TI-RADS分级联合剪切波弹性成像对鉴别甲状腺结节良恶性的诊断价值

发布时间：2018-02-10 03:55

本文关键词： 甲状腺结节超声检查 TI-RADS分级实时剪切波弹性成像　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景与目的：根据流行病学显示，在人群中随机抽查，经超声检查发现甲状腺结节的可能性为19％—67％，而发现甲状腺癌的可能性为5％—10％，并有显著增加的趋势。超声检查逐渐变为例行检查良性和恶性甲状腺结节的识别方法，但不同超声医生的知识不同，故不同结节描述也不同，影响了甲状腺科医生对甲状腺结节的判断。为了让甲状腺结节的超声描述可以有一个一致的标准，让甲状腺科大夫更准确的判断甲状腺结节的信息，更好地治疗甲状腺结节，2009年Horvath等借鉴美国放射学会制定的乳腺影像报告和数据系统(Breast imagingreporting and data system，BI-RADS)超声分级诊断标准，同样给甲状腺结节的超声描述制定了一个标准，即甲状腺影像报告与数据系统（TI—RADS）分级。甲状腺结节超声图像特征多变，良恶性病灶之间存在相似的二维声像图特征，而且不同超声医生诊断经验不同，对同一病灶可能给予不同分级。剪切波超声弹性成像(SWE)是一种可以直观定量测得组织硬度数值的新的超声诊断技术。本研究的研究目的是通过探讨TI—RADS分级、剪切波弹性成像各自在区分良性和恶性甲状腺结节时是否有诊断价值,并探索一种将SWE与TI-RADS联合的调整方法，以进一步提高TI-RADS分级诊断价值，看是否有助于减少TI—RADS分级在诊断甲状腺结节是良性还是恶性时的假阳性率及假阴性率，与病理结果尽量一致，更准确地为临床诊断和治疗甲状腺结节提供信息。资料与方法 1.第一部分研究对象是128例患者从2013年6月到2013年12月行超声体检发现了甲状腺病灶，每位患者均行手术获得病理结果，82例女性患者，46例男性患者，年龄17—78岁，平均(38.2±18.3)岁，，病灶最大径3—31mm，平均（13.02±6.54）mm。所有结节术前均采用Horvath等提出的TI—RADS分级诊断标准进行评价，术后与病理结果对照。为了更好地与病理结果对照，本研究仅入选甲状腺结节TI—RADS分级为3—5级，灰阶超声表现为单发实性结节，故总共128个病灶。将TI—RADS分级与病理结果比较，画出ROC曲线以AUC来评估TI—RADS分级对鉴别诊断甲状腺结节良性和恶性是否有价值。 2.第二部分对第一部分中的128例患者，128个病灶术前及35例正常对照组行实时剪切波弹性成像检查，得到甲状腺良性结节、恶性结节与正常甲状腺组织的杨氏模量平均值，与病理结果对照画出ROC曲线，以AUC来评估杨氏模量平均值是否对甲状腺结节良性和恶性有价值，并得出划分甲状腺结节良性和恶性界点值。 3.参考本研究第二部分的研究结果获得的区分甲状腺结节良性和恶性的分界值，对于当SWE杨氏模量平均值＞参考界值时，TI—RADS分级为3级的结节上升至4a级， TI—RADS分级为4a级的结节上升至4b级；当SWE杨氏模量平均值≤参考界值时，TI—RADS分级为4b级的结节下降至4a级；对于TI—RADS分级为5级的结节不做调整。与病理结果对照画出ROC曲线，根据AUC的不同，通过Z检验，比较结合SWE后改良的TI—RADS分级与原TI—RADS分级诊断标准对甲状腺结节的诊断价值。结果 1.128个甲状腺结节中，73个恶性结节中甲状腺乳头状癌55个，微小乳头状癌18个；55良性结节中结甲36个，甲状腺腺瘤19个。根据TI—RADS分级与病理结果对照绘制ROC曲线，AUC为0.866，敏感度为83.6%，特异度为82%。 2.良性结节组、恶性结节组及正常甲状腺对照组的杨氏模量平均值分别是（23.92±15.5）Kpa、（80.47±29.39）Kpa和（16.34±4.77）Kpa，组间比较差异有统计学意义，P0.05；甲状腺结节杨氏模量平均值诊断甲状腺结节良恶性病变的AUC为0.89，以杨氏模量平均值52.85kPa为界点，其诊断敏感度为95.9%，特异度为71.7%。 3.根据改良TI—RADS分级与病理结果对照画出ROC曲线，AUC为0.931，，敏感度为90.4%，特异度为92.7%。经Z检验，改良后的TI—RADS分级与原TI—RADS分级AUC比较差异有统计学意义。结论 1.TI—RADS分级可以帮助临床医师通过超声报告直观地看出甲状腺结节是良性还是恶性，并且进一步指导了临床医师下一步对甲状腺结节作何治疗。 2.剪切波弹性成像可以以具体的数值来反应甲状腺组织的硬度，测得的杨氏模量平均值可以帮助区分甲状腺结节是良性还是恶性。 3.剪切波弹性成像联合TI—RADS分级诊断标准对区分甲状腺结节是良性还是恶性的诊断价值高于原TI—RADS分级，减少了TI—RADS分级中的假阳性及假阴性率，更加提高了TI—RADS分级对临床的指导意义。
[Abstract]:Background and purpose:
According to epidemiological studies have shown that random sampling in the crowd, the ultrasonic inspection found the possibility of thyroid nodules was 19% - 67%, and found the possibility of thyroid cancer is 5% - 10%, and a significant increase trend. Ultrasound gradually becomes a recognition method of routine inspection of benign and malignant thyroid nodules, but different ultrasound doctors knowledge different, so different nodules description is different, the effect of thyroid doctors for thyroid nodules. In order to make the judgment ultrasound of thyroid nodules can be described with a consistent standard, let the doctor thyroid thyroid nodules more accurate information, better treatment of thyroid nodules, Horvath in 2009 from the American College of Radiology Breast imaging reporting setting and data system (Breast imagingreporting and data system, BI-RADS) ultrasonic diagnostic criteria grading, the same to super thyroid nodules Acoustic description to develop a standard, namely the thyroid imaging reporting and data system (TI - RADS) classification. Characteristics of thyroid nodule in ultrasound images and two-dimensional sonographic features are similar between benign and malignant lesions, and different ultrasound doctors experience is different, the same lesions may give different levels of shear wave elastography. (SWE) is a direct and quantitative measured technology new diagnostic ultrasound hardness value. The purpose of this study is to investigate the TI by RADS classification, shear wave elastography respectively in distinguishing between benign and malignant thyroid nodules are of diagnostic value, and to explore a kind of adjusting method of joint SWE with TI-RADS, in order to further improve the diagnostic value of TI-RADS classification, to see whether it helps reduce the TI RADS classification in the diagnosis of thyroid nodules are benign or malignant when the false positive rate and false negative rate, and disease The results are as consistent as possible and provide more accurate information for the clinical diagnosis and treatment of thyroid nodules.
