造影剂到达时间对周围型肺病变的诊断价值

发布时间：2018-03-30 11:55

  本文选题：周围型肺病变　切入点：实时　出处：《南昌大学》2017年硕士论文

【摘要】：目的:1.探讨超声造影(CEUS)时间-强度曲线(TIC)定量参数鉴别诊断周围型肺良、恶性病变的应用价值。2.采用CEUS实时对比观察法评价造影剂到达周围型肺病变及邻近肺组织内的时间差异对周围型肺病变的诊断价值。3.对比研究CEUS实时对比观察法新诊断标准及传统CEUS始增时间诊断标准鉴别诊断周围型肺病变的临床应用价值。方法:1.选取经胸部X线或CT检查发现且超声可见的95例周围型肺病变患者行CEUS检查,实时对比观察病灶及周边肺组织灌注情况,采集动态造影数据并保存备用。所有病灶均经手术或超声引导下经皮肺穿刺活检获得组织标本,行病理诊断,根据病理结果分为肺恶性病变组、肺良性病变组。选取病灶增强强度最强区域为感兴趣区(ROI),应用仪器内置绘图、分析软件绘制时间-强度曲线(TIC),获得CEUS灌注参数造影剂到达时间(AT)、达峰时间(TTP)、上升时间(RT)、峰值强度(PI)等。2.采用CEUS实时对比观察法,分别观察并记录造影剂最初到达病灶及其邻近肺组织内的时间及两者间的时间差,绘制受试者工作特征曲线(ROC),计算曲线下面积及最佳截点值。3.根据传统CEUS始增时间诊断标准,即注入造影剂后良性病灶开始增强时间10 s,恶性病灶开始增强时间≥10 s,计算该诊断标准鉴别诊断周围型肺病变的敏感度、特异度、阳性预测值、阴性预测值及诊断准确率。4.比较CEUS实时对比观察法新诊断标准及传统CEUS始增时间诊断标准诊断周围型肺病变的敏感度、特异度、阳性预测值、阴性预测值及诊断准确率。结果:1.95例周围型肺病变患者中男性60例,女性35例,平均59.1±12.6岁(24-81岁)。病灶最长的径线为范围为3.4-12.4 cm(平均6.4±3.3 cm),左叶42例,右叶53例。64例经手术获得病理,31例经超声引导下经皮肺穿刺取材活检获得最终病理诊断。95例周围型肺病变病理结果如下:肺恶性肿瘤55例(鳞癌19例,腺癌14例,小细胞肺癌11例,大细胞肺癌3例,腺鳞癌8例),肺良性病变40例(炎症组织28例,结核7例,炎性假瘤3例,错构瘤2例)。2.周围型肺良性病变组CEUS TIC曲线定量参数AT明显小于肺恶性病变组(p0.05),TTP、RT、PI在两组间均无明显统计学意义(p均0.05)。3.采用CEUS实时对比观察法显示造影剂最初到达周围型恶性肺病变时间及病灶-肺组织时间差均明显大于肺良性病变组,统计学有明显差异(p均0.05)。造影剂最初到达邻近肺组织的时间在恶性组和良性组之间无显著统计学差异(p0.05)。绘制ROC曲线,造影剂到达病灶-肺组织时间差较造影剂到达肺病灶时间诊断价值高,曲线下面积分别为0.961,0.861。计算造影剂到达病灶-肺组织时间差的最佳截止点为2.5 s,以此界值为标准,CEUS实时对比观察法鉴别诊断周围型肺病变的敏感度为96.4%、特异度为97.5%、阳性预测值为98.1%、阴性预测值为95.1%、诊断准确率为96.8%。4.与病理结果对照,采用传统CEUS始增时间诊断标准鉴别诊断周围型肺病变的敏感度为72.7%、特异度为82.5%、阳性预测值为85.1%、阴性预测值为68.7%、诊断准确率为76.8%。5.CEUS实时对比观察法新诊断标准与传统CEUS始增时间诊断标准诊断在鉴别周围型肺良恶性病灶的诊断准确率对比,具有明显统计学差异(p0.05)。结论:1.CEUS TIC曲线定量参数AT在周围型肺病变的鉴别诊断中有一定的临床应用价值。2.采用CEUS实时对比观察法鉴别诊断周围型肺病变新标准为:造影最初到达病灶与邻近肺组织的时间差异≥2.5 s,病变多为恶性;如果该时间差2.5 s,则病变趋于良性。3.CEUS实时对比观察法新诊断标准的诊断效能高于传统CEUS始增时间诊断标准的诊断效能。
[Abstract]:Objective: 1. to explore contrast-enhanced ultrasound (CEUS) time intensity curve (TIC) in differential diagnosis of quantitative parameters of peripheral pulmonary benign and malignant lesions, the application value of.2. using CEUS real-time observation method to evaluate the clinical value of real-time diagnostic value of.3. CEUS comparative study comparison of peripheral pulmonary lesions were new standard diagnosis method and traditional CEUS by the time the differential diagnosis of peripheral lung lesions diagnosis standard contrast mediareaching peripheral lung lesions and adjacent lung tissue within the time difference. Methods: 1. selected by chest X-ray or CT examination and ultrasound in 95 cases of peripheral lung lesions underwent CEUS examination showed the real-time contrast observed lesions and the peripheral lung tissue perfusion. Collection of dynamic contrast data and save backup. All lesions were confirmed by surgery or ultrasound guided percutaneous lung biopsy to obtain tissue samples for pathological diagnosis, according to the pathological results were divided into malignant lung disease Variable group, benign lung disease group. Select the strongest enhanced lesion regions of interest (ROI), using the instrument built-in drawing, drawing time intensity curve analysis software (TIC), CEUS perfusion parameters of contrast agent arrival time (AT), time to peak (TTP), rise time (RT). The peak intensity (PI) and.2. CEUS by real-time observation method, respectively, to observe and record the initial arrival time of contrast agent and its adjacent lesions in lung tissue and the time difference, the receiver operating characteristic curve (ROC), calculate the area under the curve and the best cutoff value of.3. according to the diagnostic criteria by the time before the traditional CEUS, which injected contrast agent of benign lesions began to increase 10 s, malignant lesions began to increase more than 10 time s, calculate the differential diagnosis of peripheral pulmonary lesions of the diagnostic criteria of sensitivity, specificity, positive predictive value, value and diagnostic accuracy of.4. CEUS real negativepredictive 鏃跺�规瘮瑙傚療娉曟柊璇婃柇鏍囧噯鍙婁紶缁烠EUS濮嬪�炴椂闂磋瘖鏂�鏍囧噯璇婃柇鍛ㄥ洿鍨嬭偤鐥呭彉鐨勬晱鎰熷害,鐗瑰紓搴，

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