多模式超声技术诊断甲状腺结节的临床应用价值

发布时间：2018-04-13 05:40

本文选题：多模式诊断 + 甲状腺结节　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：探讨多模式超声技术在甲状腺结节良恶性鉴别诊断的临床应用价值。方法：本文选取我院自2012年10月至2013年12月438例甲状腺结节患者，该438名患者均于我院行外科手术治疗，术前均在我科进行常规超声（Ultrasound,US）检查、实时超声弹性成像（Real-time Elastosongraphy,RE）检查、超声造影（Contrast-Enhanced Ultrasound,CEUS）检查及超声引导下细针穿刺活检（Ultrasound-guided Fine-Needle Aspiration Biopsy, US-FNAB）。回顾性分析438名患者常规超声检查、RE检查、CEUS检查及US-FNAB结果，以术后病理为金标准，与多模式超声检查结果进行对比性研究。US检查，通过观察甲状腺结节的形态、内部回声、边界、血运及是否存在钙化等特点，依据超声TI-RADS分类标准，将检查的甲状腺结节分为两类即恶性结节和良性结节，与自身术后病理结果进行对比性研究，通过对其灵敏度、特异度及准确度的计算，评估单纯应用常规超声检查鉴别诊断甲状腺结节良恶性的价值；结合US检查结果，进行RE检查，根据超声弹性评分标准，对检查的结节进行评分并分类，将弹性评分为1-3分的结节定为良性结节，将弹性评分为4-5分的结节定为恶性结节，与自身术后病理结果进行对比性研究，通过对其灵敏度、特异度及准确度的计算，评估在应用US及RE检查后，在鉴别诊断甲状腺良恶性结节中的应用价值；结合US加RE检查结果，进行CEUS检查，根据不同结节造影模式不同的特点，将甲状腺结节造影检查结果分为4种类型，分类结果中1-3类定为良性结节，，4类定为恶性结节，与其术后病理结果进行对比，通过计算其灵敏度、特异度及准确度，评价在联合应用常规超声检查、超声弹性成像技术检查及甲状腺超声造影检查后对甲状腺结节良恶性鉴别诊断的临床意义；结合US、RE加CEUS检查结果，进行US-FNAB检查，根据病理结果将结节分别定为恶性及良性，与术后病理进行对比性研究，通过其灵敏度、特异度及准确度，判断该方法在鉴别甲状腺良恶性结节中的应用价值。结果： 1.手术病理证实良性病变124例，恶性病变314例。多模式超声技术诊断结果显示良性病变129例，恶性病变309例。 2. US检查甲状腺结节的灵敏度、特异度及准确度分别为53.18%、75.00%、59.36%；US检查结合RE检查后，甲状腺结节诊断的灵敏度、特异度及准确度分别为62.42%、79.84%、67.35%；US检查、RE检查结合CEUS检查后，甲状腺结节诊断的灵敏度及特异度分别为71.01%、82.26%、74.20%；US检查、RE检查、CEUS检查结合US-FNAB检查后，甲状腺结节诊断的灵敏度、特异度及准确度分别为96.50%、95.16%、96.12%。超声引导下甲状腺多模式诊断的灵敏度、特异度及准确度分别为98.41%、100%、98.86%。 3.单纯应用US检查，其诊断甲状腺结节良恶性时灵敏度、特异度及准确度最低，多模式超声技术诊断判断甲状腺结节良恶性的灵敏度、特异度及准确度最高。在增加检查手段的同时，对甲状腺结节良恶性鉴别的灵敏度、特异度及准确度逐渐提高的。 4.应用US检查、US加RE检查、US加RE加CEUS检查及多模式超声技术鉴别诊断甲状腺结节良恶性间差异有统计学意义（P0.01）。结论： 1.多模式超声技术可以作为鉴别甲状腺结节良恶性的有效手段。 2.多模式超声技术显著提高了甲状腺良恶性结节鉴别诊断的灵敏度、特异度及准确度。 3.多模式超声技术为临床甲状腺结节的鉴别诊断提供可靠依据，具有广泛应用前景。
[Abstract]:Objective: To explore the clinical value of multimode ultrasound in differential diagnosis of thyroid nodules.
Methods: We selected in our hospital from October 2012 to December 2013, 438 patients with thyroid nodules, the 438 patients in our hospital underwent surgical treatment in our department were routine ultrasound before operation (Ultrasound, US), real-time ultrasound elastography (Real-time Elastosongraphy, RE), Ultrasound (Contrast-Enhanced, CEUS, ultrasound) examination and ultrasound guided fine needle aspiration biopsy (Ultrasound-guided Fine-Needle Aspiration Biopsy, US-FNAB). A retrospective analysis of 438 patients with conventional ultrasound examination, RE examination, CEUS examination and US-FNAB results, using surgical pathology as the gold standard, comparative study of.US examination and multi mode ultrasonic examination results, through the observation of thyroid nodules morphology, boundary, internal echo, blood supply and the presence of calcification and other characteristics, on the basis of ultrasonic TI-RADS classification standard of thyroid nodule examination will be divided into two categories namely malignant node Section and benign nodules, and comparative research of postoperative pathological results, the sensitivity, specificity and accuracy of the calculation, evaluate the application value of conventional ultrasound in differential diagnosis of benign and malignant thyroid nodules; combined with US examination, RE examination, according to the standard for evaluation of ultrasound elastography score and classification of. Check the nodules, the elastic score of 1-3 nodules as benign nodules, the elastic score of 4-5 nodules as malignant nodules, and comparative