支气管超声弹性成像技术对肺门及纵膈肿大淋巴结诊断价值的临床研究

发布时间：2018-04-18 01:37

本文选题：支气管超声 + 弹性成像　；参考：《中国人民解放军医学院》2016年硕士论文

【摘要】：目的：肺门及纵膈肿大淋巴结的良恶性判定对于疾病的诊治至关重要,随着超声技术的迅猛发展,经支气管超声弹性成像技术开始应用于临床,并在鉴别淋巴结良恶性方面表现出良好的前景.本研究旨在通过测定肺门及纵膈肿大淋巴结的超声弹性成像各参数,探讨支气管超声弹性技术对肺门及纵膈肿大淋巴结良恶性的诊断价值；并通过构建Logistic回归模型综合评价常规超声特征及超声弹性成像在肺门及纵膈肿大淋巴结良恶性鉴别方面的应用价值。方法：研究对象为2015年10月-2016年3月在解放军总医院呼吸科气管镜室行EBUS-TBNA检查的83位患者共131例淋巴结。使用仪器为日本Olympus公司的EU-ME2 (Premier Plus)超声检查仪。在进行穿刺操作前,分别对目标淋巴结行常规超声和弹性成像检查,影像资料录像留存。分析并记录淋巴结常规超声特征及弹性成像各个参数,以EBUS-TBNA穿刺的病理结果及6个月的随访确认作为诊断的金标准,构建各个特征参数的受试者工作特征曲线,得到曲线下面积及最佳诊断界值,计算出各个特征参数的诊断的准确率、敏感度、特异度、比数积等指标,比较分析弹性成像的诊断价值;运用Logistic回归分析,构建回归方程,综合研究肺门及纵膈肿大淋巴结的常规超声特征及弹性成像参数对良恶性病变的诊断价值；然后以淋巴结位置的不同进行分组,分别构建各组蓝色面积比例和应变率比值均值的受试者工作特征曲线,确定诊断界值,对不同组的淋巴结采用相应的界值进行诊断,进一步分析蓝色面积比例及应变率比值均值的诊断价值.结果：1.超声弹性成像蓝色面积比例诊断淋巴结良恶性的的最佳诊断界值为0.6,曲线下面积为0.875,诊断的准确率、敏感度、特异度分别为84.43%、83.33%、86.00%,曲线下面积和诊断准确率均显著高于常规超声；2.超声弹性应变率比值均值诊断病变良恶性的的最佳诊断界值为14.33,曲线下面积为0.882,诊断的准确率、敏感度、特异度分别为81.97%、81.94%、82.00%,曲线下面积和诊断准确率显著高于部分常规超声特征；3.超声弹性图像评分诊断病变良恶性的曲线下面积为0.837,诊断的准确率、敏感度、特异度分别为83.61%、88.89%、76.00%,曲线下面积和诊断准确率显著高于部分常规超声特征；4.超声弹性成像蓝色面积比例、应变率比值均值、弹性评分之间诊断的准确率比较,差异没有统计学意义；但三者的比数积分别为30.71、20.68、25.33,表明蓝色面积比例综合诊断价值更高；5.Logistic回归分析显示边界、回声强弱、血供、短径和蓝色面积比例对诊断病变良恶性有显著意义。利用构建的回归模型对病变性质进行预报,以回归值P0.5为恶性,P≤0.5为良性,则诊断的准确率为91.80%,敏感度为94.44%,特异度为88.00%,显著高于常规超声特征以及弹性成像各个参数的相应诊断值；6.按淋巴结位置分组后,蓝色面积比例诊断良恶性的准确率为90.08%,敏感度为89.87%，，特异度为90.38%；应变率比值均值诊断的准确率为85.25%,敏感度为84.72%,特异度为86.00%,较分组前均有所提高,但差异没有统计学意义。结论：1.蓝色面积比例、应变率比值均值和弹性评分等超声弹性成像参数对肺门及纵膈肿大淋巴结良恶性的鉴别诊断具有较高的临床使用价值,其中以蓝色面积比例综合诊断能力最高；2.Logistic回归模型能筛选出对肺门及纵膈肿大淋巴结良恶性诊断有意义的超声特征,并能够综合常规超声和弹性成像诊断的价值,有利于良恶性病变鉴别诊断；3.按淋巴结位置分组后,以不同组的蓝色面积比例及应变率比值均值的界值进行诊断,能够提高病变良恶性的诊断价值。
[Abstract]:Objective: hilar and mediastinal lymph nodes benign and malignant is essential for the diagnosis and treatment of the disease, with the rapid development of ultrasound technology, endobronchial ultrasound elasticity imaging technology has been applied to the clinic, and in the differential diagnosis of benign and malignant lymph nodes showed good prospects. This study aims to determine the parameters of ultrasound elastography in hilum of lung mediastinal lymph node enlargement, bronchial ultrasound elasticity value of benign and malignant node technology in diagnosis of hilar and mediastinal lymph nodes; and the application value of constructing Logistic regression model of comprehensive evaluation of characteristics of conventional ultrasound and ultrasound elastography in hilar and mediastinal lymph nodes in differential diagnosis of benign and malignant areas. Methods: the research object for the October 2015 -2016 year in March 83 in the Department of respiration, bronchoscope room of PLA General Hospital of EBUS-TBNA examination in patients with a total of 131 cases of lymph node. The use of instruments for the Japanese Olympu S EU-ME2 (Premier Plus) ultrasound instrument. In puncture operation, respectively to the target lymph node underwent conventional ultrasound and elastography images, video analysis and record retention. Lymph node characteristics of conventional ultrasound and elastography parameters, EBUS-TBNA biopsy and puncture 6 months follow-up confirmed as the gold standard for diagnosis, the construction parameters of the receiver operating characteristic curves, obtained the area under the curve and the optimal cutoff value, calculate the accurate rate of diagnosis of various characteristic parameters of sensitivity, specificity, ratio of product index, comparative analysis of diagnostic value of elastography; using Logistic regression analysis. To construct the regression equation, the value of hilar and mediastinal lymph nodes of the characteristics of conventional ultrasound and elastography in diagnosis of benign and malignant