双重超声造影在评估胃癌术前分期及微循环灌注的应用价值

发布时间：2018-01-08 15:15

本文关键词：双重超声造影在评估胃癌术前分期及微循环灌注的应用价值　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究旨在探讨双重超声造影在评估胃癌术前分期及定量评价胃癌微循环灌注的应用价值。方法:选取经胃镜活检证实为胃癌的70例患者进行研究,所有患者术前接受胃窗超声造影(OCUS)、双重超声造影(DCEUS)检查,通过对比OCUS、DCEUS以及临床病理学结果来反映双重超声造影在胃癌局部浸润深度及肝转移方面的应用价值,对完成手术的胃癌患者及13例胃癌肝转移的未手术患者,选取胃癌病变组织和周边正常胃壁组织为感兴趣区绘制时间-强度曲线(TIC)获取两组参数:基础强度(BI)、峰值强度(PI)、到达时间(AT)及达峰时间(TTP)、计算增强强度(EI)和灌注时间(WIT)后进行比对分析并绘制ROC曲线来评价胃癌的微循环灌注特征。结果:OCUS、DCEUS诊断胃癌T分期总符合率分别为71.92%、87.71%,与病理结果一致性kappa值分别为0.640、0.849(P0.001);OCUS检查诊断胃癌T分期的诊断符合率显著低于DCEUS(χ2=4.412,P=0.036),DCEUS对胃癌T分期的评估在B、C检查医生之间具有较高的重复可靠性。13例胃癌肝转移患者共52个病灶,OCUS、DCEUS检出率分别为51.92%、86.54%,两种检查在胃癌肝转移灶检出率之间存在显著性差异(χ2=14.625,P0.001)。比较DCEUS中胃癌病变组织与周围正常胃壁组织TIC造影参数得出,胃癌病变组织的PI、EI值均大于周围正常胃壁组织,有统计学意义(P0.001,P0.001),BI、AT、TTP及WIT的差异无统计学意义(P分别为0.087、0.316、0.261、0.524),绘制ROC曲线图,得出PI、EI诊断胃癌的最佳阈值分别为22.79dB、18.55dB;DCEUS中造影参数EI的测量在甲、乙检查医生之间具有较高的重复可靠性。结论:DCEUS可获得病灶解剖结构和微循环灌注的双重信息,在胃癌局部浸润深度、肝转移的诊断中与术后病理学的一致性较高,DCEUS有望成为评估胃癌术前分期和微循环灌注的一种非侵入性、安全、有效、可靠的新方法。
[Abstract]:Objective: This study aimed to investigate the double contrast enhanced ultrasound in the preoperative assessment of gastric cancer staging and quantitative evaluation of application value of gastric microcirculation perfusion. Methods: selected by endoscopic biopsy confirmed 70 cases of gastric cancer patients were studied, all patients received gastric window ultrasound before operation (OCUS), double contrast ultrasonography (DCEUS) examination, by contrast OCUS, the application value of DCEUS and the clinical pathology to reflect double contrast-enhanced ultrasound in the diagnosis of gastric cancer invasion and local liver metastasis, to complete the surgery in patients with gastric cancer and 13 cases of hepatic metastasis of gastric cancer without surgery, selection of gastric cancer tissue and adjacent normal gastric tissue as region of interest using time intensity curve (TIC) get two sets of parameters: the strength of the foundation (BI), peak intensity (PI), time of arrival (AT) and peak time (TTP), calculation of strength (EI) and perfusion time (WIT) after comparing and drawing the ROC. Line to evaluate the microcirculation perfusion features of gastric carcinoma. Results: OCUS and DCEUS diagnosis of gastric cancer T staging coincidence rate were 71.92%, 87.71%, and pathological results of consistency of kappa = 0.640,0.849 (P0.001); the rate was significantly lower than that of DCEUS according to the diagnostic OCUS examination for the diagnosis of T staging of gastric carcinoma (2=4.412, P=0.036), DCEUS of gastric cancer T staging evaluation in B, a total of 52 lesions, repeated cases of gastric cancer patients with liver metastasis.13 reliability with high C doctor OCUS, the detection rate of DCEUS were 51.92%, 86.54%, two kinds of examination in the detection of liver metastases of gastric cancer have significant difference between the rate of (x 2=14.625, P0.001). DCEUS TIC angiography the parameters in gastric cancer tissue and surrounding normal gastric tissue that gastric cancer tissue PI, EI values were greater than the surrounding normal gastric tissue, there was statistical significance (P0.001, P0.001), BI, AT, there were no significant differences between TTP and WIT (P = 0. 087,0.316,0.261,0.524), draw the ROC curves, the PI, the best threshold value of EI diagnosis of gastric cancer were 22.79dB, 18.55dB; EI DCEUS in the measurement of imaging parameters in a repeated high reliability between B doctor. Conclusion: DCEUS can obtain topographic dual information structure and microcirculatory perfusion in gastric cancer, depth of invasion. With the postoperative pathological high consistency in diagnosis of hepatic metastasis, DCEUS is expected to become the preoperative assessment of gastric cancer staging and microcirculatory perfusion in a non-invasive, safe, effective and reliable method.

【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R735.2

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