study of pathological results after operation, the sensitivity, specificity and accuracy of the calculation and evaluation on the application of US and RE after the inspection application the value in the differential diagnosis of benign and malignant thyroid nodules; combined with US and RE examination, CEUS examination, according to the different characteristics of different patterns of contrast nodules, nodules of thyroid angiography results will be divided into 4 types Type, classification results of 1-3 kinds of benign nodules, 4 kinds of malignant nodules, and postoperative pathological results were compared by calculating the sensitivity, specificity and accuracy of the evaluation, in combination with conventional ultrasound, ultrasound elastography examination and thyroid ultrasound examination on the clinical significance of differential diagnosis of thyroid nodules benign and malignant; combined with US, RE and CEUS examination, US-FNAB examination, according to the pathological results were classified as malignant and benign nodules, comparative study and postoperative pathology, the sensitivity, specificity and accuracy of the method, determine the application value in the diagnosis of benign and malignant thyroid nodules.
Result:
1. the pathology confirmed 124 cases of benign lesions and 314 cases of malignant lesions. The results of multi mode ultrasound diagnosis showed that 129 cases of benign lesions and 309 cases of malignant lesions.
The sensitivity of 2. US examination of thyroid nodules, specificity and accuracy were 53.18%, 75%, 59.36%; US examination combined with RE examination in the diagnosis of thyroid nodules, sensitivity, specificity and accuracy were 62.42%, 79.84%, 67.35%; US examination, RE examination combined with CEUS examination, and sensitivity in the diagnosis of thyroid nodules degrees were 71.01%, 82.26%, 74.20%; US examination, RE examination, CEUS examination combined with US-FNAB examination in the diagnosis of thyroid nodules, sensitivity, specificity and accuracy were 96.50%, 95.16%, 96.12%. sensitivity under ultrasound guided thyroid model diagnosis, specificity and accuracy were 98.41%, 100%, 98.86%.
3. simple application of US examination, the diagnosis of benign and malignant thyroid nodules the sensitivity, specificity and accuracy of the lowest, multi mode ultrasound technique in diagnosis of benign and malignant thyroid nodules to determine the sensitivity, specificity and accuracy. The highest increase in the examination at the same time, the sensitivity in differentiating benign and malignant thyroid nodules, specificity and accuracy of gradually to improve.
4. the difference between benign and malignant thyroid nodules was statistically significant (P0.01) by US examination, US plus RE, US plus RE plus CEUS and multi mode ultrasound in differential diagnosis of thyroid nodules.
Conclusion:
1. multi mode ultrasound can be used as an effective means to differentiate between benign and malignant thyroid nodules.
2. multimode ultrasound significantly improves the sensitivity, specificity and accuracy of the differential diagnosis of thyroid benign and malignant nodules.
3. multi mode ultrasound provides a reliable basis for the differential diagnosis of clinical thyroid nodules, and has a wide application prospect.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R736.1

【参考文献】