超声弹性成像在甲状腺结节鉴别诊断中的应用

发布时间：2018-11-24 21:12

【摘要】：目的：1.探讨超声弹性成像技术结合二维超声在甲状腺结节诊断中的应用价值,二者联合应用的优势及对于临床的意义2.分析影响弹性成像技术在甲状腺良恶性结节鉴别诊断的相关因素。 方法：选取符合条件在我院外科住院治疗的病例65例,其中男性患者20例,女性患者45例,年龄在17-73岁之间,平均年龄(42±2.3)岁,结节直径0.5cm-3.9cm之间。排除单纯囊性结节及囊性成分大于20%。嘱病人采取仰卧位,后仰头部或垫高肩部,充分暴露检查区,平静呼吸,行二维超声及彩色多普勒超声,根据标准鉴别诊断并记录。而后切换至弹性成像模式,对结节行超声弹性成像检查,当在彩色超声弹性成像图上该结节表现为较恒定地显示出一定的代表颜色后,定帧,存图。由两名有经验的超声诊断医师对弹性图像进行评分分级并归类。所有病例均经病理证实,良性结节65个,恶性结节23个。设备采用Siemens Acuson Antares5.0带有超声弹性成像技术软件功能彩色多普勒超声诊断仪,VF13-5高频探头。弹性图中以彩色编码代表不同组织的弹性大小,紫、蓝、绿、黄、红依次代表组织从软到硬。 结果： 1.结节的形态不规则,和周边组织边界不清楚；病灶内部呈现低回声；显示有钙化点；后方回声衰减,以二维图像特征中达到3项作为恶性诊断标准,其诊断结节良恶性的敏感性、特异性、准确性分别为73.9%、87.3%、85.1%。 2.以Alder分级≥2作为诊断恶性标准,其敏感性,特异性,准确度分别为72.5%,67.6%,69.3%,以RI≥0.7作为诊断恶性标准,其敏感性,特异性,准确性分别为65.2%,75.3%,72.0%,二者联合以Alder分级≥2,且RI≥0.7作为诊断恶性标准时,准确性有所提高,但敏感性降低。 3.弹性评分4分及以上为恶性,3分及以下为良性。超声弹性成像的敏感度、特异度、准确度为78.3%、87.6%、88.5%,超声弹性成像面积比诊断恶性结节的敏感度、特异度、准确率分别为61.0%、83.1%、71.8%。二者联合诊断,准确率有所提高,但敏感性降低。 4.弹性成像联合二维超声诊断恶性标准：当结节均满足两者的恶性标准时,则表示为恶性。其诊断甲状腺良恶性结节的敏感度、特异度、准确度为89.1%、96.9%、95.3%,高于二维超声。 结论： 1.二维超声是诊断基础,CDFI与UE可帮助二维超声提高恶性病变检出率,UE诊断价值优于CDFI及PD,UE联合二维超声可以提高诊断率。 2.对于弹性成像评分3分的结节,二维超声诊断恶性结节时不要制定过高的条件,可避免漏诊恶性结节。 3.甲状腺结节的出血坏死囊变,或钙化、或胶原纤维化等会影响弹性结果,影响诊断。
[Abstract]:Objective: 1. To explore the value of ultrasound elastic imaging combined with two-dimensional ultrasound in the diagnosis of thyroid nodules, the advantages and clinical significance of the combined use of the two methods. 2. To analyze the factors influencing the differential diagnosis of benign and malignant thyroid nodules by elastic imaging. Methods: a total of 65 cases (20 male and 45 female), aged between 17 and 73 years, with an average age of (42 卤2.3) years and diameter of 0.5cm-3.9cm, were selected for surgical treatment in our hospital. The exclusion of simple cystic nodules and cystic components was greater than 20. The patient was told to take supine position, supine head or padded shoulder, full exposure of examination area, calm breathing, two dimensional ultrasound and color Doppler ultrasound, according to the standard differential diagnosis and record. Then we switch to the elastic imaging mode and perform the ultrasonic elastic imaging on the node. When the node shows a certain color on the color ultrasonic elastic imaging image, the frame is fixed and the image is stored. Elastic images were graded and classified by two experienced ultrasound diagnostics. All cases were confirmed by pathology, 65 benign nodules and 23 malignant nodules. The equipment uses Siemens Acuson Antares5.0 with ultrasonic elastic imaging technology software, color Doppler ultrasound diagnostic instrument, VF13-5 high frequency probe. The elastic size of different tissues is represented by color coding. Purple, blue, green, yellow and red represent the tissue from soft to hard in turn. Results: 1. The shape of the nodules is irregular, and the boundary of the surrounding tissues is not clear. The sensitivity, specificity and accuracy of the diagnosis of benign and malignant nodules were 73.9%, 87.3% and 85.1%, respectively. 2. The sensitivity, specificity and accuracy of Alder grade 鈮，

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