声触诊组织定量技术在鉴别诊断甲状腺结节良恶性中的应用
发布时间：2019-01-04 07:54
【摘要】：目的探讨声脉冲辐射力成像(ARFI)声触诊组织定量(VTQ)技术在鉴别诊断甲状腺良、恶性结节中的应用价值及其影响因素。 方法测量165例共180枚甲状腺结节的二维、彩色多普勒及VTQ弹性成像,分别进行横切面和纵切面扫查,记录检查切面,结节最大径,血流,钙化及距离皮肤的深度,测量结节及周边甲状腺组织的横向剪切波速度(SWV),并计算纵切面下结节与周边正常甲状腺组织的差值。采用ROC曲线方法评价VTQ技术鉴别甲状腺良恶性结节的诊断价值并确定诊断界值,采用Z检验比较不同方法的诊断效能差异。采用多元线性回归方法分析结节的最大径、钙化、内部血流、深度、探头扫查方向及病理类型对SWV值的影响,评估各因子对SWV值的贡献。 结果①180枚甲状腺结节包括良性65枚(54枚结节性甲状腺肿,11枚滤泡性腺瘤),恶性115枚(114枚乳头状癌,1枚滤泡状癌)。横、纵切面良性结节及周边甲状腺组织的SWV值平均为(2.15±0.78)m/s、(1.93±0.47)m/s和(2.2±0.71)m/s、(2.06±0.41m/s,115枚恶性结节及周边甲状腺组织的SWV平均值分别为(2.97±1.12) m/s、(1.90±0.48) m/s和(3.09±1.08) m/s、(1.97±0.44)m/s。②恶性组的SWV值明显高于良性组,两者比较有明显统计学差异(P0.0001)；恶性结节与其周边甲状腺组织比较,差异有统计学意义(P0.0001)；而良性结节与其周边甲状腺组织无明显统计学差异(P0.05)。③横、纵切面ROC曲线下面积(AUC)分别为0.772、0.799,以2.47m/s诊断界值点时,对应的敏感度、特异度分别为敏感度为64.3%、71.9%和74.8%、73.4%。纵切面下甲状腺结节与周边组织的差值ROC曲线下面积为0.831,以差值0.34作为最佳截断点,敏感度为87.0%,特异度为67.2%。④三种方法间AUC比较差异无明显统计学意义(P0.05)。⑤多元线性逐步回归分析显示,微钙化、结节的深度、探头扫查方向对SWV值的影响差异没有统计学意义(P0.05),而结节的最大径、病理类型及内部血流对SWV值的影响有统计学意义(P0.05)。建立回归方程为：Y=1.163-0.054X1-0.054X3-0.228X6,其中病理类型对SWV值的影响最大(标准化回归系数为-0.312)。 结论①VTQ技术可以定量评价不同甲状腺组织的硬度,在鉴别甲状腺良恶性结节方面具有较高的临床应用价值。②甲状腺结节的病理类型、内部血流及结节的最大径是影响SWV值的因素,而结节距离皮肤的深度、探头扫查方向及微钙化与SWV值无关。
[Abstract]:Objective to investigate the value and influencing factors of quantitative (VTQ) technique of acoustic pulse radiography (ARFI) in the differential diagnosis of benign and malignant thyroid nodules. Methods two dimensional color Doppler imaging and VTQ elastic imaging were performed in 165 patients with 180 thyroid nodules. Transverse and longitudinal scanning were performed to record the section, the maximum diameter of the node, blood flow, calcification and depth from the skin. The transverse shear wave velocities (SWV),) of the nodule and the surrounding thyroid tissue were measured and the difference between the sublongitudinal nodule and the peripheral normal thyroid tissue was calculated. The ROC curve method was used to evaluate the diagnostic value of VTQ technique in differentiating benign and malignant thyroid nodules and the diagnostic bounds were determined. The diagnostic efficacy of different methods was compared by Z test. The effects of the maximum diameter, calcification, internal blood flow, depth, probe scan direction and pathological type on the SWV value were analyzed by multivariate linear regression method, and the contribution of each factor to the SWV value was evaluated. Results 1180 thyroid nodules included 65 benign thyroid nodules (54 nodular goiter, 11 follicular adenomas) and 115 malignant thyroid nodules (114 papillary carcinomas and 1 follicular carcinoma). The mean SWV values of benign nodules and peripheral thyroid tissues were (2.15 卤0.78) m / s, (1.93 卤0.47) m / s and (2.2 卤0.71) m / s, (2.06 卤0.41) m / s, respectively. The mean SWV values of 115 malignant nodules and peripheral thyroid tissues were (2.97 卤1.12) m / s, (1.90 卤0.48) m / s and (3.09 卤1.08) m / s, respectively. The SWV value of (1.97 卤0.44) m/s.2 malignant group was significantly higher than that of benign group (P0.0001). There was significant difference between malignant nodules and their peripheral thyroid tissues (P0.0001). However, there was no significant difference between benign nodules and their peripheral thyroid tissues (P0.05). The area (AUC) under the longitudinal ROC curve was 0.7720.799, respectively. The sensitivity was 71.9% and 74.8%, respectively. The area under the ROC curve of the difference between the sublongitudinal thyroid nodule and the surrounding tissue was 0.831. The sensitivity was 87.0 with the difference of 0.34 as the best cut-off point. There was no significant difference in AUC between the three methods with specificity of 67.2.4 (P0.05). 5 multiple linear stepwise regression analysis showed that the microcalcification, the depth of nodules, The influence of probe scan direction on SWV value was not statistically significant (P0.05), while the maximum diameter of nodules, pathological type and internal blood flow had significant effects on SWV value (P0.05). The regression equation was established as follows: YT 1.163-0.054X1-0.054X3-0.228X6, in which pathological type had the greatest influence on SWV value (normalized regression coefficient was -0.312). Conclusion 1VTQ technique can quantitatively evaluate the hardness of different thyroid tissues and has a high clinical value in differentiating benign and malignant thyroid nodules. 2 the pathological types of thyroid nodules. The internal blood flow and the maximum diameter of the nodules were the factors affecting the SWV value, while the depth of the nodules from the skin, the direction of the probe scanning and the microcalcification were not related to the SWV value.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R736.1
