弹性超声对甲状腺非钙化性和钙化性结节诊断的临床研究

发布时间：2018-01-13 20:22

本文关键词：弹性超声对甲状腺非钙化性和钙化性结节诊断的临床研究　出处：《南京医科大学》2017年博士论文　论文类型：学位论文

【摘要】：第一部分应变力弹性和剪切波弹性成像对于甲状腺非钙化性结节的诊断价值目的研究应变力弹性成像(strain elastography,SE)和剪切波弹性成像(shear wave elastography,SWE)在鉴别甲状腺非钙化性结节良恶性方面的诊断价值。方法对195例患者(平均年龄,50± 13岁)共计201例甲状腺非钙化结节(平均直径,20.1±11.2mm)进行常规超声(ultrasound,US)、SE和SWE检查,所有结节的影像均采用同一台超声仪器,包括常规SE,声辐射力冲击脉冲(acoustic radiation force impulse,ARFI)SE 和点剪切波速度(point shear wave speed,pSWS)测量等。通过绘制受试者操作特征(receiver operating characteristic,ROC)曲线下面积评估各项检查方法鉴别甲状腺非钙化性结节良恶性的诊断效能。应用单因素、多因素Logistic回归分析,评价出常规US、SE和SWE诊断甲状腺恶性结节的8个影像特征,并建立US、SE和SWE多因素回归分析模型和评价分析模型的甲状腺恶性结节的预测价值。P0.05具有统计学.意义(双尾)。结果156例良性和45例恶性甲状腺非钙化结节经病理确诊,非钙化甲状腺结节的常规超声所有特征的ROC曲线下面积均小于0.8,而传统SE、ARFI SE、pSWS和结节/周围组织的pSWS比值的ROC曲线下面积(AUROC)分别为0.826、0.848、0.860和0.845。多因素分析显示,极低回声的超声征象是非钙化甲状腺恶性征象的重要预测因子,优势比(OR值)为26.13(95%CI:3.50,194.93),而传统SE评分3分、ARFI SE分级3级、结节pSWS2.49m/s和结节/周围组织的pSWS 比值1.22 的 OR 值分别为 26.113(95%CI:3.498,194.932)、3.876(95%CI:1.241,12.106)、4.234(95%CI:1.345,13.329)、10.641(95%CI:2.990,37.864)和 4.084(95%CI:1.213,13.756)。多因素回归分析模型的显示,传统 US + SE + pSWS 的最高,为 0.936(95%CI:0.887,0.985),其次为US+pSWS(AUROC:0.889,95%CI:0.823,0.955),而常规 US 的 AUROC 只有 0.727(95%CI:0.635,0.819)。结论应变力弹性成像和剪切波弹性成像对于甲状腺非钙化结节的具有很好的良恶性鉴别能力,比常规超声具有更佳的诊断效能。常规超声结合应变力弹性成像和剪切波弹性成像时,其诊断价值最高。第二部分单一性和差异性的点剪切波速度诊断截断值对于甲状腺不同钙化结节的应用研究目的分析甲状腺结节的钙化与点剪切波速度(point shear-wave speed,pSWS)的关系,并评估单一性和差异性pSWS诊断截断值对甲状腺不同钙化结节的应用价值。材料和方法本部分回顾性研究获伦理委员会同意,并签署知情同意书。498例患者共517个甲状腺结节,其中:177个非钙化结节、159个微小钙化结节和181个粗钙化结节。上述结节于2014年1月到2015年11月间,在同一超声设备(Siemens 2000)上进行了常规超声(ultrasound,US)、应变力弹性成像(strain elastography,SE)和剪切波弹性成像(shear wave elastography,SWE)检查。单一性和差异性SE和点剪切波速度(point shear wave speed,pSWS)诊断甲状腺良恶结节的截断值,分别在最大约登指数(Youden index,YI)、90%敏感性和90%特异性诊断节点计算出。单一性和差异性pSWS截断值对甲状腺不同钙化结节的诊断效能由受试者操作特征(receiver operating characteristic,ROC)曲线下面积(AUROC)评估。P0.05具有统计学意义(双尾)。结果病理确诊346个良性和171个恶性甲状腺结节。甲状腺非钙化、微小钙化和粗钙化结节的pSWS分别为:2.60±1.49 m/s,3.27±1.85 m/s和3.68±2.26m/s(p0.001)。在最大YI诊断节点,甲状腺结节和非钙化、微小钙化及粗钙化结节的pSWS诊断截断值分别为:2.72 m/s和2.42 m/s、2.88 m/s及3.59 m/s(p =0.03)。差异性和单一性的pSWS截断值对于甲状腺结节诊断的 AUROC 为 0.859(95%CI,0.826-0.888)vs 0.816(95%CI,0.780-0.848)(p =0.011),诊断非钙化结节的 AUROC 为 0.906(95%CI,0.853-0.45)vs 0.799(95%CI,0.732-0.855)(p =0.004),诊断微小钙化结节的 AUROC 为 0.871(95%CI,0.809-0.919)vs 0.859(95%CI,0.795-0.909)(p =0.559),诊断粗钙化结节的 AUROC 为 0.805(95%CI,0.740-0.860)vs 0.698(95%CI,0.625-0.764)(p0.001)。结论甲状腺结节的pSWS平均值,从非钙化结节组、到微小钙化结节组和粗钙化结节组依次增加,对于不同钙化的甲状腺结节应采用差异性诊断截断值。差异性的pSWS截断值能够较单一性的pSWS截断值提高诊断效能。
[Abstract]:The first part of the elastic strain and shear wave elastography for the diagnosis of objective to study the value of elastic strain imaging of thyroid non calcified nodules (strain, elastography, SE) and shear wave elastography (shear wave, elastography, SWE) in the differential diagnosis of non calcified thyroid nodules benign and malignant. Methods 195 patients (the average age of 50 + 13 years) a total of 201 cases of thyroid non calcified nodules (mean diameter, 20.1 + 11.2mm) by conventional ultrasound (ultrasound, US), SE and SWE examination, all nodules images were using the same ultra sound equipment, including conventional SE, impulse acoustic radiation force (acoustic radiation force impulse ARFI, SE) and shear wave velocity (point shear wave speed, pSWS) measurement. The receiver operating characteristic (receiver operating, characteristic, ROC) and area under the curve evaluation method to identify a The thyroid non diagnostic efficacy of malignant calcific nodules. Using univariate, multivariate Logistic regression analysis, evaluation of conventional US, 8 features of SE and SWE in the diagnosis of thyroid malignant nodules, and the establishment of US,.P0.05 and SE predictive value of multi factor SWE regression analysis of thyroid malignant nodules model and evaluation model with the statistical significance. (two tailed). Results 156 cases and 45 cases of benign and malignant thyroid non calcified nodules confirmed by pathology, ROC curve area all the characteristics of conventional ultrasound non calcified thyroid nodules under were less than 0.8, while the traditional SE, ARFI SE, pSWS and ROC