联合常规超声及超声造影在甲状腺微小乳头状癌中的诊断价值

发布时间：2018-06-18 03:47

本文选题：超声造影 + 甲状腺微小乳头状癌　；参考：《遵义医学院》2014年硕士论文

【摘要】：目的：分析常规超声、超声造影以及联合常规超声和超声造影三种方法，，对鉴别甲状腺微小良恶性病变的诊断价值。评价超声造影的定性诊断及定量诊断两种方法在甲状腺微小良恶性病变诊断中的作用。方法：102例甲状腺结节纳入标准：①甲状腺内孤立性低弱回声结节，②甲状腺背景为实质回声均匀的正常甲状腺组织，③结节最大直径≤10mm，④TI-RADS分类为3类和4类；排除标准：①结节直径＞10mm的低弱回声结节，②高回声或等回声结节，③伴有多发结节，④结节内粗大钙化致使不能显示结节实性成份的结节，⑤FNA诊断分型中取材不满意不能诊断的结节。仪器采用意大利百胜公司的Mylab90超声诊断仪。造影剂选用意大利Bracco公司生产的声诺维（SonoVue），经肘正中静脉团注造影剂1.0ml。采用目测法观察甲状腺内微小结节的增强特点，并应用Qontrast4.0分析软件进行时间-强度曲线（TIC）定量参数分析，并与手术病理为金标准进行对照。超声造影操作人员要求由三个固定的具有造影经验3年以上的医师操作，以达到标准统一。统计学数据应用Binary Logistic回归分析以及诊断性试验方法中ROC曲线，得出ROC曲线下面积，进行比较分析。结果：1、单因素分析，患者一般情况中甲状腺微小乳头状癌患者的平均年龄（40.69±10.67）岁低于良性组患者的平均年龄（49.52±13.21）岁、恶性组患病年龄多在30-50岁之间，年龄在良恶性组间差异性比较中有统计学意义（P㩳0.05），性别在良恶性组间比较中无统计学意义（P＞0.05）；常规超声检查中，甲状腺微小乳头状癌的结节多显示为不规则形态、边界不清晰、纵横比（A/T）≥1、结节内微钙化以及颈部查见可疑异常肿大淋巴结在良恶性组间差异性比较中有统计学意义（P㩳0.05）；超声造影定性指标中，甲状腺微小乳头状癌的超声造影特征多表现为慢进、向心性增强、不均匀性增强、达峰时呈等增强或低增强、增强后结节径线改变、边界不清晰、结节周边无环状增强，以上指标中除不均匀性增强外良恶性组间差异性比较有统计学意义（P㩳0.05）；超声造影时间-强度曲线（TIC）定量参数中，峰值强度（PEAK）、局部血流量（RBF）、最大灌注强度（SImax）、平均灌注强度（SImean）、相对峰值强度、相对峰值时间、相对局部血流量、相对局部血容量、相对平均灌注强度、相对最大灌注强度在良恶性组间差异性比较中有统计学意义（P㩳0.05）； 2、多因素分析，常规超声及患者一般情况多因素分析中：①纵横比A/T，②形态是否规则，③结节内微钙化，④颈部有无可疑异常淋巴结进入Logistic多因素回归方程，预测甲状腺微小乳头状癌的准确性、敏感性及特异性分别为82.4%、80.0%、84.6%；超声造影定性指标多因素分析中：①造影增强时间，②有无环状增强进入多因素回归方程，运用Logistic回归方程预测甲状腺微小乳头状癌的准确性、敏感性及特异性分别为87.3%、86.0%、88.5%；超声造影定量指标中仅有相对最大灌注强度（相对SImax）一项参数进入Logistic回归方程，其预测甲状腺微小乳头状癌的准确性、敏感性及特异性分别为66.7%、60.0%、73.1%；联合常规超声以及超声造影定性定量的多因素分析中：①纵横比A/T，②微钙化，③颈部有无可疑异常淋巴结，④造影灌注方式，⑤有无环状增强及⑥SImax进入Logistic回归方程，其预测甲状腺微小乳头状癌的准确性、敏感性及特异性分别为93.1%、92.0%、94.2%。 3.ROC曲线分析，常规超声诊断方法、超声造影定性诊断和定量诊断方法以及联合常规超声和超声造影定性定量诊断方法产生的ROC曲线下面积分别为90.0%、90.7%、99.0%。由此可见，联合应用常规超声和超声造影定性定量两种诊断方法，其诊断能力明显优于单独应用前两者；分别由超声造影的定性诊断方法和定量诊断方法获得的ROC曲线，其曲线下面积分别为90.7%、69.7%。由此可见，超声造影的定性诊断能力明显优于超声造影定量诊断方法的诊断能力。结论：对甲状腺微小乳头状癌的诊断能力而言，超声造影定性诊断方法的准确性、敏感性和特异性均高于超声造影的定量诊断方法。联合应用常规超声以及超声造影定性及定量各项指标和参数对甲状腺微小良恶性结节的鉴别诊断能力明显优于单独运用前两者，值得在临床上推广应用。
[Abstract]:Objective: to analyze the diagnostic value of three methods of conventional ultrasound, ultrasound contrast and conventional ultrasound and ultrasound contrast in the differential diagnosis of benign and malignant thyroid lesions. To evaluate the role of two methods of qualitative diagnosis and quantitative diagnosis of contrast ultrasound in the diagnosis of thyroid microbenign and malignant lesions.
Methods: 102 cases of thyroid nodules were included: (1) isolated hypoechoic nodules in the thyroid gland, (2) thyroid background as parenchyma and homogeneous normal thyroid tissue, (3) the maximum diameter of the nodules were less than 10mm, and (4) TI-RADS classified as 3 and 4 categories; the exclusion criteria: (1) the low and weak echo nodules with the diameter of the nodule > 10mm, and the hyperechoic or equal echo Nodules, (3) with multiple nodules, (4) nodular calcification that can not show nodular solid components, (5) FNA diagnostic typing that is dissatisfied with undiagnosed nodules. The instrument adopts the Mylab90 ultrasonic diagnostic instrument of Italy Baisheng company. The contrast agent is selected from the SonoVue of the Bracco male division in Italy and the median vein of the elbow. The contrast agent 1.0ml. was observed by visual method to observe the enhancement of small nodules in the thyroid gland. The quantitative parameters of time intensity curve (TIC) were analyzed with Qontrast4.0 analysis software and compared with the gold standard of surgical pathology. The operators of ultrasound contrast operators were required to be operated by three fixed doctors with more than 3 years of angiography. In order to achieve standard unification, statistical data is used in the Binary Logistic regression analysis and the diagnostic test method of ROC curve to obtain the area under the ROC curve, and to make a comparative analysis.
