Acoustic radiation force impulse in differentiating benign and malignant cervical lymph nodes
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摘要:
目的探讨声脉冲辐射力成像（ARFI）中声触诊组织成像（VTI）与声触诊组织定量（VTQ）技术在颈部淋巴结良恶性鉴别诊断中的应用价值。 方法分析65例100个颈部淋巴结疾病患者的常规超声及ARFI成像特征，测量淋巴结VTI图像与二维图像面积比及其SWV值，以病理学结果作为金标准，绘制ROC曲线，获得区分颈部淋巴结良恶性VTI面积比值及SWV的临界值。 结果5个常规超声评价指标中P < 0.01的有短径/长泾、淋巴门及微钙化，它们在常规超声鉴别颈部淋巴结良恶性的敏感度、特异度及准确度分别为84.81%，90.47%，86%；86.07%，95.23%，88%；0，52.38%，11%。非特异性反应性淋巴结组VTI面积比为1.07±0.26，恶性淋巴结组的VTI面积比为1.68±0.31，两者相比差异具有统计学意义（T=8.9356，P < 0.001）。非特异性反应性淋巴结组的SWV值为1.72±0.89 m/s，恶性淋巴结组的SWV值为2.68±0.48 m/s，二者比较差异具有统计学意义（T=4.7141，P < 0.001）。构建VTI及SWV的ROC曲线后，其AUC分别为0.799和0.862，根据ROC曲线选取鉴别良恶性淋巴结的VTI面积比及SWV值的临界值分别为1.2、1.9，其对应的敏感度、特异度、准确度分别为96.20%，95.23%，96%；89.87%，90.47%，90%。 结论ARFI弹性成像有助于鉴别颈部淋巴结的良恶性。 Abstract:Objective To explore the value of virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ) technology of acoustic radiation force impulse (ARFI) elastography in the differential diagnosis of benign and malignant cervical lymph nodes. Methods The routine ultrasound (US) and ARFI imaging features of 100 cervical lymph nodes in 65 patients were analyzed.The VTI area ratio and shear wave velocity (SWV) were obtained by ARFI; then receiver operating characteristic (ROC) curves were drawn to obtaine the critical values of VTI area ratio and SWV for differentiating benign and malignant cervical lymph nodes on the basis of pathological findings. Results Short diameter/ Long, hilus and microcalcification of five US evaluation indexes were P < 0.01, and the sensitivity, specificity and accuracy of benign and malignant cervical lymph nodes were 84.81%, 90.47%, 86%; 86.07%, 95.23%, 88%;0%, 52.38%, 11%, respectively on routine US. VTI area ratio: 1.07±0.26 for nonspecific reactive lymph nodes, 1.68±0.31 for malignant lymph nodes, with significant difference (T=8.9356, P < 0.001). SWVs: 1.72±0.89 m/s for nonspecific reactive lymph nodes, 2.68±0.48 m/s for malignant lymph nodes with significant difference (T=4.7141, P < 0.001). ROC indicated that AUC was 0.799 for VTI and 0.862 for SWV, the critical value was 1.2 of VTI area ratio and 1.9 of SWV. The sensitivity, specificity and accuracy were 96.20%, 95.23%, 96% of VTI area ratio; 89.87%, 90.47%, 90% of SWV, respectively. Conclusion ARFI elastography is helpful in differentiating benign and malignant cervical lymph nodes. -
表 1 二维超声及ARFI对照病理所得结果
良性淋巴结(n=79) 恶性淋淋巴结(n=21) 灵敏度(%) 特异度((%) 准确度(%) 常规超声 边界 清晰 54 12 68.35 42.58 63 不清晰 25 9 短径(mm) 9 31 17 39.24 19.04 35 <9 48 4 短径/长径(mm) <0.5 67 2 84.81 90.47 86 ≧0.5 12 19 淋巴门 不显示 68 1 86.07 95.23 88 显示 11 20 微钙化 有 0 10 0 52.38 11 无 79 11 ARFI成像 YTQ值 <1.9m/s 71 2 89.87 90.47 90 ≧1.9m/s 8 19 VTI值 <1.2 76 1 96.2 95.23 96 ≧1.2 3 20 
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