超声造影声触诊组织定量技术在胰腺局灶性病变中的应用研究

发布时间：2018-01-13 03:29

本文关键词：超声造影声触诊组织定量技术在胰腺局灶性病变中的应用研究　出处：《北京协和医学院》2015年博士论文　论文类型：学位论文

【摘要】：目的1.观察胰腺局灶性病变的超声造影特征。2.评价超声造影及时间-强度曲线定量参数对胰腺局灶性病变的诊断与鉴别诊断价值。3.探讨利用三维超声造影重建胰周动脉血管的可行性。方法2014年1月至2015年1月,对胰腺局灶性病变患者72例,共计72个病灶的超声造影特征进行前瞻性研究。观察病灶的常规超声和超声造影表现,利用5分评分法分别对病灶进行良、恶性诊断评分,并对诊断结果进行ROC曲线分析,比较常规超声和超声造影对胰腺局灶性病变良恶性的鉴别诊断价值；同时对胰腺实性(包括以实性为主囊实性)局灶性病变的超声造影动态图像进行TIC定量分析,对不同定量参数鉴别胰腺局灶性病变良恶性的价值进行评估；利用三维超声造影(three-dimensional contrast-enhanced ultrasound,3D-CEUS)对17例胰腺局灶性病变患者的胰周动脉血管进行重建,并观察重建血管的管腔与走行情况。结果1.36例胰腺恶性病变中,75.0%表现为不均匀增强；23例实性或以实性为主囊实性良性病变中,26.1%表现为不均匀增强；13例囊性良性病变,76.9%表现为囊壁及分隔强化,23.1%无强化；良、恶性组问的增强方式有显著的统计学差异(P0.05)。2.具有明确病理诊断的胰腺癌中,77.3%表现为持续低增强,22.7%表现为动脉相等增强,静脉相低增强。以低增强(不包括伴有明确环状增强者)诊断胰腺癌的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为96.6%、90.7%、87.5%、97.5%和93.1%。3.62.5%的神经内分泌源性肿瘤表现为动脉相高增强,以动脉相高增强诊断神经内分泌源性肿瘤的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为62.5%、96.9%、71.4%、95.4%和93.1%。4.利用超声造影或常规超声、超声造影两者联合诊断,诊断结果评分为3分者明显少于常规超声；而评分为1分、5分者明显多于常规超声。常规超声与超声造影对胰腺良、恶性病灶的诊断评分有显著性差异(P=0.000)；而超声造影与两者联合诊断对胰腺良、恶性病灶的诊断评分无显著差异(P0.05)。常规超声、超声造影及两者联合诊断的ROC曲线下面积分别为0.681、0.931、0.958。5.对胰腺局灶性病变的TIC定量参数进行比较,得出胰腺恶性病灶的始增时间晚于相邻胰腺实质,差异有统计学意义(P0.05)；良性病灶与相邻胰腺实质的始增时间无统计学差异(P0.05)。胰腺癌(pancreatic cancer, PC)、胰腺神经内分泌源性肿瘤(pancreatic neuroendocrine tumors, pNETs)、胰腺炎性病变(pancreatic inflammatory lesion, PIL)及胰腺其他良性病变(other benign tumors, OBTs) 的灌入斜率比较：PCPILOBTspNETs (P0.05);1分钟洗出斜率比较：PILPCpNETsOBTs(P0.05);峰值强度与曲线下面积的比较：PCPILOBTspNETs(P0.05)。6.利用3D-CEUS对17例胰周动脉血管进行重建,重建成功率为94.1%。并通过任意角度的旋转观察,提示了2例动脉血管受累。结论1.结合常规超声的宏观图像和超声造影的微循环灌注信息,可以有效地提高胰腺局灶性病变的诊断准确率。2.利于TIC定量参数可以增加超声造影诊断胰腺局灶性病变的诊断信息的客观性。3.3D-CEUS可以实现对胰周动脉血管的立体化显示,与CT三维重建契合度较高,其临床应用价值仍有待进一步研究。目的1.评估剪切波速(SWV)测量的可重复性。2.对照病理或临床诊断结果,探讨SWV在胰腺局灶性实性病变良恶性鉴别诊断中的临床应用价值。3.评估SWV预测晚期胰腺癌辅助治疗的疗效。方法2014年1月至2015年1月,对我院51例胰腺占位患者进行常规超声和声辐射力脉冲成像(ARFI)。应用单向随机效应模型计算组内相关系数(Intraclass correlation coefficient, ICC),评估SWV测量的可重复性。对照病理结果或临床诊断,评估病灶SWV、相邻胰腺实质SWV及SWV差值在胰腺实性病变中的鉴别诊断价值。对获得穿刺细胞/组织学诊断,并后续进行辅助治疗的晚期胰腺癌患者,进行随访研究,观察病灶的大小变化情况。结果剪切波速值测量中,病灶与胰腺实质五次测量的平均组内相关系数分别为0.895和0.869。恶性组的病灶与相邻胰腺实质的SWV均值分别为2.39±125 m/s(0.60-4.39m/s)和1.59±0.63 m/s(0.76-3.22 m/s)；良性组的病灶与相邻胰腺实质的SWV均值分别为2.06±1.08 m/s(0.79-4.00 m/s)和1.44±0.41 m/s(0.80-2.23 m/s),两组内病灶与相邻胰腺实质的SWV均值均存在显著的统计学差异(P0.05)。病灶SWV、相邻胰腺实质SWV及SWV差值在良恶性组间无明显统计学差异(P=0.320、0.352、0.581)。病灶的SWV与病灶大小不相关(r=0.253,P0.05)；病灶的SWV与ROI深度呈负相关(r=-0.413,P0.05)。9例接受辅助治疗的晚期胰腺癌患者,病情延缓组与病情无改善或恶化组的病灶的SWV均值分别为2.92±0.80 m/s和0.92±0.32m/s,两组问存在明显的统计学差异(P0.05)。结论1.剪切波速(SWV)测量重复性好,多次测量可提供更加可靠的结果。2.声辐射力脉冲成像(ARFI)技术利用SWV定量鉴别诊断胰腺局灶性病变良恶性的价值有待进一步的研究。3.SWV大小与病灶大小无明确相关性,但随ROI深度的增加,SWV变小。4.初始病灶的SWV具有预测晚期胰腺癌辅助治疗疗效的潜在临床应用价值。
[Abstract]:To investigate the feasibility of three-dimensional contrast-enhanced ultrasound reconstruction of peripancreatic arteries in the diagnosis and differential diagnosis value of.3. intensity curve quantitative parameters of focal lesions of pancreas to observe 1. focal lesions of pancreas with contrast-enhanced ultrasonography and time characteristics of.2. evaluation. Methods from January 2014 to January 2015, 72 cases of patients with focal lesions of pancreas. A prospective study of a total of 72 lesions with contrast-enhanced ultrasonography. Conventional ultrasound and contrast-enhanced ultrasound to observe the lesions, with a score of 5 of lesions were benign, malignant diagnostic score, and the diagnosis results by ROC curve analysis, compared with conventional ultrasound and