直肠腔内超声弹性成像在直肠病变术前诊断中的应用研究

发布时间：2018-04-30 18:08

本文选题：直肠腺瘤 + 直肠腺癌　；参考：《北京协和医学院》2014年博士论文

【摘要】：目的 1.评估应变比值(Strain Ratio, SR)测量的可重复性。 2.对照病理结果,评价直肠腔内弹性成像——弹性分级法(Elasticity Score,ES)及应变比值法(SR)对直肠腺瘤恶变的诊断价值,并与结肠镜活检、常规ERUS进行比较。 3.探讨直肠腔内弹性成像诊断准确性的影响因素。方法 2011年1月至2013年5月,对我院门诊60例临床诊断直肠腺瘤患者进行常规ERUS、直肠腔内弹性成像检查和结肠镜活检。应用单向随机效应模型计算组内相关系数(Intraclass correlation coefficient, ICC),评估应变比值多次测量的重复性。对照手术病理结果,评估弹性分级法、应变比值法的诊断价值,同时与常规ERUS、结肠镜活检相比较。结果在60例直肠腺瘤中,直肠腺瘤恶变即直肠腺癌40例,良性腺瘤20例。弹性分级法诊断腺瘤恶变的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为85.0%,70.0%,80.0%,85%,70%。应变比值测量中,三次测量的重复性好(ICC：0.93～0.95)。直肠腺癌应变比值的平均值2.82±1.81(0.76-10.77),良性腺瘤应变比值的平均值1.23±0.57(0.62-2.65),二者的应变比值有显著统计学差异(p0.05)。应变比值法诊断的ROC曲线下面积AUC为0.850。以应变比值1.240为最佳诊断临界点,弹性成像应变比值法判断直肠腺瘤恶变的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为82.5%,75.0%,80.0%,86.8%,68.1%。常规ERUS和结肠镜活检对直肠腺瘤恶变的诊断准确性分别为58.3%和63.3%。直肠腔内弹性成像的诊断准确性明显高于前两者(p0.05),应用弹性成像可将术前结肠镜活检的漏诊率由55%下降至15%。直肠腔内弹性成像对不同大小、位置、基底情况的直肠腺瘤诊断准确性无显著统计学差异p0.05)。结论 1.直肠腔内弹性成像通过弹性分级法(ES)及应变比值法(SR)均可以较准确地诊断直肠腺瘤恶变,为临床手术方式选择提供可靠的术前影像学依据。 2.直肠腔内弹性成像判断直肠腺瘤恶变的诊断价值明显优于结肠镜活检和常规ERUS,应用该方法可降低术前结肠镜活检的漏诊率。 3.应变比值(SR)测量重复性好,多次测量可以提供可靠的应变比值。 4.直肠腔内弹性成像的诊断准确性受病灶大小、位置、基底情况等因素影响少。目的 1.评估直肠腔内超声弹性成像应变比值(Strain Ratio,SR)判断直肠癌新辅助治疗后疗效的临床应用价值 2.探讨直肠癌新辅助治疗后SR改变的病理学机制方法 2011年1月至2013年12月,对我院收治的进展期直肠癌患者31例,在新辅助放化疗前后,分别行常规ERUS和直肠腔内弹性成像检查。将放化疗前后病灶SR差异,SR差值与病理改变相比较。比较常规ERUS、弹性成像判断降期的准确性。应用角蛋白AEl/AE3,对放化疗后pTl-3期肿瘤残留病灶行免疫组化染色,分析病灶的SR与AE1/AE3标记的残留肿瘤面积的相关性。结果放化疗后,29例(93.5%)直肠癌病灶SR值明显下降(p0.05),另有2例(6.5%)SR值升高。pT0-2期的SR平均值为2.06±0.86,pT3期的SR平均值为3.23±0.91,两者具有显著性(p0.05)。以SR降幅≥34.90%判断放化疗后T分期降期的准确性为69%,高于常规ERUS的准确性(45.1%),但两者差异不具有显著性(p0.05)。结合SR降幅测定结果,常规ERUS准确诊断降期由7例升高至14例,较好地提高了降期的诊断准确性。残留病灶的SR平均值为2.33±1.03(0.35～5.05),AE1/AE3标记的病灶面积平均值为43.2±51.6mm2(0.12～193.17),两者之间呈直线正相关(p0.05)。结论 1.弹性成像显示放化疗后直肠癌病灶SR值明显下降,且不同pT期病灶SR具有差异,一定程度上反映了放化疗后病灶内部病理结构变化。 2.应用SR降幅可较好地判断直肠癌临床降期,优于常规ERUS。 3. SR降幅可作为常规ERUS的辅助方法,增加了放化疗后病灶内部生物力学变化信息,提高直肠癌放化疗后降期及肿瘤浸润深度诊断准确性,为直肠癌新辅助放化疗疗效及预后评估提供了一种新型的较为可靠、无创、简便的影像学方法。
[Abstract]:objective
1. evaluate repeatability of Strain Ratio (SR) measurements.
2. the value of Elasticity Score (ES) and strain ratio method (SR) in the diagnosis of rectal adenoma malignancy was evaluated by the pathological results of the rectum, and compared with the colonoscopy and routine ERUS.
3. to explore the influencing factors of diagnostic accuracy of rectal elastography.
Method
From January 2011 to May 2013, 60 patients with rectal adenoma in our hospital were treated with routine ERUS, rectal elastography and colonoscopy. The correlation coefficient (Intraclass correlation coefficient, ICC) was calculated by the one-way random effect model, and the repeatability of the repeated measurements of the strain ratio was evaluated. Results the diagnostic value of elastic grading method and strain ratio method was evaluated and compared with conventional ERUS and colonoscopy.
Result
Among 60 rectal adenomas, rectal adenomas were malignant changes in 40 cases of rectal adenocarcinoma and 20 of benign adenomas. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive values of the diagnosis of adenoma malignancy were 85%, 70%, 80%, 85%, 70%., respectively.
In the strain ratio measurement, the repeatability of the three measurements was good (ICC:0.93 to 0.95). The average value of the strain ratio of the rectal adenocarcinoma was 2.82 + 1.81 (0.76-10.77), the average value of the strain ratio of the benign adenoma was 1.23 + 0.57 (0.62-2.65), the strain ratio of the two was statistically significant (P0.05). The area under the ROC curve diagnosed by the strain ratio method was 0.850.. The ratio of variable ratio 1.240 was the best critical point. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the elastography strain ratio method were 82.5%, 75%, 80%, 86.8%, 68.1%., respectively, to determine the malignant change of rectal adenoma.
