声脉冲辐射力弹性成像技术对甲状腺实性结节的诊断价值

发布时间：2018-06-08 04:37

本文选题：甲状腺癌 + 甲状腺结节　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的 1、探讨常规超声对甲状腺实性结节的诊断价值。 2、应用声脉冲辐射力弹性成像(ARFI)技术评估甲状腺结节硬度,探讨其在甲状腺实性结节良恶性定性方面的价值。 3、探讨常规超声与ARFI技术联合应用对甲状腺实性结节的诊断价值。资料与方法选取2012年12月～2013年6月在我院因甲状腺结节而住院的患者106例,共121个结节,所有结节均经手术病理学证实。应用Siemens S2000彩色多普勒超声诊断仪,内置声脉冲辐射力弹性成像技术及软件,使用9L4多功能探头,探头频率为7-12MHz。患者仰卧位,后仰头部,充分暴露颈部,平静呼吸。首先行甲状腺常规超声扫查,记录甲状腺结节的位置、大小、形态、边缘、纵横比、内部回声、周边有无声晕、内部钙化特点及血流情况等。然后切换为声触诊组织成像(Virtual touch tissue imaging, VTI)模式,纵向扫查获得结节最大切面,嘱患者屏住呼吸,对甲状腺结节行VTI弹性成像检查,观察结节弹性分布情况。之后对结节及结节周边等深度正常甲状腺组织行声触诊组织定量(Virtual touch tissue quantification,VTQ)检查,读取并记录感兴趣区组织及周边相同深度正常组织剪切波速度值(Shear wave velocity, S WV)和取样深度值,重复以上操作6次,剔除最大值、最小值,余4值取平均值进行统计。本研究由2名超声医师进行检查并独立做出评估与诊断,取得一致意见,意见不同时经协商达成一致。数据统计采用SPSS13.0统计软件分析,计量资料以x±s表示,采用卡方检验比较良恶性甲状腺结节常规超声声像图特征差异。采用t检验比较甲状腺良恶性结节SWV值差异,以P0.05表示差异具有统计学意义。绘制ROC曲线,寻找VTI弹性分级、剪切波速度鉴别甲状腺结节良恶性的最佳界点。以病理结果为金标准,计算常规超声、VTI技术、VTQ技术、常规超声+VTI技术、常规超声+VTQ技术诊断甲状腺实性结节的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果在121个甲状腺结节中,良性结节55个,恶性结节66个。 1、常规超声诊断甲状腺良恶性结节的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为74.2%、80%、81.6%、72.1%、76.8%。 2、以VTI弹性分级≥IV级作为诊断甲状腺恶性结节的诊断界点,VTI诊断的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为89.3%、92.7%、93.6%、87.9%、90.9%。 3、甲状腺良性结节的SWV平均值为(2.61±1.15)m/s,甲状腺恶性结节SWV平均值为(3.96±1.31)m/s,两者比较具有显著性差异(P0.05)。通过绘制ROC曲线得出SWV最佳诊断临界点为2.85m/s,曲线下面积为0.92,对应敏感性、特异性、阳性预测值、阴性预测值、准确性分别为84.8%、83.6%、86.1%、82.1%、84.2%。 4、常规超声结合VTI技术对甲状腺良恶性结节鉴别诊断的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为90.9%、92.7%、93.7%、89.4%、91.7%。 5、常规超声结合VTQ技术对甲状腺良恶性结节鉴别诊断的敏感性、特异性、阳性预测值、阴性预测值、准确性分别为87.8%、85.4%、87.8%、85.4%、86.7%。 6、五种方法诊断甲状腺实性结节的敏感性、特异性、准确性两两比较,常规超声结合VTI技术诊断甲状腺结节良恶性的敏感性、特异性最高,且差异具有统计学意义,两者联合应用对甲状腺实性结节性质的诊断具有重要价值。结论 1、VTI可以直观的反映甲状腺结节的整体弹性特征,以VTI弹性分级1V级作为鉴别甲状腺良恶性的界点,具有较高的敏感性、特异性及准确性。 2、甲状腺良恶性结节SWV值差异具有统计学意义,恶性结节的SWV值明显高于良性结节。以SWV值=2.85m/s作为最佳诊断界点,可提高甲状腺良恶性结节诊断的准确性。 3、VTI技术与常规超声联合应用敏感性、特异性最高,两种方法联合应用有利于甲状腺实性结节良恶性的鉴别诊断。
[Abstract]:objective
1, to investigate the diagnostic value of conventional ultrasound for solid thyroid nodules.
2, we assessed the hardness of thyroid nodules by acoustic impulse radiation force elastography (ARFI), and explored its value in qualitative and malignant aspects of solid thyroid nodules.
3, to explore the diagnostic value of combined conventional ultrasound and ARFI for solid thyroid nodules.
From December 2012 to June 2013, 106 patients with thyroid nodules were hospitalized in our hospital. There were 121 nodules. All the nodules were confirmed by surgery and pathology.
Using Siemens S2000 color Doppler ultrasound diagnostic instrument, built in acoustic pulse radiation force elastic imaging technology and software, using 9L4 multi-function probe, the probe frequency is 7-12MHz.
The patients were lying on the back and back in the head to fully expose the neck and calm the breath. First, the thyroid nodules were recorded by routine ultrasound scan to record the position of thyroid nodules, size, shape, edge, longitudinal and transverse ratio, internal echoes, the peripheral corona, internal calcification and blood flow, and then switched to Virtual touch tissue imaging, VTI The model, longitudinal scan obtained the maximum section of nodules, asked the patients to hold their breath, the thyroid nodules were examined by VTI elastic imaging, and the elastic distribution of nodules was observed. Then the acoustic palpation tissue quantitative (Virtual touch tissue quantification, VTQ) examination of nodules and peripheral nodules and other deep normal thyroid tissues was examined and read and recorded. The value of shear wave velocity (Shear wave velocity, S WV) and sampling depth of the same deep normal tissue in the region and around the region were repeated 6 times, and the maximum value, minimum value, and the remaining 4 values were eliminated. This study was checked by 2 ultrasonic physicians and made the evaluation and diagnosis independently, and the agreement was not agreed at the same time. The opinions were not cooperated at the same time. The business reached agreement.