lesions of the parameters; then to lymph nodes in different groups, Each blue were constructed area ratio and strain ratio mean of the receiver operating characteristic curve to determine the diagnostic value of different groups of lymph nodes, adopt the corresponding boundary value for diagnosis, further analysis of the diagnostic value of blue area ratio and strain ratio mean. Results: 1. ultrasonic elastography in diagnosis of lymph node area proportion of blue the diagnosis of benign and malignant optimal cutoff value was 0.6, the area under the curve was 0.875, the accuracy rate of diagnosis, the sensitivity and specificity of 84.43%, respectively, 83.33%, 86%, the accuracy rate of diagnosis and the area under the curve were significantly higher than that of conventional ultrasound; 2. ultrasonic elastography strain ratio of benign and malignant lesions diagnosis mean the best diagnosis value of 14.33, area under the curve was 0.882, the accuracy rate of diagnosis, the sensitivity and specificity of 81.97%, respectively, 81.94%, 82%, the area under the curve and the diagnostic accuracy is higher than that of conventional ultrasound characteristics significantly Area 3.; elastography score for diagnosis of benign and malignant lesions under the curve is 0.837, the accuracy rate of diagnosis, the sensitivity and specificity of 83.61%, respectively, 88.89%, 76%, the accuracy rate of diagnosis was significantly higher than that of the area under the curve and some characteristics of conventional ultrasound elastography; 4. blue area ratio, mean strain ratio, more accurate the diagnosis rate of the elastic score, the difference was not statistically significant; but the three ratio of the number of integral 30.71,20.68,25.33 is, that blue area proportion of the value of higher comprehensive diagnosis; 5.Logistic regression analysis showed that the boundary, echo intensity, blood supply, short diameter and blue area ratio was significant in the diagnosis of benign and malignant lesions. To predict the nature of the lesions by regression model, the regression value of P0.5 for malignant and benign P is less than or equal to 0.5, the accurate rate of diagnosis was 91.80%, the sensitivity was 94.44%, specificity was 88%, significantly higher The corresponding diagnosis in conventional ultrasound elasticity imaging characteristics and the value of each parameter; 6. according to lymph node position after grouping the blue area proportion of benign and malignant diagnostic accuracy rate was 90.08%, the sensitivity was 89.87%, specificity was 90.38%; the accuracy rate of diagnosis of the mean strain ratio was 85.25%, the sensitivity was 84.72%, specificity was 86%. That is before grouping all increased, but the difference was not statistically significant. Conclusion: 1. blue area ratio, strain ratio and mean score of elastic parameters of ultrasound elastography has high of hilar and mediastinal lymph nodes in differential diagnosis of benign and malignant clinical value, the blue area proportion of comprehensive diagnosis ability is highest; the 2.Logistic regression model can screen out the ultrasound features of hilar and mediastinal lymph node diagnosis of malignant and benign sense, and can integrate conventional ultrasound and elastography in the diagnosis of the value of a It is helpful for differential diagnosis of benign and malignant lesions. 3., according to the location of lymph nodes, we can diagnose the value of the blue area ratio and the mean value of strain rate ratio of different groups, which can improve the diagnostic value of benign and malignant lesions.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R56;R734

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