curve area / pSWS ratio of surrounding tissue nodules the (AUROC) were 0.826,0.848,0.860 and 0.845. multivariate analysis showed that ultrasound features extremely low echo is an important predictive factor for non calcified thyroid malignant signs, odds ratio (OR value) was 26.13 (95%CI: 3.50194.93), while the traditional S The E score of 3 points, ARFI SE grade 3, pSWS2.49m/s nodules and nodules / surrounding tissue pSWS ratio of 1.22 and OR values were 26.113 (95%CI:3.498194.932), 3.876 (95%CI:1.241,12.106), 4.234 (95%CI:1.345,13.329), 10.641 (95%CI:2.990,37.864) and 4.084 (95%CI: 1.213,13.756). Multivariate regression analysis model showed that the highest traditions of US + SE + pSWS, 0.936 (95%CI:0.887,0.985), followed by US+pSWS (AUROC:0.889,95%CI:0.823,0.955), while conventional US AUROC is only 0.727 (95%CI:0.635,0.819). Conclusion the elastic strain ability to identify benign and malignant like and shear wave elastography is good for non calcified nodules of the thyroid, with better diagnostic performance than conventional ultrasound. Conventional ultrasound combined with elastography strain and shear wave elasticity imaging, the diagnostic value of the highest point. The shear wave velocity of single part and the difference of second For the purpose of diagnostic cutoff value of application of different thyroid nodules of calcification of thyroid nodules calcification and shear wave velocity (point shear-wave, speed, pSWS) the relationship between single and differential diagnostic value of different pSWS cut-off value of thyroid nodules and to evaluate. Materials and methods the retrospective study by ethics the committee agreed, and signed the informed consent of.498 patients with 517 thyroid nodules, including 177 non calcified nodules, 159 tiny calcified nodules and 181 calcified nodules. The nodules of crude from January 2014 to November 2015, in the same ultrasonic equipment (Siemens 2000) by conventional ultrasound (ultrasound, US) strain, elasticity imaging (strain elastography, SE) and shear wave elastography (shear wave, elastography, SWE). The single and difference points SE and shear wave velocity (point shear wave s Peed and pSWS diagnosis of thyroid benign and malignant nodules) truncation values respectively in maximum Youden index (Youden index, YI), 90% sensitivity and 90% specificity in the diagnosis of node calculated. Single and difference pSWS cutoff value for diagnosis of thyroid nodules calcification by receiver operating characteristic (receiver operating characteristic, ROC) the area under the curve (AUROC) with statistical significance evaluation.P0.05 (two tailed). The results of pathological diagnosis of 346 benign and 171 malignant thyroid nodules. Thyroid calcification, microcalcification and coarse calcification nodules pSWS respectively: 2.60 + 3.27 + 1.49 m/s, 1.85 m/s and 3.68 + 2.26m/s (p0.001) at the maximum. YI diagnosis of thyroid nodules and non calcified nodes, pSWS diagnosis of truncated microcalcifications and coarse calcified nodules were 2.72 m/s and 2.42 m/s, 2.88 m/s and 3.59 m/s (P =0.03). The difference and the single pSWS cutoff value for thyroid node The diagnosis of AUROC was 0.859 day (95%CI, 0.826-0.888) vs 0.816 (95%CI, 0.780-0.848) (P =0.011), the diagnosis of non calcified nodules was 0.906 AUROC (95%CI, 0.853-0.45) vs 0.799 (95%CI, 0.732-0.855) (P =0.004), the diagnosis of small calcified nodules was 0.871 (95%CI AUROC, 0.809-0.919 vs (0.859) 95%CI, 0.795-0.909) (P =0.559), the diagnosis of calcified nodules was 0.805 AUROC thick (95%CI, 0.740-0.860) vs 0.698 (95%CI, 0.625-0.764) (p0.001). Conclusion the thyroid nodules pSWS averages from non calcified nodules, small nodules of calcification group and coarse calcification nodule group increased in turn, for different thyroid nodules calcification should be used difference diagnosis cut-off value. The difference of the pSWS cutoff value of pSWS to a single cut-off value improve the diagnosis performance.

【学位授予单位】：南京医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R445.1;R581

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