contrast-enhanced ultrasound in focal lesions of pancreas benign and malignant at the same time value; pancreatic solid (including constant mainly cystic) dynamic contrast-enhanced ultrasound images of focal lesions of TIC quantitative analysis and quantitative identification of different parameters Evaluate the focal lesions of pancreas benign and malignant value; using three-dimensional contrast-enhanced ultrasound (three-dimensional contrast-enhanced, ultrasound, 3D-CEUS) were reconstructed in 17 patients with focal lesions of pancreas and peripancreatic arteries, vascular reconstruction were observed and the market condition. The results of 1.36 cases of malignant pancreatic lesions, 75% showed no enhancement uniform; 23 cases were solid or solid mainly cystic benign lesions, 26.1% showed inhomogeneous enhancement; 13 cases of cystic benign lesions, 76.9% showed cystic wall and septum enhancement, no enhancement in 23.1%; benign and malignant group, enhance the way asked there is a statistically significant difference (P0.05) with clear.2. the pathological diagnosis of pancreatic carcinoma, 77.3% showed low enhancement, 22.7% showed equal arterial venous phase enhancement, low enhanced. With low enhancement (excluding anidentifiable ring enhancement) sensitivity of diagnosis of pancreatic adenocarcinoma, The specificity, positive predictive value, negative predictive value and accuracy rate were 96.6%, 90.7%, 87.5%, 97.5% neuroendocrine tumors and 93.1%.3.62.5% in the arterial phase enhancement in arterial phase, Gao Zengqiang sensitivity, diagnosis of neuroendocrine tumors of the specificity, positive predictive value, negative predictive value and accuracy were 62.5%, 96.9%, 71.4%, 95.4% and 93.1%.4. by using contrast-enhanced ultrasound or ultrasound, contrast-enhanced ultrasound combined diagnosis, diagnostic results score was 3 less than conventional ultrasound; and the score is 1 points, 5 points more than conventional ultrasound. Conventional ultrasound and contrast-enhanced ultrasound in benign pancreatic, there was significant difference in diagnosis malignant lesion score (P=0.000); ultrasound combined with the diagnosis of pancreatic benign and malignant lesions, there was no significant difference between the score (P0.05). Conventional ultrasound, CEUS and ROC curves of the two combined diagnosis of Compare the area were 0.681,0.931,0.958.5. of focal lesions of pancreas TIC quantitative parameters, the malignant pancreatic lesions enhancement beginning time later than the adjacent pancreatic parenchyma, the difference was statistically significant (P0.05); benign lesions and adjacent parenchyma enhancement beginning time no statistical difference (P0.05). Pancreatic cancer (pancreatic cancer, PC), pancreatic neuroendocrine tumors (pancreatic neuroendocrine, tumors, pNETs), pancreatitis (pancreatic inflammatory lesions lesion, PIL) and other pancreatic benign lesions (other benign, tumors, OBTs) into slope comparison: PCPILOBTspNETs (P0.05); 1 min washout slope: PILPCpNETsOBTs (P0.05); compared the area of peak intensity and under the curve: PCPILOBTspNETs (P0.05).6. using 3D-CEUS to reconstruct 17 cases of peripancreatic arteries, reconstruction of 94.1%. power and the arbitrary rotation angle The observation, 2 cases of arterial vascular involvement. Conclusion 1. combined with microcirculation information macro image of conventional ultrasound and contrast-enhanced ultrasound, can effectively improve the objectivity of.3.3D-CEUS diagnosis of focal lesions of pancreas to the accuracy of.2. TIC quantitative parameters can increase the diagnostic information of contrast-enhanced ultrasound in diagnosis of focal lesions of pancreas can be three-dimensional for peripancreatic arteries display, three-dimensional reconstruction and CT high fit, its clinical application needs further study. 