剪切波弹性成像技术评价甲状腺结节良恶性的临床研究

发布时间：2018-06-26 11:43

  本文选题：甲状腺结节 + 剪切波弹性成像　； 参考：《山西医科大学》2017年硕士论文

【摘要】：目的:比较剪切波弹性成像(SWE)测得的各杨氏模量在甲状腺结节良恶性鉴别诊断中的价值;建立以常规超声征象及SWE杨氏模量为回归参数的Logistic回归模型,比较回归模型与常规超声在诊断甲状腺恶性结节中的价值。方法:对拟行甲状腺切除术或细针穿刺活检术的104例患者共258个结节在术前行常规超声及SWE检查。记录各结节常规超声征象和杨氏模量(Emax、Emean、Emin、Esd、E-ratio)。对比甲状腺结节的病理结果,绘制出常规超声与SWE的ROC曲线,比较SWE与常规超声的诊断甲状腺恶性结节价值,并获得各杨氏模量诊断甲状腺恶性结节的最佳临界值。通过Logistic回归分析,比较与甲状腺恶性结节相关超声征象的价值,建立回归模型。结果:(1)最终纳入本研究的甲状腺结节患者有89例,共有180个结节,恶性者34个,良性者146个。(2)常规超声征象的单因素分析中,甲状腺恶性结节以纵横比≥1、极低回声、微钙化、边界不清、边缘不规则、不规则声晕、后方回声衰减、甲状腺被膜受侵等征象多见,但上述征象诊断甲状腺恶性结节的价值有所局限。(3)SWE下,Emax、Emean及Esd在甲状腺良恶性结节中有差异(P0.01)恶性结节较良性结节硬度大。(4)Emax、Emean及Esd诊断甲状腺恶性结节的最佳临界值分别为52.07kPa、32.4kPa、6.6kPa。(5)Emax、Esd的ROC曲线形下面积(AUC)较Emean更大,且有统计学差异(0.845、0.804Vs0.680,P0.001),但Emax与Esd之间无差异(0.845 Vs 0.804,P=0.170)。与常规超声诊断甲状腺恶性结节的AUC相比,Emax、Esd的AUC较小(0.845、0.804Vs0.882),但差异无统计学意义(PEmax=0.392,PEsd=0.058)。(6)Logistic回归分析中,与甲状腺恶性结节相关的独立因素为形态、边缘与Emax,并建立了回归模型;(7)该回归模型诊断甲状腺恶性结节的特异度(95.89%Vs 82.19%)、准确度(93.33%Vs 84.44%)及AUC高于常规超声(0.958 Vs 0.882),且差异均有统计学意义(P≤0.002)。结论:常规超声为诊断甲状腺结节良恶性最重要的依据,SWE为甲状腺结节良恶性的诊断提供了新的参数,其中以Emax和Esd诊断价值更高。常规超声与SWE联合评价甲状腺结节的良恶性,可提高其诊断价值,减少误诊。
[Abstract]:Objective: to compare the value of Young's modulus measured by shear wave elastic imaging (SWE) in the differential diagnosis of benign and malignant thyroid nodules, and to establish a logistic regression model with conventional ultrasound signs and Young's modulus of SWE as regression parameters. To compare the value of regression model and conventional ultrasound in the diagnosis of malignant thyroid nodules. Methods: a total of 258 nodules of 104 patients undergoing thyroidectomy or fine needle biopsy were examined by conventional ultrasound and SWE before operation. The conventional ultrasound signs and the E / E ratio of Emaxus were recorded. By comparing the pathological results of thyroid nodules, the ROC curves of conventional ultrasound and SWE were drawn, the value of SWE and conventional ultrasound in the diagnosis of thyroid malignant nodules was compared, and the best critical value for the diagnosis of thyroid malignant nodules with Young's modulus was obtained. Logistic regression analysis was used to compare the value of ultrasound findings associated with thyroid malignant nodules and to establish a regression model. Results: (1) there were 89 patients with thyroid nodules, including 180 nodules, 34 malignant nodules and 146 benign thyroid nodules. (2) in univariate analysis of conventional ultrasound findings, thyroid nodule with aspect ratio 鈮，

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