超声造影在经皮微波消融治疗甲状腺结节中的应用价值

发布时间：2018-04-30 16:01

本文选题：超声造影 + 甲状腺结节　；参考：《滨州医学院》2014年硕士论文

【摘要】：探讨超声造影(CEUS)在微波消融术前对甲状腺结节的诊断及鉴别诊断、甲状腺结节范围确定的应用价值；评价CEUS对甲状腺结节微波消融术适时结束的指导作用及在术后随访中疗效评估中的应用价值。对2012年3月-2013年7月于我院超声科行微波消融治疗的甲状腺结节患者56例(71个病灶),术前先行二维超声(2DUS)及彩色多普勒超声(CDFI)检查,后行超声造影(CEUS)检查,全过程动态观察病灶,从造影剂进入至消退,应用ACQ软件对其进行时间-强度曲线分析,术后获取病理诊断。对在我院超声科行微波消融治疗的甲状腺结节患者76例(91个病灶),微波消融术后即刻先行2DUS及CDFI检查,评估消融是否彻底,后行CEUS检查,观察造影剂灌注情况,对CEUS显示肿瘤灭活不全的部位调整针道后进行补充治疗。对在我院超声科行微波消融治疗后的甲状腺结节患者12例(16个病灶),于术后1、3、6和12个月进行2DUS、CDFI和CEUS检查,观察结节大小、回声、血流信号和造影剂灌注变化,后于消融灶内、瘤周腺体组织、正常腺体组织内部各选择一个感兴趣区,采用ACQ软件对其进行时间-强度曲线分析。(1)微波消融术前CEUS结果显示：结节性甲状腺肿CEUS多呈等增强及低增强,少数为高增强；腺瘤CEUS多表现为“快进慢退”,呈高增强”；甲状腺癌多表现为不均匀等增强及低增强,且消退早于周边腺体实质。微波消融术前结节范围确定方面,甲状腺恶性结节最大直径CEUS测量值较二维超声测量值大。(2)微波消融结束前即刻2DUS结合CDFI显示91个结节回声均呈不同程度增强,血流信号减少或消失,两者结合检出7个结节(7/91：7.7%)有残留；CEUS显示91个结节均可见不同程度无增强区,而检出有残留结节15个(15/91,16.5%)(p0.05)。在界定消融后即刻结节大小研究中,本研究结果显示2DUS最大直径为2.67±3.16cm；CEUS最大直径为2.33±2.67cm。(p0.05)。(3)甲状腺结节微波消融治疗术后1、3、6及12个月CEUS随访病例数分别为3、2、4及3例。CEUS检查结节内可见不同程度的无增强区。随访观察16个甲状腺结节消融病灶,2DUS显示消融灶体积大小平均为1.07±2.38cm3,CEUS显示消融灶体积大小平均为1.00±2.22cm3(p0.05)。(1)CEUS可以实时、有效显示甲状腺结节血管和血流灌注情况,对微波消融术前甲状腺结节良恶性的鉴别诊断、囊实性判定及确定恶性结节范围大小方面均提供了更多的信息,对确保甲状腺结节微波消融疗效有重要应用价值。(2)CEUS能敏感的显示甲状腺结节内血流灌注情况,有助于甲状腺结节微波消融术后即刻发现残存病灶,准确确定消融范围,对超声引导下甲状腺结节微波消融治疗具有重要指导意义。(3)甲状腺结节微波消融术后病例应用CEUS检查进行随访观察,可较准确确定病灶毁损范围,有效发现残存结节并可判定甲状腺结节微波消融术后血流动力学方面的变化,对评价消融疗效具有重要意义。
[Abstract]:To investigate the diagnostic and differential diagnosis of thyroid nodules before microwave ablation by contrast-enhanced ultrasound (CEUs). Objective: to evaluate the value of CEUS in guiding the end of microwave ablation of thyroid nodules and its application in postoperative follow-up. From March 2012 to July 2013, 56 patients with thyroid nodules (71 lesions) underwent microwave ablation in our hospital from March 2012 to July 2013. 2DUSS and CDFI were performed before operation, and then contrast-enhanced ultrasonography (CEUSS) was performed. The focus was observed dynamically from contrast medium to extinction. The time-intensity curve was analyzed by ACQ software and the pathological diagnosis was obtained after operation. Sixty-six patients (91 lesions) with thyroid nodules treated by microwave ablation in our hospital were examined with 2DUS and CDFI immediately after microwave ablation to evaluate whether the ablation was complete or not, and then CEUS was performed to observe the perfusion of contrast media. After adjusting the needle path, the CEUS showed that the tumor was inactivated. Twelve patients (16 lesions) with thyroid nodules treated by microwave ablation in our hospital were examined with 2DUSU CDFI and CEUS at 1 and 12 months postoperatively. The size, echo, blood flow signal and perfusion of contrast media were observed. ACQ software was used to analyze the time-intensity curve. The results of CEUS before microwave ablation showed that the CEUS of nodular goiter showed equal enhancement and low enhancement. Most of adenoma CEUS showed "fast advance and slow regression" with high enhancement. Thyroid carcinoma showed uneven enhancement and low enhancement, and subsided earlier than peripheral glandular parenchyma. In the determination of the range of nodules before microwave ablation, the maximum diameter of thyroid nodules measured by CEUS was larger than that of two-dimensional ultrasound.) immediately before microwave ablation, 2DUS combined with CDFI showed that the echo of 91 nodules was enhanced in varying degrees. Blood flow signal decreased or disappeared, 7 / 91: 7 (7 / 91: 7) residual CEUs showed that 91 nodules showed different degrees of no enhancement, while 15 / 91 / 16. 5% of residual nodules were detected. In the study of defining the size of nodules immediately after ablation, The results showed that the maximum diameter of 2DUS was 2.67 卤3.16 cm, CEUS was 2.33 卤2.67 cm. Follow-up study showed that the mean volume size of ablation focus was 1.07 卤2.38 cm ~ (-3) CEUs was 1.00 卤2.22cm3(p0.05).(1)CEUS in 16 thyroid nodule ablation foci with 2DUS, and it could be used to display the blood vessel and blood flow perfusion of thyroid nodule in real time. More information was provided on the differential diagnosis of benign and malignant thyroid nodules before microwave ablation, the determination of cysts and solid, and the determination of the size of malignant nodules. It has important application value to ensure the curative effect of microwave ablation of thyroid nodule. It can sensitively display the blood flow perfusion in thyroid nodule, which is helpful to discover the residual focus immediately after microwave ablation of thyroid nodule, and to determine the ablation range accurately. It is important to guide the treatment of thyroid nodule by microwave ablation under the guidance of ultrasound. (3) CEUS examination can be used to follow up the patients after microwave ablation of thyroid nodules, which can accurately determine the extent of lesion lesion. The effective detection of residual nodules and the determination of hemodynamic changes after microwave ablation of thyroid nodules are of great significance in evaluating the efficacy of ablation.
【学位授予单位】：滨州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R581

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