超声实时组织弹性成像对甲状腺弥漫性病变的应用研究

发布时间：2018-02-10 16:55

本文关键词： 超声弹性成像甲状腺弥漫性病变诊断　出处：《川北医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨超声实时组织弹性成像(Real-time Tissue Elastography,RTE)对甲状腺弥漫性病变的诊断及鉴别诊断价值。方法:选择2014年2月至2014年10月在本院检查发现的甲状腺弥漫性病变患者156例作为病例组,其中毒性弥漫性甲状腺肿(Graves’disease,GD)组46例,桥本氏甲状腺炎(Hashimoto’s thyroiditis,HT)组94例,亚急性甲状腺炎(Subacute thyroiditis,SAT)组16例,另选择60例正常对照组。对病例组及正常组进行常规超声及超声实时组织弹性成像(RTE)检查,获得弹性分级评分及弹性参数,各病变组与正常组间进行常规及弹性成像比较,各组弹性参数MEAN值与实验室指标进行相关性分析,以临床诊断为标准,绘制受试者操作特征曲线(Receiver Operating Characteristic curve,ROC曲线)寻找鉴别不同的甲状腺弥漫性病变的界值点。结果:1.正常组及GD组腺体较软,弹性图像以绿色为主,夹杂少许红色及蓝色,弹性分级以1级为主(52/60,36/46),差异无统计学意义;HT组稍硬,弹性图像以蓝绿夹杂多见,弹性分级以2级为主(62/94);SAT组较硬,弹性图像以蓝色为主,弹性分级以3级及4级为主(6/16,10/16)。2.病例组与正常组的弹性参数比较,相对应变均数(MEAN)依次为GD组正常组HT组SAT组,感兴趣区域(Region of interest,ROI)蓝色面积比例(%AREA)依次为SAT组HT组GD组正常组。除了GD组与正常组组间比较P0.05,其余各组组间比较P0.05。各组MEAN值与%AREA呈高度负相关,Pearson相关系数r=-0.947,P0.001。3.根据ROC曲线下面积(Area under the curve,AUC)可知,GD组与HT组比较,AUC为0.958,GD的MEAN值高于HT组,当MEAN的界值点为119.6时,准确诊断出GD36例(共46例)诊断敏感性82.6%,特异性96.8%;SAT组与HT组比较,AUC为0.984,SAT组的MEAN值低于HT组,差异有统计学意义,当MEAN的界值点为60.6时,准确诊断出SAT15例(共16例),诊断敏感性95.7%,特异性93.3%。4.正常甲状腺血流信号呈散在稀疏的点状及短棒状血流信号,均为1级(60/60);GD组血流信号明显增多,部分呈“火海征”,分级以3级及4级为主(24/46,18/46);HT组大部分血流信号增多(79/94);SAT组病变区域血流信号多正常或稍减少,正常区域血流信号正常或稍增多,以1级为主(12/16)。5.甲状腺血管搏动感在GD患者中常见,可作为特征性指标。6.甲状腺弥漫性病变GD、HT、SAT的MEAN值与FT3、FT4呈低度正相关,与TSH、Tg Ab、TPOAb无明显相关性。7.常规超声诊断GD、HT、SAT的准确率分别为78.3%、85.1%、87.5%,结合RTE准确率分别提高至91.3%、93.6%、100%。结论:超声实时弹性成像(RTE)对甲状腺弥漫性病变诊断与鉴别诊断有一定帮助,但对于声像图必须综合分析,联合常规超声能提高诊断的准确率。
[Abstract]:Objective: to evaluate the value of real-time Tissue Elastography (RTE) in the diagnosis and differential diagnosis of diffuse thyroid lesions. Methods: from February 2014 to October 2014, the patients with diffuse thyroid lesions were selected. 156 cases as case groups, Among them, there were 46 cases in the GDgroup, 94 cases in the Hashimoto's thyroiditis group and 16 cases in the subacute thyroiditis subacute thyroiditis group, among which there were 46 cases in the GDgroup, 94 cases in the Hashimoto's thyroiditis group and 16 cases in the subacute thyroiditis group. In addition, 60 cases of normal control group were examined by conventional ultrasound and real-time tissue elastography (RTEs), and the elastic grading and elastic parameters were obtained. The conventional and elastic imaging were compared between each pathological group and the normal group. The correlation between the MEAN value of elastic parameters and the laboratory indexes was analyzed, and the clinical diagnosis was used as the standard. The receiver Operating Characteristic curve (ROC curve) was drawn to find the threshold points for distinguishing different diffuse thyroid lesions. Results: 1. The glands in normal group and GD group were soft, the elastic images were green and a little red and blue. The elastic grading was based on grade 1 (52 / 60 / 36 / 46). The difference was not statistically significant in HT group. Blue and green inclusions were more common in elastic images. In elastic grading, 62 / 94 / SAT group was more rigid, and blue was dominant in elastic images. The elastic grade of grade 3 and grade 4 were 6 / 16 / 10 / 16 / 16 路2.Compared with the normal group, the relative strain mean (RMSM) was GD group (HT group), HT group (SAT group), and normal group (P < 0.05). The blue area ratio of region of interest to area of interest is SAT group HT group GD group normal group, except GD group and normal group comparison P 0.05. The MEAN value of each group is highly negatively correlated with Ara and Pearson correlation coefficient rnr ~ 0.947 P 0.001.3.The value of MEAN in each group is negatively correlated with that of normal group (r = 0.947, P = 0.001. 3, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05). Under the ROC curve, the area under the MEAN value of GD group was higher than that of HT group, and the MEAN value of GD group was higher than that of HT group. When the threshold value of MEAN was 119.6, the diagnostic sensitivity of 46 cases of GD36 was 82.6, and the MEAN value of the group with specificity 96.8T was lower than that of the HT group. The difference was statistically significant when the threshold of MEAN was 60.6. Accurate diagnosis of SAT15 (16 cases, sensitivity 95.7m, specificity 93.3.4.The normal thyroid blood flow signal was scattered in sparse point and short rod blood flow signal, the blood flow signal was increased obviously in the GD group of grade 1 60 / 60%, the normal thyroid blood flow signal was scattered in the sparse point shape and short rod shape, all of which were grade 1 / 60 / 60 + GD group, the normal thyroid blood flow signal was increased obviously. Some of them showed "fire sign", and most of the blood flow signals were increased in 24 / 46 / 46 / 46 / 46 ~ (-1) HT group with grade 3 and grade 4. Most of the blood flow signals in the diseased area of the SAT group were normal or slightly decreased, but the blood flow signals in the normal area were normal or slightly increased. Thyroid vascular pulsation was common in GD patients, and could be used as a characteristic index. The MEAN value of GDT in diffuse thyroid lesions was positively correlated with FT3 / FT4. There was no significant correlation between T#en0# and T#en0#. 7. the accuracy of conventional ultrasound in the diagnosis of GDHT TPOSAT was 78.3% and 87.5%, respectively. The accuracy of RTE was improved to 91.3% and 93.66%, respectively. Conclusion: real time elastography is helpful in the diagnosis and differential diagnosis of diffuse thyroid lesions. But the sonogram must be analyzed synthetically, and the diagnostic accuracy can be improved by combining conventional ultrasound.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.1;R581

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