超微血管显像技术在甲状腺结节中的临床研究

发布时间：2018-01-18 00:27

本文关键词：超微血管显像技术在甲状腺结节中的临床研究　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：目的:1、分别采用“结节内部血流信号”、“显著结节内部血流信号”及“仅结节内部血流信号”诊断甲状腺癌,确定诊断准确性最高的特征。2、对比评价SMI、CDIF、PDFI对甲状腺结节血流分布、内部血管特征的显示,确定检测甲状腺结节的最佳多普勒工具。资料和方法:我院50个住院患者58个甲状腺结节被纳入,患者男女比例为23:27,中位年龄44岁。其中良性结节27个,恶性结节31个。分别使用SMI、CDFI、PDFI对甲状腺结节的血流分型、内部血管特征进行检测。甲状腺结节血流分型:0型:无血流信号,Ⅰ型:仅周边血流信号,Ⅱa型:混合血流信号-外周多于内部,Ⅱb型:混合血流信号-内部多于外周,Ⅲ型:仅内部血流信号。Ⅱ和Ⅲ型合并为“结节内部血流信号”,Ⅱb和Ⅲ型合并为“显著结节内部血流信号”,Ⅲ型即“仅结节内部血流信号”。采用上述3个依据诊断甲状腺癌,对比诊断准确性。甲状腺结节内部血管特征包括:①血流量分级:按血流信号与结节面积之比分为0～25%;25%～50%;50%～75%;75%～100%;②血流信号分布是否均匀;③血管走形是否扭曲;④分支是否正常;⑤穿支:穿入角度是否为直角,穿入深度是否大于1/2,是否有单支粗大滋养血管穿入。结果:“仅结节内部血流信号”诊断准确性较“结节内血流信号”、“结节内显著血流信号”偏高,使用其诊断甲状腺癌时,3种血流显像模式的诊断特异性、敏感性分别为:CDFI-92.5%、41.9%,PDFI-88.9%、48.3%,SMI-96.3%、77.4%。SMI较其他两者敏感性显著提高,原因是:①SMI能够显示甲状腺癌内部细小血管;②SMI能够区分结节边缘密集细穿支和结节周围环绕血管。3种模式下甲状腺结节血流量为SMIPDFICDFI;SMI和CDFI显示甲状腺癌血流信号分布不均优于PDFI;SMI显示甲状腺癌血管走形扭曲及分支失常优于CDFI和PDFI。血流量、穿支角度及穿支深度在良、恶性组间无统计学差异,但4级血流量和单支粗大穿支均仅在恶性结节被探及。结论:“仅结节内部血流信号”有助于诊断甲状腺癌。SMI在评估甲状腺结节血流特征方面优于CDFI或PDFI。目的:1、在超声恶性征象中,确定甲状腺癌的独立危险因素。2、探索超微血管显像联合灰阶超声诊断甲状腺癌的较合理方法。资料和方法:我院92个住院患者共113个甲状腺结节被纳入,患者男女比例为12:11,中位年龄42岁,其中良性结节34个,恶性结节79个。使用灰阶超声和SMI检测甲状腺结节灰阶征象和血流分型,灰阶征象包括①回声:分为低、中、高回声;②结构:分为实性、实性为主、囊性为主或囊性;③纵横比是否大于1;④钙化:分为无钙化、微小钙化、粗大钙化;⑤边缘:分为规整、不规整。血流分型分为0型无血流信号、Ⅰ型仅周边血流信号、Ⅱ型混合型血流信号、Ⅲ型仅内部血流信号。采用多因素二元logistic回归分析甲状腺癌独立危险因素并且建立诊断模型。对比模型和以下6项依据诊断甲状腺癌的准确性,①任一灰阶恶性征象;②任一灰阶恶性征象或血流恶性征象;③边缘不规则、微钙化、纵横比1中任一征象;④依据3或血流恶性征象;⑤任一独立危险因素;⑥低回声结节并且满足依据4。结果:甲状腺癌独立危险因素为纵横比1、微钙化、Ⅲ型血流,OR值分别为5.474、10.597、36.530。模型诊断甲状腺癌的ROC曲线下面积为0.92,显著高于单一恶性征象和6项诊断依据,P0.05。结论:纳入微钙化、纵横比1、SMI仅结节内部血流的Logistic模型有助于诊断甲状腺癌。灰阶超声联合SMI诊断甲状腺癌优于单独使用灰阶超声。目的:1、了解Ang1、Ang2、VEGF在甲状腺乳头状癌中的表达水平。2、探索Ang1、Ang2、VEGF在甲状腺乳头状癌血管形成中的作用机制。3、通过研究SMI血流特征与Ang1、Ang2、VEGF相关关系,分析甲状腺乳头状癌SMI血流特征的本质意义。资料与方法:37个甲状腺乳头状癌手术病理标本被纳入,包含经典型19个、滤泡型18个。20个良性结节作为对照组,包括6个结甲腺瘤样增生、5个腺瘤、9个结甲。所有甲状腺结节术前行SMI检查,术后制备石蜡标本切片进行CD34抗体、Ang1抗体、Ang2抗体、VEGF抗体免疫组化染色。计数CD34标记的微血管密度(Micro-vessel density,MVD),分析甲状腺结节 Ang1、Ang2、VEGF 表达水平与微血管密度之间的关系,分析Ang1、Ang2、VEGF表达与甲状腺乳头状癌颈部淋巴结转移和SMI特征的相关性。结果:甲状腺乳头状癌的Ang2表达水平、VEGF表达水平和MVD值显著高于良性结节,Ang1表达水平显著低于良性结节。甲状腺乳头状癌MVD与Ang2表达水平呈正相关(r=0.35,p=0.035),与Ang1、VEGF未见明显相关关系。甲状腺乳头状癌颈部淋巴结转移与VEGF表达水平呈正相关(r=0.40,p=0.03)。甲状腺乳头状癌边缘密集细穿支与Ang2表达水平和Ang2、Ang1表达强度差呈正相关(r=0.35,p=0.04;r=0.35,p=0.03),单支粗大穿支与Ang2、Ang1表达强度差呈负相关(r=-0.42,p=0.01),分支异常与Ang2表达水平呈正相关(r=0.33,p=0.046)。结论:Ang2可能在甲状腺乳头状癌血管生成中发挥关键作用。甲状腺乳头状癌边缘密集细穿支与Ang2表达水平和Ang2、Ang1表达水平之差呈正相关,提示边缘密集细穿支或许是新生血管。单支粗大滋养穿支与Ang2、Ang1表达水平之差呈负相关,提示单支粗大滋养血管可能是宿主血管增粗形成。
[Abstract]:Objective: 1, the intranodular blood flow signals "," thyroid cancer diagnosis significantly intranodular blood flow signal "and" only intranodular blood flow signal, determine the characteristics of.2 the highest diagnostic accuracy, SMI CDIF PDFI, comparative evaluation, blood flow distribution of thyroid nodules, internal vascular features that determine the best tool for detecting Doppler thyroid nodules. Materials and methods: in our hospital 50 patients with 58 thyroid nodules were included, male to female ratio was 23:27. The median age was 44 years. Among them, 27 benign nodules and 31 malignant nodules respectively. Using SMI, CDFI, PDFI of thyroid nodules blood type, internal vascular characteristics detection of thyroid nodules. Blood type: Type 0: no blood flow signal, type I: only the surrounding blood flow signals, type IIA: mixed peripheral blood flow signal than internal type: mixed blood flow signal