声辐射力脉冲成像联合BI-RADS在乳腺良恶性肿块鉴别中的应用价值

发布时间：2018-03-18 09:10

本文选题：声辐射力脉冲成像技术　切入点：BI-RADS　出处：《苏州大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究目的:1.探讨声辐射力脉冲成像技术(acoustic radiation force impulse,ARFI),包括声触诊组织成像(virtual touch tissue imaging,VTI)技术和声触诊组织定量(virtual touch tissue quantification,VTQ)技术在乳腺良恶性肿块鉴别诊断中的应用价值。2.以乳腺肿块内部区域的剪切波速度(shear wave velocity,SWV)平均值,构建受试者工作特性曲线(receiver operator characteristic curve,ROC)获得SWV最佳截断值,为乳腺病变良恶性鉴别提供新的观察指标。3.探讨旧版及新版BI-RADS分级对乳腺肿块良恶性鉴别的诊断价值。4.ARFI技术联合新版BI-RADS分级诊断标准对乳腺肿块良恶性鉴别的诊断价值。资料与方法:本研究入选2014年11月~2015年7月于无锡第二人民医院就诊发现有乳腺肿块的女性患者107例,共123个肿块。所有病例均手术或穿刺活检后经病理证实,其中良性肿块76个,恶性肿块47个。超声诊断仪:Siemens Acuson S2000,具备声辐射力脉冲成像技术。所有肿块均先在二维超声模式下观察乳腺肿块的大小、形态、内部回声、周围组织情况等,然后进入彩色多普勒观察乳腺肿块及周边的血流情况,用频谱多普勒超声技术测量乳腺肿块阻力指数。对肿块进行bi-rads分级后,运用vti技术获取乳腺肿块vti图像,对肿块进行评分。再用vtq技术分别测量肿块内部、肿块边缘处及周围正常乳腺腺体的swv值,各测量5次,取平均值,对以上数据应用统计学软件进行统计分析,判断vtq技术对乳腺肿块良恶性的诊断价值,p0.05为差异有统计学意义。研究结果:1.vti技术评分法评分1~3分判断为良性,4~5分判断为恶性,鉴别诊断乳腺肿块的准确性、敏感性、特异性分别为87.00%(107/123)、85.11%(40/47)、88.16%(67/76)。vtq技术乳腺良性肿块组肿块内部、边缘及正常乳腺swv平均值分别为2.66±0.99m/s、2.55±0.78m/s、1.92±0.48m/s;乳腺恶性肿块组肿块内部、边缘及正常乳腺swv平均值分别为5.75±2.11m/s、4.43±1.78m/s、2.46±0.57m/s。乳腺良性肿块组与乳腺恶性肿块组肿块内部的swv平均值比较具有统计学差异(p0.01)。2.以病理结果为金标准,以乳腺肿块内部区域的swv均值构建roc,所得的曲线下面积(areaundercurve,auc)为0.911,约登指数最大值为0.809,该点所对应的swv最佳诊断临界值为3.795m/s,其诊断乳腺肿块的准确性89.43%(110/123)、敏感性80.85%(38/47)、特异性94.74%(72/76)。3.旧版bi-rads分级鉴别诊断乳腺肿块良恶性的准确性79.67%(98/123)、敏感性89.36%(42/47)、特异性73.68%(56/76);新版BI-RADS分级鉴别诊断乳腺肿块良恶性的准确性86.99%(107/123)、敏感性82.98%(39/47)、特异性89.47%(68/76)。新版BI-RADS与旧版BI-RADS分级诊断的准确性、特异性之间有统计学差异(P0.05)。4.ARFI技术(VTI技术+VTQ技术)联合新版BI-RADS分级诊断标准鉴别诊断乳腺肿块良恶性的准确性、敏感性分别为89.43%、91.49%,均高于单一一种方法,但相互间两两比较均无统计学意义。结论:1.ARFI技术作为二维超声的有效补充,在乳腺良恶性肿块的鉴别诊断方面有较高的临床应用价值,ARFI技术能客观定量定性评价肿块硬度信息,VTI技术可定性鉴别乳腺肿块的良恶性,VTQ技术SWV平均值以3.795m/s为界,可区分乳腺良、恶性肿块。2.新版BI-RADS分级诊断乳腺良恶性肿块的准确性、特异性高于旧版BI-RADS分级。3.ARFI技术与新版BI-RADS联合诊断后,可提高对乳腺肿块良恶性的鉴别诊断能力。
[Abstract]:Objective: 1. to investigate the acoustic radiation force impulse imaging technology (acoustic radiation force impulse, ARFI), including virtual touch tissue imaging (virtual touch tissue imaging, VTI) technology and virtual touch tissue (virtual touch tissue quantification quantitative, VTQ) application value of.2. in differential diagnosis of benign and malignant breast tumors using shear internal region of breast mass velocity (shear wave velocity, SWV) on average, construct the receiver operating characteristic curve (receiver operator characteristic curve, ROC SWV) to obtain the optimal cut-off value, provide a new observation index of.3. for differentiating malignant from benign breast lesions and to investigate the diagnostic value and classification of the old version of the new version of BI-RADS in the diagnosis of breast cancer diagnosis the value of.4.ARFI technology combined with the new BI-RADS classification criteria for the differential diagnosis of breast tumors. Materials and methods: This study selected in November 2014 ~2015 In July Second People's Hospital of Wuxi were found in 107 cases of female patients with breast tumors, a total of 123 tumors. All cases after surgery or biopsy confirmed by pathology, including 76 benign lesions, 47 were malignant. Ultrasonic diagnostic instrument: Siemens Acuson S2000, with acoustic radiation force impulse imaging technology. The masses were first in the two-dimensional ultrasound mode observation of breast tumor size, shape, internal echo, surrounding tissues, and