Information and methods
The 1. part is the research object in 128 patients from June 2013 to December 2013 underwent ultrasound examination found thyroid lesions, each patient underwent surgical pathological results, 82 cases of female patients and 46 male patients, aged 17 - 78 years old, the average (38.2 + 18.3) years old, and the maximum diameter of the lesions was 3 31mm (average. 13.02 + 6.54) mm. all nodules before surgery were proposed by Horvath and TI - RADS classification standards to evaluate the postoperative results compared with pathology. In order to better control results and pathology, this study selected TI RADS classification of thyroid nodules was 3 - 5, ultrasound showed solitary solid nodule. Therefore, a total of 128 lesions. The TI RADS classification and compared with pathological results, draw ROC curves with AUC to assess the TI RADS classification in differential diagnosis of benign and malignant thyroid nodules is valuable.
2. the second part of the first part of 128 cases in patients with normal control group underwent real-time shear wave elastography examination 128 lesions before surgery and 35 cases were benign thyroid nodules, the young's modulus of malignant nodules and normal thyroid tissue on average, compared with the pathological results to draw ROC curves, using AUC to evaluate the average young's modulus if the value of benign and malignant thyroid nodules have value, and draw the division of benign and malignant thyroid nodules cut-off point.
Study on the 3. reference to the second part of the study results of thyroid nodules to differentiate between benign and malignant boundary value for SWE, when the average young's modulus, cut-off values, TI RADS classification for nodules increased to 4A level 3, TI - RADS grade nodules increased to 4B level 4a; when SWE the average young's modulus is less than or equal to the reference value of community, TI - RADS grade nodules decreased to 4A 4B level; no adjustment for TI - RADS grade 5 nodules. Compared with pathologic results and draw ROC curve, according to the different AUC, through the Z test, compared with the value of TI and RADS classification the original TI diagnostic criteria of RADS classification of thyroid nodules in diagnosis of SWE after improvement.
Result
In 1.128 thyroid nodules and 73 malignant nodules in thyroid papillary carcinoma in 55, papillary microcarcinoma 18; a 36 node 55 benign nodules in thyroid adenoma, 19. According to the TI RADS classification and pathologic findings were the ROC curve, AUC was 0.866, the sensitivity was 83.6%, specificity 82%.
2. groups of benign nodules, the young's modulus of malignant nodules and normal thyroid control group mean values were (23.92 + 15.5) Kpa, (80.47 + 29.39) Kpa and (16.34 + 4.77) Kpa, the difference between groups was statistically significant, P0.05; the average young's modulus of thyroid nodule diagnosis of benign and malignant thyroid nodules AUC is 0.89, with the average young's modulus of 52.85kPa is bounded, the diagnostic sensitivity was 95.9%, specificity was 71.7%.
3. according to the improved TI RADS classification and pathological results, ROC curve was drawn, AUC was 0.931, sensitivity was 90.4%, specificity was 92.7%., after Z test, the modified TI RADS classification had a statistically significant difference compared with the original TI RADS classification AUC.
conclusion
1.TI RADS grading can help clinicians to see whether thyroid nodules are benign or malignant through ultrasound reports, and further guide clinicians to further treat thyroid nodules.
2., shear wave elastography can reflect the hardness of thyroid tissue with specific values. The average value of Young's modulus can help distinguish thyroid nodules from benign or malignant ones.
3. shear wave elastography combined with TI diagnostic criteria of RADS classification to distinguish thyroid nodules are benign or malignant diagnosis value higher than the original TI RADS classification, reduce the false positive and false negative rate of TI - RADS grade, more to improve the TI RADS classification of clinical significance.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1

【参考文献】