inside more than peripheral, type III: only in Blood flow signal. II and III merged into the intranodular blood flow signal, B II and III type with "significant intranodular blood flow signals", type III "only intranodular blood flow signal. Using the 3 diagnosis of thyroid cancer, compared the accuracy of the diagnosis. Including internal vascular features of thyroid nodules: 1. The blood flow grading score: according to the signal and area is 0 ~ 25% nodules; 25% to 50%; 50% to 75%; 75% to 100%; the blood flow signal distribution is uniform; the vessel shape is distorted; the branch is normal; the penetration angle is not for perforator: right angle, the penetration depth is greater than 1/2, whether a single large vessels penetrated. Results:" only intranodular blood flow signal "diagnostic accuracy than" nodules within the blood flow signal "," significant flow signal "nodules is high, the diagnosis of thyroid carcinoma, 3 imaging diagnosis model Broken specificity, sensitivity were: CDFI-92.5%, 41.9%, PDFI-88.9%, 48.3%, SMI-96.3%, 77.4%.SMI were significantly increased than that of the other two reasons are: the sensitivity of SMI can show the thyroid cancer internal small blood vessels; the SMI can differentiate the nodules and nodules around the edge of dense thin perforator vascular.3 surround modes of thyroid nodules blood flow was SMIPDFICDFI; SMI and CDFI showed that the uneven distribution of blood flow signal of thyroid cancer is better than that of PDFI; SMI showed thyroid cancer vascular zouxing distort and branch arrhythmia is better than that of CDFI and PDFI. blood flow, angle and depth of the perforator perforator, there was no significant difference between malignant group, but 4 level of blood flow and single thick perforator were only in malignant nodules was detected conclusion: "only intranodular blood flow signal is helpful to the diagnosis of thyroid carcinoma.SMI in the assessment of blood flow characteristics of thyroid nodules is better than that of CDFI or PDFI. to 1, in the ultrasonic features of malignant, To determine the.2 independent risk factors of thyroid cancer, a more reasonable method to explore micro vascular imaging combined with gray-scale sonography in the diagnosis of thyroid carcinoma. Materials and methods: 92 patients who were hospitalized in our hospital of 113 patients with thyroid nodules were included, the proportion of men and women for 12:11, the median age was 42 years, including 34 benign nodules and 79 malignant nodules using gray scale ultrasound and SMI detection of thyroid nodules and blood typing signs of gray, gray features including: echo, divided into low, high echo; the structure is divided into: solid, solid, cystic or cystic; the aspect ratio is not greater than 1; the calcification is: calcification, microcalcification, macrocalcification; the edge: divided into regular, irregular blood flow. Divided into 0 types with no blood flow signal, type I only peripheral blood flow signal, mixed flow signal of type II, III only the internal flow signals. By using multi factor Logistic regression analysis of thyroid two yuan Independent risk factors for cancer and establish a diagnosis model. Comparing the model with the following 6 items according to the accuracy of diagnosis of thyroid carcinoma, malignant signs of any gray scale; the gray scale of any signs of malignancy or malignant signs