经阴道三维能量多普勒超声与超声弹性成像技术对宫颈癌的诊断价值

发布时间：2018-05-04 04:31

  本文选题：宫颈癌 + 经阴道三维能量多普勒　； 参考：《中南大学》2014年硕士论文

【摘要】：目的：探讨三维能量多普勒超声及超声弹性成像技术对宫颈癌的诊断价值,并比较两种方法的优越性。 资料与方法：研究对象包括宫颈癌患者组(共40个病灶),CIN患者组(共25个病灶)和正常对照组(20例健康志愿者)。患者术前用GE公司的logic E9超声诊断仪,具备三维能量多普勒技术及超声弹性成像技术,选择阴道探头,检查时嘱患者排空膀胱取截石位,将探头缓慢置于阴道后穹窿部,进行横向、纵向等多方位、多角度扫查,先于二维超声模式下观察宫颈形态、大小、内部回声以及有无占位病变,宫颈粘膜层及部分阴道情况等.同时观察子宫颈旁情况,宫颈肿块内部及周边血流动力学特征,以及血管分布情况。然后切换至弹性成像模式对宫颈行实时弹性成像检查,健康体检女性则对整个宫颈进行弹性成像检查。 参照Thomas提出的5级评分法对宫颈癌患者、CIN患者及正常对照组女性的宫颈弹性成像图像进行分析,获得图像弹性评分值。再切换到三维能量多普勒程序,通过VOCAL系统用计算机程序法自动得到三维直方图,从而获得肿瘤血流参数VI、FI、VFI,健康体检女性则测量整个宫颈的血流参数VI、FI、VFI。探讨宫颈癌患者、CIN组、正常对照组之间的弹性图像评分是否有差异,统计分析宫颈癌患者组、CIN组、正常对照组之间三维能量多普勒血流参数VI、FI、VFI是否有差异,有差异时通过ROC曲线获得截断点。最后探讨比较经阴道常规二维超声、三维能量多普勒超声与超声弹性成像技术对宫颈癌的诊断的准确度、敏感度、特异度,比较其诊断价值。 结果： (1)宫颈癌组的三维能量多普勒血流参数VI、FI、VFI高于正常对照组及CIN组,差异有统计学意义(P0.05) (2)宫颈癌组超声弹性成像评分高于正常对照组与CIN组,差异有统计学意义(P0.05)； (3)CIN组三维能量多普勒血流参数VI、FI、VFI与正常对照组间的差异无统计学意义(P0.05)；CIN组的弹性评分明显高于正常对照组,差异有统计学意义(P0.05) (4)准确度由高到低的顺序为：弹性成像三维能量多普勒常规二维超声。两两比较,弹性成像与常规二维超声、三维能量多普勒与常规二维超声之间准确度差异有统计学意义(P0.05),三维能量多普勒与弹性成像之间差异无统计学意义(P0.05)。 敏感度由高到低的顺序三维能量多普勒弹性成像常规二维超声。两两比较,弹性成像与常规二维超声、三维能量多普勒与常规二维超声之间敏感度差异有统计学意义(P0.05),弹性成像与三维能量多普勒之间差异无统计学意义(P0.05)。 特异度由高到低的顺序为弹性成像三维能量多普勒常规二维超声。两两比较,弹性成像与常规二维超声、三维能量多普勒与常规二维超声之间特异度差异有统计学意义(P0.05),弹性成像与三维能量多普勒之间差异无统计学意义(P0.05) 结论： 1、经阴道超声弹性成像通过提供组织的软硬度信息,推断宫颈病变良恶性,弹性评分在正常组、CIN组及宫颈癌组间均存在差异,对宫颈癌的诊断有良好的应用价值。 2、经阴道三维能量多普勒技术可提供宫颈肿块内的血流情况,了解局部血供特点及血管生成状况,三维能量多普勒血流参数VI、FI、VFI在正常组与CIN组间无统计学意义差异,在宫颈癌组与CIN及正常组间差异有统计学意义,为宫颈癌的诊断提供重要信息。 3、经阴道超声弹性成像及三维能量多普勒超声联合二维超声可在一定程度上提高对宫颈癌的检出率,是对常规经阴道二维超声的良好补充。 4、超声的弹性成像技术与三维能量多普勒相比,对宫颈癌的诊断准确性、灵敏性、特异性差异无统计学意义。
[Abstract]:Objective: To explore the diagnostic value of three-dimensional power Doppler ultrasound and ultrasound elastography in cervical cancer, and compare the advantages of the two methods.
Data and methods: the subjects included the cervical cancer patients group (40 lesions), CIN patients group (25 lesions) and normal control group (20 healthy volunteers). The patients were used the logic E9 ultrasonic diagnostic instrument of GE company before operation, with three-dimensional energy Doppler technique and ultrasound elastography, the vaginal probe was selected, and the patient's emptying bladder was asked to check. Taking the cystotomy position, the probe was slowly placed in the posterior fornix of the vagina, transversely, longitudinally and multi azimuthal and multi angle scanning. The cervical morphology, size, internal echoes, cervical mucosa and some vagina conditions were observed in the two-dimensional ultrasound mode. The conditions of the cervix and the internal and peripheral blood flow of the cervix were observed at the same time. The dynamic characteristics, and the distribution of blood vessels. Then switch to the elastic imaging mode for real-time elastic imaging of the cervix, and the women in the health examination have an elastic imaging examination of the whole cervix.
According to the 5 grade scoring method proposed by Thomas, the cervical elastography images of cervical cancer patients, CIN patients and normal control groups were analyzed, and the value of image elasticity score was obtained. Then the three-dimensional energy Doppler program was switched to the three-dimensional energy Doppler program, and the three dimensional histogram was automatically obtained by the computer program method of the VOCAL system, and the tumor blood flow parameters VI, FI, VFI were obtained. Women in health examination measured the blood flow parameters of the whole cervix VI, FI, and VFI. to explore the difference between the elastic image scores between the patients with cervical cancer, the CIN group and the normal control group. The statistical analysis of the three dimensional energy Doppler blood flow parameters of the cervical cancer group, the CIN group and the normal control group was VI, FI, VFI, and the difference was obtained by the ROC curve when there was a difference. Finally, the accuracy, sensitivity, specificity and diagnostic value of conventional two-dimensional ultrasound, three-dimensional energy Doppler ultrasound and ultrasound elastography in the diagnosis of cervical cancer were compared.
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