本文编号：2400002
[Abstract]:Objective to investigate the value and influencing factors of quantitative (VTQ) technique of acoustic pulse radiography (ARFI) in the differential diagnosis of benign and malignant thyroid nodules. Methods two dimensional color Doppler imaging and VTQ elastic imaging were performed in 165 patients with 180 thyroid nodules. Transverse and longitudinal scanning were performed to record the section, the maximum diameter of the node, blood flow, calcification and depth from the skin. The transverse shear wave velocities (SWV),) of the nodule and the surrounding thyroid tissue were measured and the difference between the sublongitudinal nodule and the peripheral normal thyroid tissue was calculated. The ROC curve method was used to evaluate the diagnostic value of VTQ technique in differentiating benign and malignant thyroid nodules and the diagnostic bounds were determined. The diagnostic efficacy of different methods was compared by Z test. The effects of the maximum diameter, calcification, internal blood flow, depth, probe scan direction and pathological type on the SWV value were analyzed by multivariate linear regression method, and the contribution of each factor to the SWV value was evaluated. Results 1180 thyroid nodules included 65 benign thyroid nodules (54 nodular goiter, 11 follicular adenomas) and 115 malignant thyroid nodules (114 papillary carcinomas and 1 follicular carcinoma). The mean SWV values of benign nodules and peripheral thyroid tissues were (2.15 卤0.78) m / s, (1.93 卤0.47) m / s and (2.2 卤0.71) m / s, (2.06 卤0.41) m / s, respectively. The mean SWV values of 115 malignant nodules and peripheral thyroid tissues were (2.97 卤1.12) m / s, (1.90 卤0.48) m / s and (3.09 卤1.08) m / s, respectively. The SWV value of (1.97 卤0.44) m/s.2 malignant group was significantly higher than that of benign group (P0.0001). There was significant difference between malignant nodules and their peripheral thyroid tissues (P0.0001). However, there was no significant difference between benign nodules and their peripheral thyroid tissues (P0.05). The area (AUC) under the longitudinal ROC curve was 0.7720.799, respectively. The sensitivity was 71.9% and 74.8%, respectively. The area under the ROC curve of the difference between the sublongitudinal thyroid nodule and the surrounding tissue was 0.831. The sensitivity was 87.0 with the difference of 0.34 as the best cut-off point. There was no significant difference in AUC between the three methods with specificity of 67.2.4 (P0.05). 5 multiple linear stepwise regression analysis showed that the microcalcification, the depth of nodules, The influence of probe scan direction on SWV value was not statistically significant (P0.05), while the maximum diameter of nodules, pathological type and internal blood flow had significant effects on SWV value (P0.05). The regression equation was established as follows: YT 1.163-0.054X1-0.054X3-0.228X6, in which pathological type had the greatest influence on SWV value (normalized regression coefficient was -0.312). Conclusion 1VTQ technique can quantitatively evaluate the hardness of different thyroid tissues and has a high clinical value in differentiating benign and malignant thyroid nodules. 2 the pathological types of thyroid nodules. The internal blood flow and the maximum diameter of the nodules were the factors affecting the SWV value, while the depth of the nodules from the skin, the direction of the probe scanning and the microcalcification were not related to the SWV value.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R736.1
【引证文献】
相关期刊论文 前1条
1 张英;张蕾;王欢;;超声成像联合声触诊定性弹性成像在鉴别甲状腺良恶性结节中应用研究[J];湖南师范大学学报(医学版);2017年01期
，本文编号：2400002
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