甲状腺结节围手术期的超声检查多参数评价研究

发布时间：2018-03-16 09:10

本文选题：甲状腺结节　切入点：超声造影　出处：《川北医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：研究甲状腺结节围手术期超声检查的多参数指标，筛选出对甲状腺结节良恶性鉴别诊断显著的特征变量，评估其诊断价值，探讨甲状腺结节围手术期的最佳超声检查方案。方法：对54例甲状腺患者63个结节行常规超声、超声弹性成像及超声造影检查，，观察各种检查方法的多项指标，采用X2检验、logstic回归分析、ROC曲线等分析评估指标对甲状腺良恶性结节的鉴别诊断效果。结果： 1、恶性结节16个，常规超声多表现为低回声，结节边界呈分叶状及浸润，内常见微钙化，超声弹性成像分级主要为IV-V级，超声造影多表现为低增强，不均匀增强，增强后边界不清；良性结节47个，常规超声多表现为高回声，结节边界清晰，内无钙化或可见粗钙化，超声弹性成像分级以I-III级多见，超声造影多表现为均匀高增强； 2、多因素回归分析显示微钙化、结节边界呈分叶状及浸润、弹性成像分级IV-V级、超声造影低增强对恶性结节诊断预测作用显著，P0.1； 3、ROC曲线下面积：常规超声的7个指标，微钙化最高为0.869（对恶性结节诊断敏感性为75%,特异性为97.87%）；结节边界0.864（边界分叶状及浸润对恶性结节诊断敏感性为81.25%,特异性为85.11%）；实性部分回声0.793（低回声对恶性结节诊断敏感性为68.75%,特异性为78.72%）；弹性成像分级IV-V级为0.874（以大于III级为最近诊断值，对恶性结节诊断敏感性为81.25%,特异性为93.62%,）；超声造影增强程度曲线下面积为0.901(低增强对恶性结节诊断敏感性为81.25%、特异性为91.49%)；增强均匀度曲线下面积为0.652（不均匀对恶性结节敏感性为68.75%、特异性为61.7%）；增强后边界曲线下面积为0.643（边界不清对恶性结节敏感性为56.25%、特异性为72.34%）；微钙化+分叶浸润曲线下面积为0.905（敏感性为87.5%，特异性为85.11%）；微钙化+分叶浸润+分级曲线下面积为0.920（敏感性为87.5%，特异性为95.74%）；微钙化+分叶浸润+造影：曲线下面积为0.942（敏感性为81.25%，特异性为95.74%）；微钙化+分叶浸润+分级+造影增强多参数曲线下面积为0.946（敏感性为87.5%、特异性为95.74%）； 4、单个诊断指标对恶性甲状腺结节诊断曲线下面积均大于0.8，而多参数联合诊断曲线下面积均大于0.9。结论：甲状腺恶性结节及良性结节间有着不同的常规超声、超声造影及超声弹性成像特征。单个指标鉴别诊断甲状腺结节的性质有一定的价值，然而多指标联合可明显提高诊断准确率，三种检查方法的显著性指标联合鉴别诊断甲状腺结节良恶性的价值最高。
[Abstract]:Objective: to study the multiparameter indexes of thyroid nodule in perioperative period, to screen out the significant characteristic variables for the differential diagnosis of benign and malignant thyroid nodules, and to evaluate its diagnostic value. Objective: to investigate the best ultrasound examination for thyroid nodule during perioperative period. Methods: Sixty-three nodules of 54 patients with thyroid gland were examined by conventional ultrasonography, elastography and contrast-enhanced ultrasonography. The differential diagnosis of benign and malignant thyroid nodules was evaluated by X _ 2 logistic regression analysis and ROC curve. Results:. 1, 16 malignant nodules, most of them were hypoechoic, the boundary of the nodules were lobulated and infiltrated, and microcalcification was common in them. The grade of ultrasound elastic imaging was mainly IV-V grade, and most of them showed low enhancement and uneven enhancement. There were 47 benign nodules with hyperechoic, clear boundary and no calcification or coarse calcification. The grade of elastic imaging was I-III, and the contrast enhanced with uniform and high contrast enhanced ultrasound. The results were as follows: (1) in contrast, the boundary of benign nodules was hyperechoic, the boundary of the nodules was clear, no calcification or coarse calcification was seen in the nodules. 2, multivariate regression analysis showed that microcalcification, lobulation and infiltration of nodular boundary, IV-V grade of elastic imaging grade, and low enhancement of contrast-enhanced ultrasonography could significantly predict the diagnosis of malignant nodules (P0.1). 3 area under ROC curve: 7 indexes of conventional ultrasound, The highest value of microcalcification is 0.869 (sensitivity to diagnosis of malignant nodules is 7575, specificity is 97.87), boundary of nodules is 0.864 (sensitivity of lobulation and infiltration to diagnosis of malignant nodules is 81.25 and specificity is 85.1111), solid partial echo is 0.793 (diagnosis of malignant nodules with low echo). The sensitivity was 68.75 and the specificity was 78.72. The IV-V grade of elastic imaging grade was 0.874 (the most recent diagnostic value was greater than III level). The sensitivity to diagnosis of malignant nodules was 81.25 and the specificity was 93.62. The area under the enhanced degree curve of contrast-enhanced ultrasound was 0.901 (the sensitivity of low contrast enhancement to the diagnosis of malignant nodules was 81.25 and the specificity was 91.490.The area under the enhancement uniformity curve was 0.652 (uneven for malignant nodules). The sensitivity of the nodules was 68.75, the specificity was 61.7%; the area under the enhanced boundary curve was 0.643 (the sensitivity to malignant nodules was 56.25 and the specificity was 72.34; the area under the curve of microcalcification lobular infiltration was 0.905 (sensitivity was 87.5, specificity was 85.11; microcalcium; The area under the curve was 0.920 (sensitivity was 87.5 and specificity was 95.74). Microcalcification lobulography: the area under the curve was 0.942 (sensitivity was 81.25, specificity was 95.74g), microcalcification lobular infiltration grading was increased. The area under the strong multi-parameter curve was 0.946 (sensitivity 87.5, specificity 95.7474); 4. The area under the diagnosis curve of malignant thyroid nodule was larger than 0.8 by single diagnostic index, and the area under multi-parameter combined diagnosis curve was larger than 0.9. Conclusion: there are different characteristics of conventional ultrasound, contrast-enhanced ultrasound and elastography between malignant and benign thyroid nodules. It is valuable to differentiate the nature of thyroid nodules by single index. However, the diagnostic accuracy can be significantly improved by the combination of multiple indexes, and the diagnostic value of the three methods is the highest in the differential diagnosis of benign and malignant thyroid nodules.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R653;R445.1

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