The similar performance of the two imaging orientations provides examination flexibility for imaging patients with anatomical or physiological limitations.
","bibtexUrl_en":"http://xuebao.sdfmu.edu.cn/EN/article/getTxtFile.do?fileType=BibTeX&id=575","abstractUrl_cn":"http://xuebao.sdfmu.edu.cn/CN/10.3969/j.issn.2097-0005.2023.12.004","zuoZheCn_L":"张鑫茹, 马喆, 徐帅娅, 巴晨曦, 孙萌","juanUrl_cn":"http://xuebao.sdfmu.edu.cn/CN/Y2023","lanMu_en":"Clinical Researches","qiUrl_en":"http://xuebao.sdfmu.edu.cn/EN/Y2023/V44/I12","zuoZhe_EN":"Xinru ZHANG(), Zhe MA(), Shuaiya XU, Chenxi BA, Meng SUN","risUrl_en":"http://xuebao.sdfmu.edu.cn/EN/article/getTxtFile.do?fileType=Ris&id=575","title_en":"Influence of section orientation of ultrasound shear wave elastography on the measurement of thyroid nodules stiffness","hasPdf":"true"},"authorNotes_cn":["张鑫茹，硕士研究生，研究方向：超声医学浅表、腹部、血管等，E-mail：zhangxinru1214@163.com。","马喆，博士研究生，主任医师，硕士研究生导师，研究方向：超声医学浅表、腹部、血管等，E-mail：mazhe315@163.com。
切面方向对剪切波弹性成像测量甲状腺结节硬度的影响
张鑫茹, 马喆, 徐帅娅, 巴晨曦, 孙萌
betway必威登陆网址 (betway.com )学报››2023, Vol. 44››Issue (12): 900-903.
PDF(882 KB)
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切面方向对剪切波弹性成像测量甲状腺结节硬度的影响
Influence of section orientation of ultrasound shear wave elastography on the measurement of thyroid nodules stiffness
目的评估横切面和纵切面对剪切波弹性成像（shear wave elastography，SWE）测量甲状腺结节硬度的影响。方法选取2022年2月至2022年11月在betway必威登陆网址 第一附属医院行SWE检查的67例甲状腺结节患者（79枚结节），所有患者均经穿刺活检或手术取得病理结果，依据病理结果将结节分为良性和恶性。比较良恶性结节横纵两切面的弹性模量最大值（maximum elastic modulus，Emax）、弹性模量平均值（mean elastic modulus，Emean），构建受试者工作特征（receiver operating characteristic，ROC）曲线，并应用曲线下面积（area under the curve，AUC）分析不同切面方向的SWE对甲状腺结节良恶性的诊断效能；采用Cronbach信度和Bland-Altman图分析SWE横切面和纵切面2个方向对诊断甲状腺结节的可靠性和一致性。结果甲状腺恶性结节的横切面和纵切面弹性模量值均高于良性结节。对于良性结节，横切面及纵切面的Emax值、Emean值的差异均无统计学意义（P> 0.05）；对于恶性结节，横切面及纵切面的Emax值均大于Emean值，2个值的差异有统计学意义（P< 0.05）。ROC曲线分析表明，纵向SWE的Emax、Emean，横向SWE的Emax、Emean的AUC分别为0.955、0.939、0.942、0.930，2个指标的AUC的诊断性能差异无统计学意义（P> 0.05）。79枚甲状腺结节横切面和纵切面SWE的Emax和Emean的Cronbach信度分析表明具有良好的相关关系（信度系数值为0.941，0.943），Bland-Altman图直观表明，横切面和纵切面的弹性模量值在很大范围内几乎没有偏差，说明数据具有良好的一致性水平。结论切面方向（横切面和纵切面）对SWE测量甲状腺结节Emax和Emean具有良好的一致性和可靠性。2种成像方向的相似表现为有解剖或生理限制的患者成像提供了检查灵活性。
ObjectiveTo assess the effect of transverse and longitudinal sections on shear wave elastography （SWE） measurements of thyroid nodule stiffness.MethodsA total of 67 patients （79 nodules） who underwent thyroid ultrasound examination in our hospital from February 2022 to November 2022 and underwent SWE examination for all nodules were included in this study. All patients had pathological results obtained through either fine-needle aspiration or surgical biopsy， which allowed the nodules to be classified as benign or malignant. The study aimed to compare the maximum elastic modulus （Emax） and mean elastic modulus （Emean） between benign and malignant nodules in both transverse and longitudinal shear wave elastography. Receiver operating characteristic （ROC） curves were constructed， and the area under the curve （AUC） was calculated to assess the diagnostic performance of SWE in different directions for distinguishing benign and malignant thyroid nodules. The Cronbach reliability coefficient and Bland-Altman plot were used to analyze the reliability and consistency of SWE in both transverse and longitudinal directions for diagnosing thyroid nodules.ResultsThe transverse and longitudinal elastic modulus values of malignant thyroid nodules were higher than those of benign nodules. The differences in Emax and Emean values in transverse and longitudinal sections were not statistically significant for benign nodules， but they were statistically significant for malignant nodules. The ROC analysis showed that the AUC values for Emax and Emean in longitudinal shear wave elastography were 0.955 and 0.939， respectively， while the AUC values for Emax and Emean in transverse shear wave elastography were 0.942 and 0.930， respectively. There was no statistically significant difference in the diagnostic performance （AUC） between these two measurements. Cronbach's reliability analysis of Emax and Emean for SWE in cross-sectional and longitudinal sections of 79 thyroid nodules showed a good correlation （reliability coefficient values of 0.941， 0.943）. The Bland-Altman plots visually showed that the values of the elastic modulus in the transverse and longitudinal sections had almost no deviation over a wide range， indicating a good level of agreement in the data.ConclusionThe section orientation （transverse and longitudinal sections） shows good agreement and reliability for SWE measurements of maximum and mean modulus values of thyroid nodules. The similar performance of the two imaging orientations provides examination flexibility for imaging patients with anatomical or physiological limitations.
