经阴道超声结合弹性成像技术对宫腔占位病变诊断价值的预测研究

发布时间：2018-10-08 07:32

【摘要】：背景与目的子宫内膜癌(Endometrial Carcinoma, EC)是女性生殖系统常见的三大肿瘤之一。在欧美国家发病率较高,在我国近年来发病率显著增多。绝经后妇女为高发人群。这种疾病发生在子宫内膜,属于上皮性恶性肿瘤。主要表现为阴道不规则出血。近些年来,超声弹性成像(Ultrasonic Elastography,UE)作为一项新的诊断技术在不断发展。依据组织不同的软硬度(与其病理构成密切相关)提供病变组织新的诊断信息。对乳腺、甲状腺等浅表器官疾病的诊断也有了普遍应用,在肝脏、心肌等方面也有了一系列的研究,但在宫腔方面的研究不多见。宫腔恶变时组织硬度增加。利用经阴道超声结合弹性成像技术客观地分析病变组织硬度,然后通过不同显色以及相关数据来表达病变的良恶性。本研究的目的包括以下四项： 1.分别描述正常子宫、子宫内膜息肉、粘膜下肌瘤及子宫内膜癌等不同宫腔状态下的二维超声及弹性成像显像特点。 2.探讨血流类型不同的情况下子宫内膜癌是否对弹性分级造成影响。 3.研究弹性成像技术对宫腔占位病变性质的诊断价值。 4.比较弹性评分与应变率比值(Strain Ratio, SR)对宫腔占位病变良恶性的诊断准确性。对象与方法选取2013年1月-2014年1月在我院妇科就诊的患者中,行经阴道超声及经阴道超声弹性成像检查。正常宫腔组25例,平均年龄(30±2.3)岁。宫腔占位63例,平均年龄(43±3.1)岁。良性病灶28个,恶性病灶35个,均在我院进行手术治疗及病理诊断。选用日立HV-900彩色多普勒超声诊断仪,频率4-8MHZ的阴道超声探头。对被检者行经阴道超声检查。发现病灶后,分析图像特点,取得理想二维图像。然后进入弹性成像模式。分析不同宫腔状态的弹性图像特点。测定应变率比值。最后做出弹性评分(5分标准)。结果 1.不同宫腔状态的弹性图像特点正常宫腔：以绿色为主。子宫内膜息肉：以绿色为主伴少量红色和(或)蓝色。粘膜下肌瘤：以绿色为主,可见蓝绿相间,或以蓝色、红色为主。子宫内膜癌：以蓝色为主,可见少许绿色,或全为蓝色。 2.血流信号丰富型子宫内膜癌15例,6例5分,7例4分,2例≤3分。血流信号不丰富型子宫内膜癌11例,1例5分,7例4分,3例≤3分。无血流信号型子宫内膜癌9例,1例5分,2例4分,6例≤3分。 3.分析宫腔占位病变的性质时,经阴道超声的特异度、灵敏度分别为：59.0%、79.2%。弹性评分的特异度、灵敏度分别为：68.8%、80.6%。两者结合成像的特异度、灵敏度分别为：86.7%、93.9%。两者分别与结合成像对比。统计结果分别为(χ2=5.760,P0.05。χ2=6.261,P0.05),提示统计学存在显著差异。 4.应变率比值测宫腔占位病变良恶性的最佳截断值为2.98。应变率比值与弹性评分诊断宫腔占位病变的受试者工作曲线(ROC)下面积(Az)分别为：0.852和0.761,统计结果为(χ2=4.663,P0.05),提示统计学不存在显著差异。结论 1.超声弹性成像作为经阴道超声检查的良好补充,为病变的确诊提供了更多有价值的信息,为宫腔占位病变性质的诊断提供更加直观有力的佐证。 2.子宫内膜癌的血流分布类型不会对弹性分级造成影响。 3.采用弹性评分、应变率比值诊断宫腔占位病变性质是一种新的技术手段,前者准确度稍低于后者,二者差异无统计学意义。
[Abstract]:Background and Purpose Endometrial cancer (EC) is a common three-major tumor in female reproductive system One. In Europe, the incidence rate is high, and the incidence rate is remarkable in China in recent years. Increased number of postmenopausal women Population. This disease takes place in the endometrium and belongs to epithelial malignant. Neoplasm mainly manifested as irregular vagina In recent years, ultrasound elastography (UE) is a new diagnostic technique Development. New diagnosis of diseased tissue based on the different soft hardness of the tissue (closely related to its pathological composition) The diagnosis of superficial organ diseases, such as breast and thyroid, has also been widely used, and a series of studies have been carried out in liver, myocardium and so on, but the study in the aspect of uterine cavity does not Multiple see. Tissue hardness in case of malignancy of the uterine cavity Objective To study the tissue hardness of diseased tissue by means of transvaginal ultrasound combined with elastic imaging technique, and then to express lesions by different color development and related data. Malignant. Package for the purpose of this study The two-dimensional ultrasound in different uterine cavity states such as normal uterus, endometrial polyps, submucosal myoma and endometrial carcinoma were described. Characteristics of elastography imaging: study of endometrial carcinoma in different types of blood flow Is there an impact on the elastic grading? 3. Study elastic imaging technology Diagnostic value of the nature of lesions in the uterine cavity. 