Results: 1, single factor analysis, the average age of the patients with thyroid small papillary carcinoma (40.69 + 10.67) was lower than that of the benign group (49.52 + 13.21). The age of the malignant group was 30-50 years old, and the age was statistically significant between the benign and malignant groups (P? 0.05), and the sex was in the benign and malignant group. There was no statistical significance in the comparison (P > 0.05); in the routine ultrasound examination, the nodules of the thyroid micropapillary carcinoma showed irregular shape, the boundary was not clear, the longitudinal and transverse ratio (A/T) was more than 1, the microcalcification in the nodules and the suspicious abnormal lymph nodes in the neck were statistically significant (P? 0.05) in the benign and malignant groups; The contrast-enhanced ultrasound features of thyroid micropapillary carcinoma were characterized by slow progress, centripetal enhancement, inhomogeneity enhancement, enhanced or low enhancement in the peak, enhanced posterior nodular diameter, unclear boundary, non circular enhancement in the periphery of nodules, and the differences among the above groups in addition to non uniformity and non uniformity. Statistical significance (P? 0.05); in the quantitative parameters of the time intensity curve (TIC), the peak intensity (PEAK), the local blood flow (RBF), the maximum perfusion intensity (SImax), the average perfusion intensity (SImean), the relative peak intensity, the relative peak time, relative local blood flow, relative local blood volume, relative mean perfusion intensity, relative maximum perfusion intensity, and relative maximum perfusion were observed. There was a significant difference in the intensity between the benign and malignant groups (P? 0.05).
2, multifactor analysis, conventional ultrasound and patient general analysis of multifactor analysis: (1) the accuracy of the thyroid micropapillary carcinoma is 82.4%, 80%, and 84.6%, respectively, whether the longitudinal and transverse A/T, the second shape is regular, the third is the microcalcification in the nodules, and the suspicious abnormal lymph nodes in the neck are entered into the multiple regression equation of the multiple factors of the thyroid papillary carcinoma. The multiple factor analysis of ultrasound contrast qualitative indexes: (1) contrast enhancement time, or ring enhancement into multiple regression equation, using Logistic regression equation to predict the accuracy of thyroid small papillary carcinoma, the sensitivity and specificity were 87.3%, 86%, 88.5%, respectively, and only the relative maximum perfusion intensity in the hyper contrast quantitative index. Relative SImax) a parameter entered the Logistic regression equation, and its accuracy was 66.7%, 60%, and 73.1% for the prediction of thyroid small papillary carcinoma, respectively, and the qualitative and quantitative analysis of combined conventional ultrasound and ultrasound contrast: (1) the longitudinal and transverse ratio A/T, the second microcalcification, and the neck without suspicious abnormal lymph nodes; (4) angiography The accuracy of the thyroid micropapillary carcinoma was predicted with 93.1%, 92%, 94.2%., respectively, with no annular enhancement and 6 SImax into the Logistic regression equation.
3.ROC curve analysis, conventional ultrasonic diagnosis, qualitative diagnosis and quantitative diagnosis of contrast-enhanced ultrasound and qualitative and quantitative diagnosis of combined conventional ultrasound and ultrasound contrast ROC curves are 90%, 90.7%, 99.0%., respectively. The combined use of conventional ultrasound and ultrasound contrast qualitative and quantitative diagnosis of two methods, the diagnosis The ability of the ROC curve obtained by qualitative diagnosis and quantitative diagnosis of ultrasound contrast, respectively, is 90.7% and 69.7%., respectively. The qualitative diagnosis ability of ultrasound contrast is better than that of the quantitative diagnostic method of ultrasound contrast.
Conclusion: for the diagnosis of thyroid small papillary carcinoma, the accuracy, sensitivity and specificity of the qualitative diagnosis are higher than the quantitative diagnostic methods of contrast-enhanced ultrasound. The differential diagnosis of thyroid small benign and malignant nodules by combined use of conventional ultrasound and ultrasound contrast medium and quantitative parameters and parameters The force is obviously better than the former two. It is worth popularizing in clinic.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R736.1;R445.1

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