of blood flow; the irregular edge, micro calcification, aspect ratio of 1 in any of the signs; on the basis of the 3 blood or malignant signs; independent risk. Any of the factors; low echo nodules and meet on the basis of the 4. results: the independent risk factors for thyroid cancer aspect ratio 1, micro calcification, blood type, OR = ROC curve area model of 5.474,10.597,36.530. in the diagnosis of thyroid carcinoma was 0.92, significantly higher than that of single malignant signs and 6 diagnosis. Conclusion: P0.05. into micro calcification 1, aspect ratio, Logistic model SMI only intranodular blood flow contributes to the diagnosis of thyroid cancer. Ultrasound combined with SMI in diagnosis of thyroid cancer is better than using ultrasound alone. Objective: 1, Ang1, A NG2,.2, VEGF expression in papillary thyroid carcinoma on Ang1, Ang2, the mechanism of VEGF in papillary thyroid carcinoma angiogenesis in.3, through the study of SMI flow characteristics and Ang1, Ang2, VEGF correlation, essential analysis of papillary thyroid carcinoma SMI flow characteristics. Materials and methods: 37 a papillary thyroid carcinoma surgical specimens were enrolled, including the classic type 19, type 18.20 follicular benign nodules as control group, including 6 nodular goiter adenomatous hyperplasia, 5 adenoma, 9 nodular goiter thyroid nodules. All patients underwent SMI examination, postoperative paraffin sections were prepared by CD34 antibody, Ang1 antibody, Ang2 antibody, VEGF antibody immunohistochemistry. Microvessel density marked by CD34 (Micro-vessel density MVD), Ang1 Ang2, thyroid nodules were analyzed. The relationship between VEGF expression and microvessel density analysis of Ang1, Ang2, and VEGF expression Correlation of thyroid papillary carcinoma and cervical lymph node metastasis and SMI features of papillary thyroid carcinoma. Results: the expression level of Ang2, the expression level of VEGF and MVD was significantly higher than that of benign nodules, the expression level of Ang1 was significantly lower than benign nodules of thyroid papillary carcinoma. MVD and Ang2 expression levels were positively correlated (r=0.35, p=0.035), and Ang1. VEGF had no obvious correlation. Papillary thyroid carcinoma cervical lymph node metastasis and the expression level of VEGF was positively correlated (r=0.40, p=0.03). Thyroid papillary carcinoma edge dense fine perforators and the expression level of Ang2 and Ang2, Ang1 expression intensity difference was positively correlated (r=0.35, p=0.04; r=0.35, p=0.03), a single thick perforator with Ang2 Ang1, the expression intensity difference was negatively correlated (r=-0.42, p=0.01), abnormal branch and Ang2 expression levels were positively correlated (r=0.33, p=0.046). Conclusion: Ang2 may play a key role in angiogenesis in thyroid papillary carcinoma of thyroid. Gland papillary carcinoma edge dense fine perforators and the expression level of Ang2 and Ang2, the expression level of Ang1 was positively related to the difference, that is perhaps the edge of dense fine perforator neovascularization. Single perforator and coarse nourishing Ang2, negatively correlated with Ang1 expression level difference, suggesting that a single large vessels may be the host vascular thickening formation.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R445.1;R581

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