唾液腺超声评分及弹性成像对干燥综合征的诊断价值

发布时间：2018-04-14 10:28

本文选题：声辐射力脉冲 + 弹性成像　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:1.通过观察干燥综合征(SS)患者唾液腺常规超声特征,探讨超声评分对SS的诊断的价值。2.运用声辐射力脉冲(ARFI)技术测量SS患者唾液腺硬度,探讨ARFI成像对SS的诊断价值。方法:收集我院风湿免疫科门诊或住院的SS疑诊的患者者155例,将患者分为SS组76例和非SS组79例。对所有患者双侧腮腺及颌下腺进行二维超声检查,获得双侧腮腺及颌下腺的声像图表现,采用半定量评分方法对其进行评分。随后对双侧腮腺及颌下腺进行ARFI检查,获得双侧腮腺及颌下腺的剪切波速度(SWV)。比较两组间唾液腺超声评分及SWV值的差异性并分析其诊断SS的价值。结果:1、非SS组中唾液腺超声64例(64/79,81.0%)表现为正常,评为0分,而SS组64例(64/76,84.2%)唾液腺超声评分≥1分。SS组唾液腺超声评分高于非SS组(P0.001)。2、唾液腺超声评分诊断SS的ROC曲线下面积为0.883(95%置信区间0.826,0.940),以2分为临界值诊断SS灵敏度为73.7%,特异度为94.9%,准确率为84.5%。3、SS组及非SS组同组内双侧腮腺、颌下腺间SWV值差异均无统计学意义(P0.05);不同组间腮腺及颌下腺SWV值差异均有统计学意义(P0.05)4、颌下腺ARFI诊断SS的ROC曲线下面积为0.859(95%置信区间0.767,0.950),以2.14m/s为临界值诊断SS灵敏度为76.3%,特异度为84.6%。腮腺ARFI诊断SS的ROC曲线下面积为0.843(95%置信区间0.741,0.945),以1.98m/s为临界值诊断SS灵敏度为84.2%,特异度为84.6%。唾液腺ARFI成像诊断SS的最佳截断值、敏感性、特异性、准确率及ROC曲线下面积分别为2.11 m/s、81.6%、88.5%、85.2%及0.890。5、唾液腺超声评分联合ARFI成像诊断SS的敏感性、特异性及准确率分别为95.2%、84.0%、89.0%。结论:唾液腺超声评分法可为唾液腺回声的均匀程度提供半定量指标,辅助SS的诊断具有较高的特异度。ARFI成像可以提供唾液腺SWV值,定量反应唾液腺弹性,SS患者的腮腺及颌下腺的硬度高于非SS患者,在SS诊断中具有重要价值。唾液腺常规超声联合ARFI成像对SS的诊断价值与单一成像相当。
[Abstract]:Purpose 1.By observing the characteristics of salivary gland routine ultrasound in patients with Sjogren's syndrome (SS), the value of ultrasonic score in the diagnosis of SS was discussed.The salivary gland hardness of SS patients was measured by acoustic radiation power pulse technique (ARFI), and the diagnostic value of ARFI imaging for SS was discussed.Methods: 155 patients with suspected SS were divided into SS group (n = 76) and non-SS group (n = 79).Two-dimensional ultrasonography was performed on the bilateral parotid and submandibular glands of all patients, and the sonographic features of the bilateral parotid and submandibular glands were obtained and scored by semi-quantitative scoring method.The shear wave velocities of bilateral parotid and submandibular glands were obtained by ARFI.The differences of salivary gland ultrasound score and SWV between the two groups were compared and the diagnostic value of SS was analyzed.Results in the non-SS group, 64 cases of salivary gland ultrasound showed normal results (64 / 79 / 81.0), with a score of 0.The salivary gland ultrasound score of SS group was higher than that of non-SS group (P 0.001). The area under the ROC curve of SS was 0.88395% confidence interval 0.8260.9400.The critical value of SS was 73.7%.The specificity was 94. 9 and the accuracy was 84. 5%. The parotid glands in the same group and non-SS group were 84.5% and 84. 5% respectively.There was no significant difference in SWV value between submandibular glands (P 0.05), and there were significant differences in SWV value of parotid gland and submandibular gland between different groups (P 0.05). The area under ROC curve of ARFI diagnosis of SS in submandibular gland was 0.859% 95% confidence interval 0.7670.95% confidence interval 0.7670.500.The critical value of 2.14m/s was sensitive to diagnose SS.The degree was 76. 3 and the specificity was 84. 6.The area under the ROC curve of parotid gland ARFI diagnosis SS was 0.843 ~ 95% confidence interval 0.741 ~ 0.945%. The sensitivity and specificity of 1.98m/s were 84.2% and 84.6% respectively.The best truncation value, sensitivity, specificity, accuracy and area under the ROC curve of salivary gland ARFI were 2.11 m / s 81.6% and 0.890.5%, respectively. The sensitivity, specificity and accuracy of salivary gland ultrasound score combined with ARFI imaging in the diagnosis of SS were 95.2or 84.0 and 89.0, respectively.Conclusion: the salivary gland ultrasound scoring method can provide a semi-quantitative index for the homogeneity of salivary gland echo. The diagnostic specificity of the adjuvant SS is higher. ARFI imaging can provide the salivary gland SWV value.The hardness of parotid gland and submandibular gland in patients with quantitative response to salivary gland elasticity was higher than that in non-SS patients, which was of great value in the diagnosis of SS.The diagnostic value of salivary gland conventional ultrasound combined with ARFI imaging in SS is similar to that of single imaging.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R593.2

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