常规超声联合弹性成像在桥本氏甲状腺炎合并甲状腺癌诊断中的应用

发布时间：2018-03-23 11:20

本文选题：超声弹性成像　切入点：桥本甲状腺炎　出处：《吉林大学》2014年硕士论文

【摘要】：目的：探讨弹性成像应变率比值法诊断桥本氏甲状腺炎(HT)合并甲状腺癌的最佳诊断临界点。对比研究常规超声、弹性成像应变率比值法、常规超声联合弹性成像应变率比值法三种方法对HT合并甲状腺癌的诊断价值。方法：选取我院经穿刺活检或手术病理证实为HT合并甲状腺结节的患者62例，共75个结节，分别行常规超声及超声弹性成像（UE）检查。常规超声检查时将结节形态、边界、回声水平、回声特点、内部钙化、后方回声、有无颈部淋巴结肿大、血流分布情况等作为观察指标，多切面观察并描述结节；UE检查获得弹性图像后，采用应变率比值法进行评价，对照病理结果，绘制受试者工作特征(ROC)曲线，计算曲线下面积(AUC)，，得出最佳诊断临界点。将常规超声和弹性成像应变率比值法联合应用，以二者均诊断为良性为良性，二者其一诊断为恶性为恶性作为诊断标准，对75个结节进行评价。采用SPSS17.0统计软件，以病理诊断为金标准分别与常规超声、弹性成像应变率比值法、常规超声联合弹性成像应变率比值法三种方法的诊断结果进行对照，绘制三种方法的ROC曲线，采用Z检验比较AUC。计量资料采用t检验。结果： 1.常规超声检查诊断HT合并甲状腺癌的敏感度为65.3%，特异度为79.6%，准确度为74.7%。 2.弹性成像应变率比值法测得HT合并良性结节的SR为2.29±1.36，HT合并恶性结节的SR为5.44±2.59， HT合并恶性结节的SR明显高于HT合并良性结节，经t检验，二者具有显著差异(P＜0.01)。对照病理结果，绘制ROC曲线，AUC为0.863±0.047，根据约登指数最大的切点值，确定3.945为最佳诊断临界点。弹性成像应变率比值法诊断HT合并甲状腺癌的敏感度为76.9%、特异度为85.7%、准确度为82.7%。 3.常规超声联合弹性成像应变率比值法诊断HT合并甲状腺癌的敏感度为92.3%、特异度为79.6%、准确度为84.0%。 4.ROC曲线显示：常规超声、弹性成像应变率比值法、常规超声联合弹性成像应变率比值法的AUC分别为0.725、0.813、0.859，均具有较高的诊断准确性，常规超声联合应变率比值法的诊断准确性最高。采用Z检验两两对比，常规超声联合弹性成像应变率比值法与常规超声ROC曲线下面积之间的差异存在统计学意义。结论： 1.弹性成像应变率比值法以半定量的方式客观的反映HT合并结节的相对硬度，具有较高的诊断价值。 2.常规超声联合弹性成像应变率比值法对HT合并甲状腺癌的诊断价值高于常规超声及弹性成像应变率比值法。
[Abstract]:Objective:. To explore the best critical point for the diagnosis of HTH (Hashimoto's thyroiditis) combined with thyroid carcinoma by strain rate ratio method of elastic imaging. Diagnostic value of conventional ultrasound combined with elastic imaging strain rate ratio method for HT with thyroid carcinoma. Methods:. Sixty-two patients (75 nodules) with HT complicated with thyroid nodules confirmed by puncture biopsy or surgery and pathology in our hospital were examined by conventional ultrasound and ultrasonic elastography respectively. The shape, boundary and echo level of the nodules were measured by conventional ultrasound. Echo characteristics, internal calcification, posterior echo, neck lymphadenopathy and blood flow distribution were used as indicators. Compared with the pathological results, the operating characteristics of the subjects were drawn, the area under the curve was calculated and the optimal diagnostic critical point was obtained. The conventional ultrasound and the strain rate ratio method of elastic imaging were used together, and both were diagnosed as benign. In the first case, 75 nodules were evaluated according to the diagnostic criteria of malignant or malignant. The SPSS17.0 statistical software was used to evaluate 75 nodules. The pathological diagnosis as gold standard was compared with conventional ultrasound and strain rate ratio of elastic imaging. The diagnostic results of the three methods of conventional ultrasound combined with elastic imaging strain rate ratio method were compared, the ROC curves of the three methods were drawn, and the AUC was compared by Z test and t test. Results:. 1. The sensitivity, specificity and accuracy of conventional ultrasonography in diagnosing HT with thyroid carcinoma were 65.3, 79.6 and 74.7 respectively. 2. The SR of HT with benign nodules was 2.29 卤1.36 by strain rate ratio of elastic imaging. The SR of HT with malignant nodules was 5.44 卤2.59.The SR of HT with malignant nodules was significantly higher than that of HT with benign nodules, and there was significant difference between them by t test (P < 0.01). The ROC curve is 0.863 卤0.047. According to the maximum value of Jorden index, 3.945 is the best critical point for diagnosis. The sensitivity, specificity and accuracy of elastic imaging strain rate ratio method for diagnosing HT with thyroid carcinoma are 76. 9%, 85. 7% and 82. 7% respectively. 3. The sensitivity, specificity and accuracy of conventional ultrasound combined with elastic imaging strain rate ratio in the diagnosis of HT complicated with thyroid carcinoma were 92.3, 79.6 and 84.0 respectively. The 4.ROC curves showed that the AUC of conventional ultrasound, elastic imaging strain rate ratio method and conventional ultrasound combined with elastic imaging strain rate ratio method were 0.725 ~ 0.813 ~ 0.859, respectively. The diagnostic accuracy of the conventional ultrasound combined with strain rate ratio method was the highest. The difference between the conventional ultrasound combined with elastic imaging strain rate ratio method and the area under the conventional ultrasound ROC curve was statistically significant by using Z test. Conclusion:. 1. The elastic imaging strain rate ratio method can objectively reflect the relative hardness of HT with nodule in a semi-quantitative manner, which is of high diagnostic value. 2. The diagnostic value of conventional ultrasound combined with elastic imaging strain rate ratio method for HT with thyroid carcinoma was higher than that of conventional ultrasound and elastic imaging strain rate ratio method.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R581.4;R736.1;R445.1

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