超声剪切波弹性成像对女性盆腔肿物鉴别价值的初探

发布时间：2018-02-14 19:15

本文关键词： 剪切波弹性成像盆腔肿物弹性模量值鉴别价值　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过应用超声剪切波弹性成像技术定量测定女性盆腔肿物的弹性模量值,初步研究良恶性肿物及不同病理类型肿物间弹性模量值的统计学差异,并探讨超声弹性成像技术对女性盆腔肿物性质判定的可行性及价值。方法:选取2015年11月到2016年11月期间于我院住院拟行手术,术前于我科行超声检查的女性盆腔肿物患者137例,其中实性肿物90例,囊实性肿物47例。采用philips i U22彩色多普勒超声诊断仪,内配置有SWE模式成像技术软件,可进行肿物的弹性模量值的测定。对所有受检者先行常规二维超声扫查,观察肿物基本情况,而后启用SWE模式,对肿物进行多次多点测量并记录其弹性模量最大值、最小值及平均值。追踪每个受检者的病理结果,以术后病理结果为金标准分组,对各自剪切波模量值进行分析。其中实性组分为类实性组、良性实性组和恶性实性组。类实性组共14例,按病理类型分为子宫内膜异位囊肿组和出血性囊肿组,良性实性组共60例,按病理类型分为肌瘤组、特殊类型肌瘤组和性索间质肿瘤组,恶性实性组共19例,按病理类型分为上皮性肿瘤组和肉瘤组。囊实性肿物也分为良性组和恶性组,良性组13例,按病理类型分为卵巢囊腺瘤组和成熟囊性畸胎瘤组,恶性组34例,按病理类型分为恶性腺癌组、未成熟畸胎瘤组和转移性肿瘤组。所有数据采用SPSS21.0进行统计学分析,分别比较实性肿物组及囊实性肿物组良、恶性肿物间及不同病理类型肿物间的剪切波模量值是否有统计学差异。所有计量资料均以均数±标准差表示。以P0.05为差异有统计学意义。依据病理结果及剪切波模量值绘制ROC曲线,据此得出良恶性盆腔肿物鉴别的最佳剪切波模量值截断值,并评价其敏感性、特异性。结果:1对类实性肿物组、良性实性肿物组、恶性实性肿物组平均、最大、最小弹性模量值分别进行两两比较,结果差异均具有统计学意义(P0.05),且认为良性实性肿物弹性模量值恶性实性肿物类实性肿物。2实性盆腔肿物不同病理类型间弹性模量值的比较:(1)良性实性肿物组:肌瘤组、性索间质肿瘤组及特殊类型肌瘤组平均、最大、最小弹性模量分别比较,结果肌瘤组与性索间质肿瘤组弹性模量值无明显差别(P0.05),而两者弹性模量值均大于特殊类型肌瘤组(P0.05)。(2)恶性实性肿物组:上皮性肿瘤组与肉瘤组平均、最大、最小弹性模量值分别比较,结果差异均具有统计学意义(P0.05),认为上皮性肿瘤组弹性模量值大于肉瘤组。(3)类实性肿物组:子宫内膜异位囊肿与出血性囊肿弹性模量平均值、最大值、最小值分别比较,结果差异均具有统计学意义(P0.05),认为子宫内膜异位囊肿弹性模量值大于出血性囊肿。3鉴别诊断截断值:以病理结果为金标准,良、恶性实性盆腔肿物的弹性模量值为基础,绘制ROC曲线,结果得出以弹性模量平均值12.56KP、最大值43.55KP、最小值6.8KP为截断值时的准确率最高,分别是75.0%、61.84%、78.95%,三者比较差异具有统计学意义(P0.05),认为以最小弹性模量截断值鉴别实性肿物的良恶性准确率更佳。以病理结果为金标准,实性盆腔肿物及类实性盆腔肿物弹性模量值为基础绘制ROC曲线,结果得出以弹性模量平均值8.65KP、最大值17.62KP、最小值4.5KP为截断值时的诊断准确率最高,分别是91.11%、84.44%、92.22%,三者比较差异无统计学意义(P0.05),认为平均、最大、最小弹性模量截断值对鉴别肿物的囊、实性均有较高的准确率,无明显差别。4常规超声与剪切波弹性成像技术联合诊断恶性实性盆腔肿物的敏感性为93.75%,特异性为91.67%,阳性预测值为75.0%,阴性预测值为98.21%,正确率为92.11%。单独应用常规超声正确诊断恶性盆腔肿物的灵敏度、特异度、阳性预测值、阴性预测值、准确率分别为81.25%、81.67%、54.17%、94.23%、81.58%。两者准确率差异具有统计学意义(P0.05),认为超声弹性成像联合常规超声诊断盆腔恶性肿物的准确率高于单独应用常规超声。5良性囊实性肿物组与恶性囊实性肿物组组间及组内不同病理类型间平均、最大、最小弹性模量值分别比较,结果差异均无统计学意义(P0.05)。结论:超声弹性成像技术对良性实性及恶性实性肿物,盆腔实性肿物及类实性的囊性肿物的鉴别均具有可行性及较高的潜在价值。在常规超声的基础上应用弹性成像技术可以进一步增强良、恶性实性盆腔肿物鉴别诊断的准确率。但其对囊实性盆腔肿物良恶性的鉴别意义不大。
[Abstract]:Objective: to determine the elastic modulus of female pelvic masses by using ultrasonic shear wave elastography quantitative values of benign and malignant tumor and different pathological types of tumors between the elastic modulus of the differences, and to explore the feasibility and value of ultrasound elastography to judge the nature of female pelvic tumor. Methods: from November 2015 to November 2016 during the our hospital underwent surgery, preoperative ultrasound examination in our department for female pelvic tumor in 137 cases, including 90 cases of solid tumor, solid cystic mass in 47 cases. The Philips I U22 color Doppler ultrasonic diagnostic apparatus, configuration software SWE mode imaging technology, determination of modulus of elasticity for mass value. All subjects received conventional two-dimensional ultrasound scan, the basic situation was observed, and then enable SWE mode of tumor multiple measure and record its elastic modulus The maximum, minimum and average values. The pathological results of tracking each of the subjects with postoperative pathological results as the gold standard for each packet, the shear wave modulus were analyzed. The solid component is a kind of real group, benign group and malignant solid solid solid class group. Group 14 according to the pathological types were divided into endometriosis group and hemorrhagic cyst group, benign solid group were 60 cases, according to the pathological types of leiomyoma group, cord stromal tumor group and the group of special types of leiomyoma, malignant solid group 19 cases, according to the pathological type is divided into epithelial tumor group and sarcoma group. Cystic tumors are divided into benign and malignant group and benign group 13 cases, according to the pathological types of ovarian cystadenoma and divided into groups of mature cystic teratoma group, malignant group 34 cases, according to the pathological types are divided into malignant adenocarcinoma group, immature teratoma group and metastasis group. All the data SPSS21.0 statistics Compared analysis, solid tumor group and cystic mass of benign and malignant tumor, shear wave modulus and different pathological types of tumors between values have significant difference. All measurement data are mean standard deviation. In P0.05 the difference was statistically significant. According