The accuracy of the diagnosis of rectal adenoma malignancy by conventional ERUS and colonoscopy is 58.3% and 63.3%. in the rectal cavity, respectively. The accuracy of the diagnosis is significantly higher than that of the previous two (P0.05). The use of elastography can reduce the missed diagnosis rate from 55% to 15%. by the preoperative colonoscopy.
There was no significant difference in the diagnostic accuracy of rectal elastography for rectal adenoma of different size, location and basal condition. P0.05).
conclusion
1. the elastic imaging of the rectum can be used to diagnose the malignant change of rectal adenoma accurately by the elastic classification (ES) and the strain ratio method (SR). It provides a reliable preoperative imaging basis for the selection of surgical methods.
2. the diagnostic value of rectal elastography to determine rectal adenoma malignancy is better than that of colonoscopy and routine ERUS. The application of this method can reduce the missed diagnosis rate of preoperative colonoscopy.
3. strain ratio (SR) measurements are repeatable, and multiple measurements can provide reliable strain ratios.
4. the diagnostic accuracy of elastography in the rectum is less affected by the size of the lesion, location, and basal condition.
objective
1. evaluate the clinical value of Strain Ratio (SR) in evaluating the efficacy of neoadjuvant therapy for rectal cancer.
2. to explore the pathological mechanism of SR changes after neoadjuvant therapy for rectal cancer.
Method
From January 2011 to December 2013, 31 patients with advanced rectal cancer treated in our hospital were treated with conventional ERUS and rectal elastography before and after neoadjuvant radiotherapy. The difference of the lesion SR before and after radiotherapy, the difference between the SR and the pathological changes, was compared with the pathological changes. Comparison of the conventional ERUS, the accuracy of the elastography, and the application of keratin AEl/AE3, Immunohistochemical staining was performed on residual tumor in pTl-3 phase after radiotherapy and chemotherapy, and the correlation between SR and AE1/AE3 residual tumor area was analyzed.
Result
After radiotherapy and chemotherapy, the SR value of 29 cases (93.5%) of rectal cancer was significantly decreased (P0.05), and 2 cases (6.5%) SR value increased.PT0-2 SR average value of 2.06 + 0.86, pT3 phase SR average value was 3.23 + 0.91, both were significant (P0.05). The accuracy of T stage descending after radiotherapy and chemotherapy was 69%, higher than the accuracy of conventional ERUS (45.1%). However, the difference was not significant (P0.05). Combined with the results of SR reduction, the accurate diagnosis of ERUS was raised from 7 to 14, which improved the accuracy of the diagnosis. The average SR of the residual focus was 2.33 + 1.03 (0.35 ~ 5.05), and the average value of the focus surface product of the AE1/AE3 marker was 43.2 + 51.6mm2 (0.12 to 193.17). Linear positive correlation (P0.05).
conclusion
1. elastography showed that the SR value of the lesion of rectal cancer was significantly decreased after radiotherapy and chemotherapy, and the difference of SR in different pT phases was shown to some extent, and to some extent, the pathological changes of the internal pathological structure of the lesion after radiotherapy and chemotherapy were reflected.
2. the application of SR decreased the clinical decline of rectal cancer better than conventional ERUS..
The 3. SR drop can be used as an auxiliary method of conventional ERUS, increasing the information on the internal biomechanical changes of the lesion after radiotherapy and chemotherapy, improving the accuracy of the diagnosis of rectal cancer after radiotherapy and chemotherapy and the depth of tumor infiltration. It provides a new and more reliable, noninvasive and simple imaging method for the evaluation of the curative effect and prognosis of neoadjuvant radiotherapy and chemotherapy for rectal cancer.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R445.1;R735.37

【参考文献】