then enter the color Doppler to observe the blood flow of breast masses and the surrounding, with spectral Doppler ultrasound measurement of breast mass technical resistance index. BI-RADS classification of tumor of breast masses, obtaining VTI images using VTI Technology wasassessed by vtq technology. Mass were measured within the mass, mass at the edge and surrounding normal breast glands SWV values, measured 5 times, taking the average value, the data should be Statistical analysis was performed using SPSS software, determine the value of vtq in the diagnosis of benign and malignant breast tumors, P0.05 was considered significant. Results: 1.vti scoring 1~3 points to judge benign, 4~5 judgment of malignant, the accuracy of diagnosis of breast masses sensitivity and specificity were 87% (107/123). 85.11% (40/47), 88.16% (67/76).Vtq group of benign breast tumor and normal breast lumps inside edge of the average value of SWV was 2.66 + 0.99m/s, 2.55 + 0.78m/s, 1.92 + 0.48m/s; breast tumor group and normal breast lumps inside edge of the average value of SWV was 5.75 + 2.11m/s, 4.43 + 1.78m/s, 2.46 0.57m/s. + benign breast tumor group and malignant tumor of breast tumor group internal SWV average value was statistically difference (P0.01).2. with pathological results as the gold standard to construct the ROC internal region of breast masses SWV mean, The area under the curve (areaundercurve, AUC) is 0.911, the maximum value of Youden's index was 0.809, the corresponding SWV optimal diagnostic critical value was 3.795m/s, the diagnosis of breast tumor with accuracy of 89.43%, sensitivity of 80.85% (110/123) (38/47), specificity 94.74% (72/ 76).3. the old version of the BI-RADS classification of differential diagnosis the accuracy of benign and malignant breast tumors 79.67% (98/123), the sensitivity was 89.36%, specificity 73.68% (42/47) (56/76); the new BI-RADS classification of differential diagnosis of benign and malignant breast tumors and the accuracy of 86.99%, sensitivity of 82.98% (107/123) (39/47), specificity 89.47% (68/76). The accuracy of the new BI-RADS with the old version of the BI-RADS classification. There were significant differences in the specificity between (P0.05).4.ARFI (VTI +VTQ) with a new version of the BI-RADS grading diagnosis standard in differential diagnosis of benign and malignant breast tumors of the accuracy, the sensitivity were 89.43%, 91.49%, were higher than that of a single Among the 22 methods, but the difference was not statistically significant. Conclusion: 1.ARFI technology is an effective supplement to two-dimensional ultrasound, high in differential diagnosis of benign and malignant breast tumors and the clinical application value, ARFI technology can objectively and quantitatively assess the mass hardness information, VTI technology can be qualitative identification of breast tumor, VTQ technology the average value of SWV to 3.795m/s, can distinguish between breast benign and malignant tumors,.2. version of the BI-RADS classification accuracy in diagnosis of benign and malignant breast tumors that is more specific than the old version of the BI-RADS.3.ARFI technology combined with the new version of the BI-RADS grading diagnosis, can improve the differential diagnosis of benign and malignant breast masses.

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.1;R737.9

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