双重超声造影对胃部疾病的诊断价值

发布时间：2018-06-11 13:16

本文选题：双重超声造影(DCUS) + 胃部疾病　；参考：《川北医学院》2017年硕士论文

【摘要】：目的:探讨胃双重超声造影(Double Contrast-enhanced Ultrasound DCUS)在胃良、恶性疾病诊断中的应用,以病理结果作为金标准,分析DCUS对胃良、恶性疾病的诊断价值,并总结不同类型胃部疾病的DCUS图像特征及与相关造影参数的意义。方法:回顾分析自2014年6月至2016年6月就诊于四川省人民医院怀疑有胃部疾病的门诊及住院患者150例,其中共103例行胃充盈检查及双重超声造影后纳入本研究,最终共计107个病灶进行分析研究。所有检查结果分为恶性、良性疾病两类,采用卡方检验比较US和DCUS对胃良、恶性疾病诊断准确性的差异,分别计算敏感度、特异度、准确率、阳性预测值(PPV)、阴性预测值(NPV)对两种检查方法的诊断效能进行比较;总结本研究涉及的四种不同病理类型病灶的造影特征,同时进行造影参数分析,病灶与周围正常组织间采用配对t检验,病灶间造影参数的差异采用单因素方差分析,探讨造影参数及造影增强特征在对鉴别不同类型胃部疾病中的价值。结果:本研究中所有进行DCUS检查的患者在检查过程中均未出现不良反应。经手术及切除病理活检证实,75例恶性病灶(33例胃癌,42例胃间质瘤),32例良性病灶(11例炎性病灶,21例胃息肉);DCUS与US在鉴别胃良、恶性病灶时,敏感度(90.6%vs.70.6%)、特异度(75%vs.62.5%)、阳性预测值(89.5%vs.81.5%)、阴性预测值(77.4%vs.47.6%)均高于US检查;DCUS诊断准确性85.9%,高于US准确性68.2%(P=0.01),差异有统计学意义;对造影参数进行分析的结果表明,胃癌与周围正常胃壁组织比较时具有更快的到达时间(AT),更高的峰值强度(PI),更大的曲线下面积(AUC),均P0.05,差异具有统计学意义;胃间质瘤与胃炎性病灶都较周围正常组织峰值强度高(P0.05);4种不同类型病灶造影参数分析结果表明,胃癌和GIST的到达时间均短于胃息肉(P0.05);在峰值强度方面,胃炎性病灶高于其它3类病灶,胃癌则高于胃间质瘤和胃息肉(P0.05);在曲线下面积的比较中,胃癌和炎性病灶均大于胃息肉和胃间质瘤(P0.05)。结论:1、超声胃充盈检查及双重超声造影均有助于鉴别胃良、恶性疾病;2、双重超声造影鉴别胃良、恶性疾病的敏感度和特异度明显高于超声胃充盈检查,提高了超声在胃部疾病诊断中的应用价值,值得临床推广应用;3、胃间质瘤造影后表现为特征性的“环状”高增强,肿瘤内部则表现各异,可与其它3种类型病灶进行鉴别,可减少不必要的穿刺活检。4、胃癌双重超声造影后,较周围正常胃壁组织为快速的高增强,具有到达时间短,峰值强度高,曲线下面积大的特点;胃炎性病灶造影后,病灶的增强强度(PI)高于周围正常胃壁组织,但与周围正常组织到达时间无异;造影增强特征结合造影参数分析有助于鉴别胃癌及GIST恶性胃部疾病。
[Abstract]:Objective: to investigate the application of double Contrast-enhanced Ultrasound (DCUSS) in the diagnosis of gastric benign and malignant diseases, and to analyze the value of DCUS in the diagnosis of gastric benign and malignant diseases. The features of DCUS images of different types of gastric diseases and the significance of the relevant imaging parameters were summarized. Methods: from June 2014 to June 2016, 150 outpatients and inpatients with suspected gastric diseases in Sichuan Provincial people's Hospital were retrospectively analyzed. 103 cases were included in this study after gastric filling examination and dual contrast-enhanced ultrasonography. A total of 107 lesions were analyzed and studied. All the examination results were divided into malignant and benign diseases. The diagnostic accuracy of US and DCUS in gastric benign and malignant diseases was compared by chi-square test. Sensitivity, specificity and accuracy were calculated respectively. The positive predictive value (PPVV) and the negative predictive value (NPV) were compared between the two methods, and the imaging features of four different pathological types of lesions were summarized, and the parameters of the two methods were analyzed. The paired t test was used between the lesions and the surrounding normal tissues. The difference of the contrast parameters among the lesions was analyzed by single factor variance analysis. The value of the contrast parameters and contrast-enhanced features in the differential diagnosis of different types of gastric diseases was discussed. Results: no adverse reactions were observed in all patients undergoing DCUS in this study. 75 cases of malignant lesions 33 cases of gastric carcinoma 42 cases of gastric stromal tumors 32 cases of benign lesions 11 cases of inflammatory lesions 21 cases of gastric polyps with DCUS and US in the differential diagnosis of benign and malignant gastric lesions. The sensitivity of 90.6V s.70.6, the specificity of 75vs.62.5, the positive predictive value of 89.5vs.81.5 and the negative predictive value of 77.4vs.47.6were higher than that of US examination and the diagnostic accuracy of DCUS was 85.9, and the accuracy of US was 68.2P0.01.The difference was statistically significant. Compared with the normal gastric wall tissue, gastric cancer had a faster time of arrival, a higher peak intensity and a larger area under the curve (P 0.05). The peak intensity of gastric stromal tumors and gastritis lesions were higher than that of the surrounding normal tissues. The results showed that the arrival time of gastric cancer and GIST was shorter than that of gastric polyps, and the peak intensity of gastric cancer and GIST was lower than that of normal tissues. Gastritis lesions were higher than other three types of lesions, gastric cancer was higher than gastric stromal tumors and gastric polyps (P0.05), and under the curve, gastric cancer and inflammatory lesions were both larger than gastric polyps and gastric stromal tumors (P0.05). Conclusion: the sensitivity and specificity of ultrasound filling examination and dual contrast-enhanced ultrasonography are significantly higher than that of ultrasonography in differentiating gastric benign and malignant diseases from gastric benign and malignant diseases (P < 0. 05), and the sensitivity and specificity of dual contrast-enhanced ultrasonography in differentiating gastric benign and malignant diseases are significantly higher than that of ultrasonography. The value of ultrasound in the diagnosis of gastric diseases is improved, and it is worth popularizing in clinical application. Gastric stromal tumors are characterized by "annular" high enhancement after contrast examination, and the internal manifestations of the tumors are different, which can be distinguished from other three types of lesions. It can reduce unnecessary puncture biopsy. 4. After double contrast-enhanced gastric cancer, compared with the surrounding normal gastric wall tissue, it has the characteristics of short arrival time, high peak intensity and large area under the curve. The enhancement intensity of the lesion was higher than that of the surrounding normal gastric wall tissue, but the arrival time of the lesion was the same as that of the surrounding normal tissue, and the enhancement features of the lesion combined with the analysis of the parameters were helpful in differentiating the gastric cancer from the GIST malignant gastric disease.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R573

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