RESUMO
Objective:To investigate the application value of shear wave elastography (SWE) and real-time tissue elastography (RTE) in differential diagnosis of thyroid Amereican College Radiology (ACR) TR5 nodules.Methods:Patients who underwent ultrasound examination at the Fourth Affiliated Hospital of Harbin Medical University from August 2018 to June 2019 diagnosed as ACR TR5 nodules were surveyed, and received SWE and RTE examinations to evaluate the nodules hardness. The receiver operating characteristic curve (ROC curve) was drawn to obtain the best diagnostic cutoff value for the Young's modulus maximum (Emax) of the benign and malignant thyroid ACR TR5 nodules using SWE technique; using the 5-point method, the elasticity score (ES) was used to evaluate the benign and malignant ACR TR5 nodules by RTE technology, and the pathological results were regarded as "gold standard". The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of SWE, RTE and two elastography techniques in differential diagnosis of benign and malignant thyroid ACR TR5 nodules were compared.Results:A total of 65 patients were enrolled, with a total of 73 ACR TR5 nodules. The optimal Emax threshold for differential diagnosis of ACR TR5 nodules by SWE technology was 41.8 kPa, and 32 malignant nodules and 41 benign ones were determined. Of the 73 ACR TR5 nodules using RTE technology, 38 had ES scores of 1 to 3 and 35 had ES scores of ≥4. Pathological results showed that among 73 thyroid ACR TR5 nodules, benign nodules accounted for 45.21% (33/73), malignant nodules accounted for 54.79% (40/73). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SWE, RTE and two elastography techniques for differential diagnosis of benign and malignant thyroid ACR TR5 nodules were 72.50%, 77.50%, 87.50%; 90.91%, 87.88%, 87.88%; 80.82%, 82.19%, 87.67%; 90.63%, 88.57%, 89.24% and 73.17%, 76.32%, 85.29%.Conclusions:Ultrasound elastography of two different imaging principles of SWE and RTE is an effective method for differential diagnosis of benign and malignant thyroid ACR TR5 nodules. The combination of the two is more advantageous.