The data statistics were analyzed by SPSS13.0 statistical software. The measurement data were expressed in X + s, and the difference between the benign and malignant thyroid nodules was compared by the chi square test. The difference of SWV value between the benign and malignant thyroid nodules was compared with the t test, and the difference was statistically significant by P0.05. The ROC curve was drawn to find the elastic classification of VTI and the shear wave. Velocity identification of the best boundary of benign and malignant thyroid nodules. Using the pathological results as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional ultrasound, VTI, VTQ, conventional +VTI, and conventional ultrasound +VTQ were used to diagnose the thyroid nodules.
Result
Of the 121 thyroid nodules, 55 were benign nodules and 66 were malignant nodules.
1, the sensitivity, specificity, positive predictive value and negative predictive value of conventional ultrasound in diagnosing benign and malignant thyroid nodules were 74.2%, 80%, 81.6%, 72.1%, 76.8%. respectively.
2, the diagnostic boundary of thyroid malignant nodules was diagnosed by VTI elastic classification or IV grade. The sensitivity, specificity, positive predictive value and negative predictive value of VTI diagnosis were 89.3%, 92.7%, 93.6%, 87.9%, 90.9%., respectively.
3, the average value of SWV of thyroid benign nodules was (2.61 + 1.15) m/s, and the average value of SWV of thyroid malignant nodules was (3.96 + 1.31) m/s, and there was a significant difference between them (P0.05). By plotting the ROC curve, the optimal critical point of SWV diagnosis was 2.85m/s, the area under the curve was 0.92, corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The sex was 84.8%, 83.6%, 86.1%, 82.1%, 84.2%., respectively.
4, the sensitivity, specificity, positive predictive value and negative predictive value of conventional ultrasound combined with VTI technique in the differential diagnosis of thyroid benign and malignant nodules were 90.9%, 92.7%, 93.7%, 89.4%, 91.7%., respectively.
5, the sensitivity, specificity, positive predictive value and negative predictive value of conventional ultrasound combined with VTQ technique in the differential diagnosis of thyroid benign and malignant nodules were 87.8%, 85.4%, 87.8%, 85.4%, 86.7%., respectively.
6, the sensitivity, specificity and accuracy of the diagnosis of thyroid nodules by five methods are compared. The sensitivity of conventional ultrasound combined with VTI technique in the diagnosis of benign and malignant thyroid nodules is of the highest specificity, and the difference is statistically significant. The combination of the two methods is of great value for the diagnosis of the properties of thyroid nodules.
conclusion
1, VTI can directly reflect the overall elastic characteristics of thyroid nodules, and the VTI elastic classification of 1V level as a boundary point for the identification of thyroid benign and malignant, with high sensitivity, specificity and accuracy.
2, the difference of SWV value of thyroid benign and malignant nodules is statistically significant, and the SWV value of malignant nodules is significantly higher than that of benign nodules. The SWV value =2.85m/s is the best diagnostic point, which can improve the accuracy of the diagnosis of thyroid benign and malignant nodules.
3, the sensitivity and specificity of the combination of VTI and conventional ultrasound are the highest. The combination of the two methods is beneficial to the differential diagnosis of benign and malignant thyroid nodules.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R736.1;R445.1

【参考文献】