超声多模态在肝泡型包虫病诊断中的应用

发布时间：2018-01-08 11:37

本文关键词：超声多模态在肝泡型包虫病诊断中的应用　出处：《青海大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨超声多模态在肝泡型包虫病诊断中的应用价值。方法:收集2015年9月至2017年2月在我院住院就诊拟诊为肝泡型包虫病的95例肝脏结节病例,分别进行二维超声、彩色多普勒、弹性成像检查,对疑似肝泡型包虫病的部分病灶进行了超声造影检查,分别记录病灶的大小及弹性评分,弹性评分采用5级评分法。把超声造影视频存盘并进行处理分析,绘制时间-强度曲线。对肝泡型包虫病灶进行分型,分别记录每一型肝泡型包虫病灶的中心区、边缘区和周围区的造影定量参数(pI;Tp;AUC;MTT)。然后与手术或病理结果对比,综合评价超声对肝泡型包虫诊断的临床应用价值。结果:所有被检病例可分为原发性肝癌、肝泡型包虫、肝血管瘤和肝囊型包虫四个疾病组。同一切面下,原发性肝癌和肝泡型包虫病组中,弹性成像状态下的面积、周长和体积均显著大于常规超声状态下的面积、周长和体积(t=-3.164、-2.292、-2.359;-4.388、-2.442、-4.559;P=0.005、0.033、0.029;0.000、0.018、0.000)。原发性肝癌的弹性评分显著大于肝泡型包虫病灶的弹性评分(t=2.640;P=0.013),肝泡型包虫病灶的弹性评分显著大于肝血管瘤的弹性评分(t=9.136;P0.001)。在所有的肝泡型包虫病灶中,中心非增强区、边缘区和周围正常区的pI和AUC具有显著性差异(p0.01);在不同类型的病灶边缘区的造影定量参数比较中,浸润型、钙化型和液化型病灶之间,pI、Tp和MTT具有显著性差异(F=8.832、9.088、5.538;P=0.001、0.001、0.007),通过两两比较,pI、Tp、AUC和MTT四个参数中,浸润型与液化型、钙化型与液化型之间差异均有统计学意义(P=0.000、0.007、0.025、0.013;0.000、0.000、0.032、0.002)。浸润型与钙化型之间差异没有统计学意义。在病灶的中心非增强区和周围正常区,pI、Tp、AUC和MTT均没有表现出显著性差异(P0.05)。结论:弹性成像能够很好的区分原发性肝癌、肝泡型包虫病和肝血管瘤的硬度,对肝泡型包虫病的诊断能够起到有效的辅助作用。超声造影较常规超声能更精确的显示病灶边缘区血供特点;不同类型肝泡型包虫病灶的边缘区超声造影参数特点不同,液化型肝泡型包虫的边缘区血液供应较其他两型更差,这为进一步研究肝泡型包虫的生长提供了有益线索,也对手术的切除范围界定提供了一定的理论依据。
[Abstract]:Objective: To investigate the ultrasound mode in hepatic alveolar echinococcosis diagnosis. Methods: from September 2015 to February 2017 in our hospital were diagnosed as hepatic alveolar echinococcosis in 95 cases of liver nodules were respectively assessed by two-dimensional ultrasound, color Doppler, elasticity imaging examinations, on the part of the lesions suspected of hepatic alveolar type hydatid disease of CEUS were recorded, and the size of elastic lesion score, elasticity score by 5 grade score. The ultrasound video archiving and processing analysis, rendering time intensity curve. The hepatic alveolar echinococcosis foci were classified and recorded respectively center area of each type of hepatic alveolar echinococcosis the lesions, quantitative parameters of contrast-enhanced marginal zone and peripheral zone (pI; Tp; AUC; MTT). Then compared with the surgical or pathological results, comprehensive evaluation of ultrasound for hepatic alveolar echinococcosis diagnosis clinical value. Results: all cases can be divided into Primary liver cancer, hepatic alveolar echinococcosis, hepatic hemangioma and hepatic hydatid disease in four groups. The same section, hepatocellular carcinoma and liver hydatidosis group, elasticity imaging under the condition of area, perimeter and volume were significantly higher than that of conventional ultrasound under the condition of the area, perimeter and volume (t=-3.164, -2.292, -4.388, -2.442, -2.359; -4.559; P=0.005,0.033,0.029; 0.000,0.018,0.000). The elastic score of primary liver cancer was significantly greater than the elastic score of liver alveolar hydatid disease (t=2.640; P=0.013), elastic score of liver alveolar hydatid lesions was significantly greater than that of hepatic hemangioma (t=9.136; P0.001). In all the liver alveolar hydatid lesions in the center, non enhanced area, edge area and normal peripheral zone of pI and AUC have significant difference (P0.01); invasive contrast quantitative parameters in different types of the lesion edge region, and between the calcified lesions and liquefaction PI, Tp, and MTT have significant difference (F=8.832,9.088,5.538; P=0.001,0.001,0.007), 22 by comparison, pI, Tp, AUC and MTT four parameters, infiltration and liquefaction, liquefaction and calcification type between the differences were statistically significant (P=0.000,0.007,0.025,0.013; 0.000,0.000,0.032,0.002). The difference between invasive and calcification was not statistically significant in the center of the lesion. Non enhanced area and normal peripheral zone, pI, Tp, AUC and MTT did not show significant difference (P0.05). Conclusion: elastography can well differentiated hepatocellular carcinoma, hepatic alveolar echinococcosis and hepatic hemangioma hardness in the diagnosis of hepatic alveolar echinococcosis can play a supporting role effectively. CEUS can accurately display characteristics for the lesion edge blood; fringe parameters of contrast-enhanced ultrasound features of different types of hepatic alveolar hydatid lesions, liquefaction of hepatic alveolar type The blood supply in the marginal zone of the worm is worse than the other two types, which provides a useful clue for further study of the growth of hepatic alveolar echinococcosis, and also provides a theoretical basis for the definition of the extent of resection.

【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R532.32

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