弹性成像联合常规超声对甲状腺结节性疾病诊断价值的研究

发布时间：2018-08-27 13:35

【摘要】：目的：主要探讨常规超声与超声弹性成像的联合应用对甲状腺结节良恶性结节的诊断价值,为临床甲状腺结节良恶性结节的鉴别诊断提供新的思路,为临床手术方法的选择以及指导治疗提供相关帮助。方法：应用灰阶超声、彩色多普勒超声以及超声弹性成像技术对80例患者共128个甲状腺结节进行对比检查,所有患者的甲状腺结节在术后均经过病理证实。主要观察患者甲状腺结节的部位、数目、大小、形态、边界、包膜、内部回声、微小钙化、内部以及周边血流分布特征、收缩期峰值血流速度(PSV)、阻力指数(RI)以及弹性成像评分。结果： 1、甲状腺良恶性结节的灰阶超声图像其相关特征性主要在其大小、形态、边界、包膜、内部回声、微小钙化等参数上存在显著性差异(P0.05)；甲状腺良恶性结节的Alder血流分级、收缩期峰值血流速度(PSV)、阻力指数(RI)之间的差异均存在显著性差异(P0.05)；甲状腺良恶性结节的弹性分级之间存在显著性差异(P0.05)。 2、使用常规超声诊断甲状腺结节良恶性,甲状腺良性结节81个,甲状腺恶性结节47个。常规超声的敏感性为71.8%(28/39),特异性为78.7%(70/89),准确性为76.6%(98/128)；使用超声弹性成像诊断甲状腺结节良恶性,甲状腺良性结节83个,甲状腺恶性结节45个。超声弹性成像的敏感性为69.2%(27/39),特异性为79.8%(71/89),准确性为76.6%(98/128)；使用常规超声联合超声弹性成像诊断甲状腺结节良恶性,甲状腺良性结节88个,甲状腺恶性结节40个。常规超声联合超声弹性成像的敏感性为89.7%(35/39),特异性为95.5%(85/89),准确性为93.8%(120/128)。 3、常规超声与超声弹性成像之间的敏感性(χ2=0.06,P0.05)、特异性(χ2=0.03,P0.05)以及准确性(χ2=0.00,P0.05)之间均不存在显著性差异,常规超声的敏感性(χ2=4.04,P0.05)、特异性(χ2=10.1,P0.05)与准确性(χ2=15.0,P0.05)均显著性低于联合超声。超声弹性成像的敏感性(χ2=5.03,P0.05)、特异性(χ2=10.2,P0.05)与准确性(χ2=15.0,P0.05)均显著性低于联合超声。结论： 1、常规超声是诊断甲状腺良恶性的基础,在甲状腺恶性结节中,其血流信号的强度比甲状腺良性结节强,但是在其常规声像图特征中,甲状腺良恶性结节的一些血流参数存在着部分重叠,因此不能单一使用常规超声检查结果作为甲状腺结节良恶性的诊断标准,应当使用其他相关的检查手段以及多个参数综合分析,以提高甲状腺结节良恶性诊断的准确率。 2、超声弹性成像在甲状腺结节良恶性诊断中主要作用是提供甲状腺病灶组织的硬度信息,为甲状腺结节良恶性的诊断提供更多的参考依据。 3、通过将超声弹性成像与常规超声联合使用,大大提高甲状腺结节良恶性诊断的准确性,具有十分重要的临床价值。
[Abstract]:Objective: to explore the diagnostic value of conventional ultrasound and elastography in the diagnosis of benign and malignant thyroid nodules, and to provide a new method for the differential diagnosis of benign and malignant thyroid nodules. To provide relevant help for the selection of clinical surgical methods and the guidance of treatment. Methods: a total of 128 thyroid nodules were examined by gray scale ultrasound, color Doppler ultrasound and elastography in 80 patients. The thyroid nodules of all patients were confirmed by pathology after operation. The location, number, size, shape, boundary, capsule, internal echo, microcalcification, internal and peripheral blood flow distribution, peak systolic blood flow velocity (PSV),) resistance index (RI) and elastic imaging score of thyroid nodules were observed. Results: 1, there were significant differences in the size, shape, boundary, capsule, internal echo and microcalcification in the gray scale ultrasound images of benign and malignant thyroid nodules (P0.05). There were significant differences in Alder blood flow classification and peak systolic blood flow velocity (PSV), resistance index (RI) between benign and malignant thyroid nodules (P0.05). There was significant difference in elastic grade between benign and malignant thyroid nodules (P0.05). 2. Conventional ultrasound was used to diagnose benign and malignant thyroid nodules, 81 benign thyroid nodules and 47 thyroid malignant nodules. The sensitivity, specificity and accuracy of conventional ultrasound were 71.8% (28 / 39), 78.7% (70 / 89) and 76.6% (98 / 128), respectively. The sensitivity, specificity and accuracy of elastography were 69.2% (27 / 39), 79.8% (71 / 89) and 76.6% (98 / 128), respectively. The sensitivity, specificity and accuracy of conventional ultrasound combined with elastography were 89. 7% (35 / 39), 95. 5% (85 / 89) and 93. 8% (120 / 128), respectively. There was no significant difference in sensitivity, specificity and accuracy between conventional ultrasound and ultrasound elastography (蠂 2 / 0.06 P 0.05), specificity (蠂 2 0 03 P 0.05) and accuracy (蠂 2 0.000 05). The sensitivity, specificity and accuracy of conventional ultrasound were significantly lower than those of combined ultrasound. The sensitivity, specificity and accuracy of elastography were significantly lower than that of combined ultrasound (蠂 2 + 5.03 P 0.05), specificity (蠂 2 + 10.2% P 0.05) and accuracy (蠂 2% 15.0% P 0.05). Conclusion: 1. Conventional ultrasound is the basis for the diagnosis of benign and malignant thyroid. In thyroid nodule, the intensity of blood flow signal is stronger than that in benign thyroid nodule. Some blood flow parameters of benign and malignant thyroid nodules are partially overlapped, so the results of conventional ultrasonography cannot be used as the diagnostic criteria for benign and malignant thyroid nodules. Other relevant means of inspection and a comprehensive analysis of multiple parameters should be used, In order to improve the accuracy of benign and malignant diagnosis of thyroid nodules. 2. The main role of elastography in the diagnosis of benign and malignant thyroid nodules is to provide the hardness information of thyroid lesions. It provides more references for the diagnosis of benign and malignant thyroid nodules. 3. By using the combination of ultrasound elastic imaging and conventional ultrasound, the accuracy of benign and malignant diagnosis of thyroid nodules can be greatly improved, which has very important clinical value.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R581.3

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