超声弹性成像和超声造影对甲状腺结节诊断价值的meta分析

发布时间：2017-12-27 09:36

本文关键词：超声弹性成像和超声造影对甲状腺结节诊断价值的meta分析　出处：《广西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：超声弹性成像(Ultrasonic elastography, UE)和超声造影(Contrast enhanced ultrasound,CEUS)检查是鉴别甲状腺结节(Thirod nudles,TN)良恶性的两种重要手段,也是目前甲状腺结节的诊断及鉴别诊断方面的研究热点。本研究的目的主要是综合评价UE和CEUS在诊断甲状腺结节方面的价值。方法：根据预先设定好的英文关键词:Contrast Media Ultrasonography、 Elasticity Imaging Techniques、Thriod Nodule和中文关键词：弹性成像、超声造影、甲状腺结节,在Pubmed、Cochrane Library、万方数据库、中国知网、维普医药信息资源系统网站上进行检索。检索范围涵盖为2015年1月之前所有公开发表的关于超声弹性成像和超声造影检查对甲状腺结节的诊断意义的文献。以术后病理或穿刺细胞学检查为金标准,提取纳入文献中以上两种检查的诊断恶性甲状腺结节的四格表资料(真阳性、真阴性、假阳性、假阴性例数),以诊断比值比(Diagnositic odd ratio, DOR)为效应量对纳入文献进行异质性检验,通过meta分析合并诊断效应量(敏感性、特异性、阳性似然比、阴性似然比、诊断比值比),拟合总受试者工作特征曲线(summary receiver operating characteristic,SROC),比较超声弹性成像和超声造影鉴别甲状腺结节良恶性的诊断效能。结果：本次meta分析共纳入5篇文献,纳入甲状腺结节数549个,其中恶性甲状腺结节218个,良性甲状腺结节331个。纳入文献研究质量均较高。以DOR为效应量进行异质性检验,超声弹性成像检查和超声造影检查的Cochran-Q值分别为10.35和6.94,P分别为0.0349和0.1392。同时计算I2值,分别为61.4%和42.3%。使用随机效应模型合并诊断效应量。超声弹性成像检查合并敏感性和特异性及其95%可信区间(95%Confidence interval,95%CI)为0.83(95%CI,0.78-0.88)和0.87(95%CI,0.83-0.91)。超声造影检查合并的敏感性和特异性为0.86(95%CI,0.81-0.91)和0.73(95%CI,0.68-0.77)。超声弹性成像检查合并的阳性似然比、阴性似然比和诊断比值比为：6.29(95%CI,4.43-8.92),0.18(95%CI,0.10-0.32),37.07(95%CI,15.62-88.07)。超声造影检查合并的阳性似然比、阴性似然性和诊断比值比为：5.76(95%CI,1.13-29.40),0.19(95%CI,0.13-0.30),29.61(95%CI,9.01-97.34)。根据SROC曲线提示,超声弹性成像和超声造影的Q*统计量分别为0.8590和0.8737,SROC曲线下面积(Area under the curve, AUC)分别为0.9248和0.9371。结论：超声弹性成像和超声造影检查两者对鉴别恶性甲状腺结节都有较高的诊断效能,且超声造影的诊断价值要优于超声弹性成像检查。
[Abstract]:Objective: ultrasonic elastography (Ultrasonic elastography, UE) and contrast-enhanced ultrasound (Contrast enhanced ultrasound, CEUS) examination is the differential diagnosis of thyroid nodules (Thirod nudles, TN) two important means of benign and malignant, is currently the diagnosis and differential diagnosis of thyroid nodules on the hot break. The purpose of this study was to evaluate the value of UE and CEUS in the diagnosis of thyroid nodules. Methods: according to the preset English keyword: Contrast Media Ultrasonography, Elasticity Imaging Techniques, Thriod Nodule and Chinese Keywords: elastography, ultrasonography, thyroid nodules were retrieved in Pubmed, Cochrane, Library, Wanfang database, China CNKI, VIP medical information system website. The search scope covers all published literature on the diagnostic significance of ultrasound elastography and ultrasound contrast examination for thyroid nodules before January 2015. The postoperative pathology or biopsy as the gold standard, extraction of included studies the above two kinds of examinations for the diagnosis of malignant thyroid nodules four data table (true positive, true negative, false positive and false negative cases), the diagnostic odds ratio (Diagnositic odd ratio, DOR) for the amount of literature into effect heterogeneity test, meta analysis by the combined diagnostic effect (sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio), the total fitting receiver operating characteristic curve (summary receiver operating characteristic, SROC), ultrasonic elastography and contrast-enhanced ultrasound in the differential diagnosis of benign and malignant thyroid nodule diagnosis efficacy. Results: 5 articles were included in this meta analysis, including 549 thyroid nodules, of which 218 were malignant thyroid nodules and 331 were benign thyroid nodules. The quality of the study was high. DOR was used to test the heterogeneity. The Cochran-Q values of ultrasound elastography and ultrasound contrast examination were 10.35 and 6.94, respectively, and P was 0.0349 and 0.1392, respectively. At the same time, the I2 values were calculated, 61.4% and 42.3% respectively. The random effect model was used to combine the diagnostic effect. The sensitivity and specificity of ultrasound elastography were 95% (95%Confidence interval, 95%CI) and 0.83 (95%CI, 0.78-0.88) and 0.87 (95%CI, 0.83-0.91), respectively. The sensitivity and specificity of the combined ultrasound examination were 0.86 (95%CI, 0.81-0.91) and 0.73 (95%CI, 0.68-0.77). The positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of ultrasound elastography were 6.29 (95%CI, 4.43-8.92), 0.18 (95%CI, 0.10-0.32), 37.07 (95%CI, 15.62-88.07). The positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of combined ultrasonography were 5.76 (95%CI, 1.13-29.40), 0.19 (95%CI, 0.13-0.30), 29.61 (95%CI, 9.01-97.34). According to the SROC curve, the Q* statistics of ultrasound elastography and contrast-enhanced ultrasound were 0.8590 and 0.8737, respectively. The area under the SROC curve (Area under the curve, AUC) was 0.9248 and 0.9371, respectively. Conclusion: both ultrasound elastography and contrast-enhanced ultrasound have high diagnostic efficiency in differentiating malignant thyroid nodules, and the diagnostic value of CEUS is better than that of ultrasound elastography.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R581;R445.1

【参考文献】