剪切波弹性成像联合超声造影参数预测甲状腺乳头状癌颈部淋巴结转移的效能OA

Objective:To analyze the efficacy of parameters from shear wave elastography(SWE)combined with contrast-enhanced ultrasound(CEUS)in predicting cervical lymph node metastasis of papillary thyroid carcinoma(PTC).Methods:Patients diagnosed with PTC in the ultrasound department of our hospital from October 2019 to October 2023 were included.All patients underwent SWE and CEUS examinations.The SWE parameters of the metastasis group and the non-metastasis group were compared,including the maximum elastic modulus(Emax),the minimum elastic modulus(Emin),and the average elastic modulus(Emean);as well as the time-intensity curve parameters of CEUS,including peak intensity(PE),rise time(RT),and time to peak(TTP).Binary logistic regression was used to screen independent predictive factors,and ROC curves were drawn to evaluate the predictive value of different examinations for cervical lymph node metastasis in PTC patients.Results:A total of 157 PTC patients(193 nodules)were included,among which 80 nodules(62 cases)were in the metastasis group and 113 nodules(95 cases)were in the non-metastasis group,with a metastasis rate of 39.49％.The elastic modulus Emax,Emin and Emean of nodules in the metastatic group were all greater than those in the non-metastatic group,and the difference was statistically significant(P＜0.05).The PE in the metastasis group was higher than that in the non-metastasis group,and the difference was statistically significant(P＜0.05),while there was no statistically significant difference in RT,TTP,WiR,and mTT between the two groups(P＞0.05).The results of binary logistic regression analysis indicated that Emax,Emean,and PE were the influencing factors of cervical lymph node metastasis in PTC(P＜0.05).ROC curve analysis showed that the AUC value of SWE combined with CEUS was 0.967(95％CI:0.947～0.988),and the optimal cut-off values were Emax＞104.74 kPa,Emean＞52.71 kPa and PE＞12.07(Youden index=0.817).The sensitivity,specificity and accuracy of SWE combined with CEUS diagnosis were 92.92％,88.75％and 91.19％respectively,and the sensitivity was significantly higher than that of SWE(79.65％)and CEUS(76.11％)(P=0.032,0.028＜0.05).Conclusion:SWE combined with CEUS can significantly improve the diagnostic efficacy of cervical lymph node metastasis in PTC(AUC=0.967),reduce the over-treatment rate of cervical lymph node dissection by 18.3％,and provide a key basis for the formulation of personalized surgical plans.