1. objective assessment of shear wave velocity (SWV) pathological or clinical diagnosis results of the measurement repeatability of.2., investigate the clinical value of.3. evaluation of SWV in differential diagnosis of focal pancreatic lesions benign and malignant SWV prediction in treatment of advanced pancreatic cancer adjuvant therapy. Methods from January 2014 to January 2015, were examined by conventional ultrasound and acoustic radiation force in our hospital 51 cases of pancreatic lesions Pulse imaging (ARFI). The application of the one-way random effects model to calculate the intraclass correlation coefficient (Intraclass correlation, coefficient, ICC, SWV) to evaluate the repeatability of the measurement. The pathology or clinical diagnosis, assessment of lesion of SWV, SWV and SWV value of adjacent pancreatic parenchyma difference differential diagnosis in pancreatic lesions. The puncture cell / tissue diagnosis, follow-up and adjuvant therapy in patients with advanced pancreatic cancer, were studied, to observe the changes of the size of the lesion. The results of shear wave velocity measurement, the average lesion with the pancreatic parenchyma of five measurements in the correlation coefficients were 0.895 lesions and adjacent pancreatic parenchyma and 0.869. in malignant group mean SWV were 2.39 + 125 and 1.59 + m/s (0.60-4.39m/s) 0.63 m/s (0.76-3.22 m/s); the lesion and the adjacent pancreatic benign group mean SWV were 2.06 + 1.08 m/s (0.79-4.00 m/s) and 1.4 4 + 0.41 m/s (0.80-2.23 m/s), two groups of lesions and adjacent pancreatic parenchyma SWV mean there was a statistically significant difference (P0.05). SWV lesions, adjacent pancreatic parenchyma SWV and SWV difference no statistically significant differences between groups in benign and malignant lesions (P=0.320,0.352,0.581). The SWV is not related with the size of the lesion (r=0.253 P0.05); SWV was negatively correlated with the depth of ROI lesions (r=-0.413, P0.05).9 patients received adjuvant therapy for patients with advanced pancreatic cancer, the disease and illness without delay group improvement or deterioration group lesions mean SWV were 2.92 + 0.80 and 0.92 + two m/s 0.32m/s group asked the obvious statistical difference (P0.05 1.). Conclusion the shear wave velocity (SWV) measurement repeatability, multiple measurements can provide more reliable results of.2. acoustic radiation force impulse imaging (ARFI) technique using the value of SWV quantitative differential diagnosis of benign and malignant focal lesions of pancreas to be studied further.3.S The size of WV is not correlated with the size of lesion, but with the increase of ROI depth, SWV is decreased. The SWV of.4. initial lesion has potential clinical value in predicting the efficacy of adjuvant therapy for advanced pancreatic cancer.

【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】：2015
【分类号】：R445.1;R735.9

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