thyroid nodule/SWE/section orientation/elastic modulus value
| 1 | Cabanillas ME， McFadden DG， Durante C. Thyroid cancer［J］.Lancet，2016，388（10061）： 2783. |
| 2 | Haugen BR， Alexander EK， Bible KC， et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer： the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer［J］.Thyroid，2016，26（1）： 1. |
| 3 | Liao LJ， Chen HW， Hsu WL， et al. Comparison of strain elastography， shear wave elastography， and conventional ultrasound in diagnosing thyroid nodules［J］.J Med Ultrasound，2019，27（1）： 26. |
| 4 | Chen Y， Dong B， Jiang Z， et al. SuperSonic shear imaging for the differentiation between benign and malignant thyroid nodules： a meta-analysis［J］.J Endocrinol Invest，2022，45（7）： 1327. |
| 5 | Filho RHC， Pereira FL， Iared W. Diagnostic accuracy evaluation of two-dimensional shear wave elastography in the differentiation between benign and malignant thyroid nodules： systematic review and meta-analysis［J］.J Ultrasound Med，2020，39（9）： 1729. |
| 6 | Swan KZ， Nielsen VE， Bonnema SJ. Evaluation of thyroid nodules by shear wave elastography： a review of current knowledge［J］.J Endocrinol Invest，2021，44（10）： 2043. |
| 7 | 李健明， 胡向东， 张岩峰， 等. 剪切波弹性成像的影响因素分析［J］.中华医学超声杂志（电子版），2019，16（8）： 565. |
| 8 | Sigrist RMS， Liau J， Kaffas AE， et al. Ultrasound elastography： review of techniques and clinical applications［J］.Theranostics，2017，7（5）： 1303. |
| 9 | Taljanovic MS， Gimber LH， Becker GW， et al. Shear-wave elastography： basic physics and musculoskeletal applications［J］.Radiographics，2017，37（3）： 855. |
| 10 | Shiina T， Nightingale KR， Palmeri ML， et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography： part 1： basic principles and terminology［J］.Ultrasound Med Biol，2015，41（5）： 1126. |
| 11 | Kim JK， Baek JH， Lee JH， et al. Ultrasound elastography for thyroid nodules： a reliable study？［J］.Ultrasound Med Biol，2012，38（9）： 1508. |
| 12 | Barbone PE， Bamber JC. Quantitative elasticity imaging： what can and cannot be inferred from strain images［J］.Physics in Medicine & Biology，2002，47（12）： 2147. |
| 13 | Lin P， Chen M， Liu B， et al. Diagnostic performance of shear wave elastography in the identification of malignant thyroid nodules： a meta-analysis［J］.European radiology，2014，24： 2729. |
| 14 | 王艳春， 肖沪生， 徐芳， 等. 实时剪切波弹性成像在骨骼肌系统中的应用［J］.中国医学影像学杂志，2016，24（3）： 238. |
| 15 | Lee HY， Lee JH， Shin JH， et al. Shear wave elastography using ultrasound： effects of anisotropy and stretch stress on a tissue phantom andin vivoreactive lymph nodes in the neck［J］.Ultrasonography，2017，36（1）： 25. |
| 16 | Gennisson JL， Deffieux T， Macé E， et al. Viscoelastic and anisotropic mechanical properties of in vivo muscle tissue assessed by supersonic shear imaging［J］.Ultrasound Med Biol，2010，36（5）： 789. |
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