to the pathological results and the value of the modulus of shear wave the ROC curve, the optimal shear wave modulus to derive the identification of benign and malignant pelvic tumors and to evaluate the value of the cutoff value, sensitivity and specificity. Results: 1 kinds of solid tumor group, benign lesions and malignant solid tumor group, group average, maximum, the small elastic modulus values were 22 comparison results all the differences were statistically significant (P0.05), and that of malignant solid tumors of solid tumor.2 of pelvic tumor in different pathological types between the elastic modulus of the elastic modulus of benign solid tumors: (1) benign lesions group: myoma group And sex cord stromal tumor group and special types of leiomyoma group average, maximum and minimum elastic modulus were compared, the results of myoma group and sex cord stromal tumor group had no significant difference in elastic modulus (P0.05), and the two elastic modulus values are higher than the special types of leiomyoma group (P0.05). (2) malignant solid tumors group: epithelial tumor group and sarcoma group average, maximum and minimum values of elastic modulus were compared, the results were statistically significant difference (P0.05), that the epithelial tumor group elastic modulus value is greater than the sarcoma group. (3) class of solid tumor group: Endometriosis cyst with hemorrhagic cysts, the average elastic modulus. The maximum value, the minimum value were compared, the results were statistically significant difference (P0.05), that the endometriosis elastic modulus value is greater than the hemorrhagic cyst.3 differential diagnosis cut-off value: with pathological results as the gold standard of benign, malignant solid tumor in pelvic cavity elasticity The value of the modulus based on ROC curve, the result shows that the average elastic modulus 12.56KP, maximum 43.55KP and minimum 6.8KP for the accuracy of truncation values of the highest, respectively is 75%, 61.84%, 78.95%, a statistically significant difference between the three groups (P0.05), that identification of solid mass with the minimum elastic modulus of truncation the value of the accuracy is better. In the benign and malignant pathological results as the gold standard, solid pelvic mass elastic modulus of solid tumor and pelvic value ROC curve as the foundation, the result shows that the average elastic modulus 8.65KP, maximum 17.62KP and minimum 4.5KP for the diagnosis of truncation value when the highest accuracy rate were 91.11% 84.44%, 92.22%, there was no significant difference between the three groups (P0.05), that the average, maximum, minimum value of elastic modulus of truncated mass identification accuracy of sac, solid were high, there was no significant difference between the.4 and the conventional ultrasonic shear wave The sensitivity of combined diagnosis of malignant solid tumor in pelvic cavity imaging was 93.75%, specificity was 91.67%, the positive predictive value was 75%, the negative predictive value was 98.21%, the correct rate of sensitivity, 92.11%. single conventional ultrasound correctly diagnosed malignant pelvic tumor specificity, positive predictive value, negative predictive value, accuracy was 81.25% 81.67%, 54.17%, 94.23%, 81.58%., the accuracy rate of the difference was statistically significant (P0.05), that the accuracy rate of ultrasound elastography and conventional ultrasound in diagnosis of pelvic malignant tumor is higher than that of different pathological types of single conventional ultrasonic.5 of benign cystic solid tumors and malignant cystic tumor group and between groups in the group average, maximum the minimum elastic modulus were compared, and the results showed no significant difference (P0.05). Conclusion: ultrasound elastography in benign and malignant solid lesions, pelvic solid tumor and class The potential value of differential solid cystic masses were feasible and high. Application of elasticity imaging technique based on conventional ultrasound can further enhance the accuracy of differential diagnosis of benign and malignant solid tumor in pelvic cavity. But the identification of significant malignant cystic benign pelvic mass.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.3

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