4. Comparison of the ratio of elastic score to strain rate (Strain Ratio, SR) The uterine cavity accounts for Accuracy of diagnosis of benign and malignant lesions in patients with benign and malignant lesions. The object and method were selected from January 2013 to January 2014 in the department of gynaecology in our hospital In patients, transvaginal ultrasound and transvaginal ultrasound elastography Normal uterine cavity group (n = 25), mean age (30/ 2. 3) There were 63 cases with uterine cavity, and the average age was 43. 3. 1. There were 28 benign lesions. 35 malignant lesions were operated in our hospital for surgical treatment and pathological diagnosis. Hitachi HV-900 was selected. Color Doppler ultrasonic diagnostic instrument, frequency A 4-8MHz vaginal ultrasound probe. Ultrasonic examination. After the lesion was found, An ideal two-dimensional image is obtained by analyzing the characteristics of the image. and then enters the elastic imaging, Mode. Analysis of elastic patterns of different uterine cavity states Elephant Point. Measure the ratio of strain rate. Finally, make a bullet. Sex score (5 sub-standard). Junction Fruit 1. The characteristics of elastic images of different uterine cavity states are normal. Uterine cavity: predominantly green. Endometrial polyp: Mainly green with a small amount of red and/ or blue. Submucosal myoma: predominantly green, visible blue Green and interphase, or blue, red predominantly. Endometrial cancer: predominantly blue, visible with a little green Color, or total blue. 2. Blood flow signal rich endometrial carcinoma 15 cases, 6 cases 5 points 7 cases, 4, 2 cases, 3 points. The blood flow signal was not abundant in 11 cases of endometrial carcinoma, 1 In 5, 7, 4, 3, 3, 9, 5, 2, 6, and 3, respectively.. 3. Analysis of the specificity of transvaginal ultrasound in the analysis of the properties of uterine cavity occupying lesions The sensitivity was 59. 0%, 79. 2%, and the specificity of the elastic score, the spirit and the sensitivity were: 59. 0%, 79. 2%, respectively. acuity of 68. 8%, 80. 6%. The specificity and sensitivity of both of them are: 86. 7%, 93. 9%. Both of them were compared with the combined imaging. The results showed that the results showed that the results showed that the results showed that the results were as follows: (2 = 5. 760, P 0.05. 2 = 6. 261, respectively). The ratio of strain rate was 2. 98. The ratio of strain rate and elastic score were used to diagnose the area under the working curve (ROC) of the subjects with uterine cavity occupying lesions (Az). respectively The results showed that there was no significant difference between 0. 852 and 0. 761. Conclusion 1. Ultrasound elastography was used as a model. The good complement of vaginal sonography provides more value for the diagnosis of lesions Information that provides more visual support for the diagnosis of the nature of the uterine cavity occupying lesions. The type of blood flow distribution in endometrial cancer does not have an impact on the elastic grading
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1

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