声脉冲辐射力成像技术评估周围型肺部肿块的可行性研究

发布时间：2018-11-22 06:23

【摘要】：目的：探讨采用声脉冲辐射力弹性成像技术用于评价并鉴别周围型肺部肿瘤及肿瘤样病变的良、恶性的应用价值，尽早为临床医生制定合理的治疗方案提供方便可靠地依据。方法：收集河南科技大学第一附属医院2011年10月至2012年10月期间经X线胸片或CT诊断发现并住院的周围型肺部肿块患者74例（74个病灶，一般选取将要进行超声介入手术穿刺的部位），术前经彩色超声常规检查，，患者采取能充分暴露病变部位的合适体位，对肿块部位进行反复扫查，选择一个恰当的兴趣区，首先进行常规超声检查，观察测量肿块部位、大小、形态、边界、内部回声、后方回声有无衰减、纵横比。用彩色能量多普勒观察肿块周边及内部血供多少，了解肿块供血情况。最后主要利用其中的声脉冲辐射力弹性成像功能定量测得肿块的剪切波速度，取样过程中嘱患者屏气，保持探头与扫查部位垂直固定，不同深度及部位重复测量5次，取其平均值，若瘤体内有液化坏死者，感兴趣区置于瘤体实性部分，余均置于瘤体回声相对均一的位置。统计分析不同病理类型肺部肿瘤之间弹性成像特征及剪切波速度的差异，同时采用ROC曲线评价剪切波速度值对周围型肺部肿块良恶性的鉴别诊断价值，并确定其截断点。结果：74例肺部肿块病人的病理检查结果：恶性病灶共44个，良性病灶30个，其中鳞癌20例，腺癌17例，小细胞肺癌6例，原始神经外胚层肿瘤1例，孤立性纤维性肿瘤1例,炎性29例。良性病灶的剪切波速度值（0.91±0.32）m/s明显低于恶性病灶的剪切波速度值（1.54±0.44）m/s，经SPASS19.0统计软件分析，P=0.000＜0.05,差异有统计学意义。恶性组中肺腺癌和肺鳞癌剪切波速度值比较[（1.38±0.43）m/s VS（1.40±0.41）m/s],经SPASS19.0统计软件分析，P=0.92＞0.05，差异无统计学意义。将肿块分成良性组和恶性组进行比较，建立ROC曲线，获得良恶性病变的截断值，以1.2m/s作为鉴别良恶性病变截断点，提示恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为77.3%、80%、84.3%、52.6%。结论：声脉冲辐射力弹性成像技术对于评估周围型肺部肿瘤和肿瘤样病变的良恶性具有可行性，结合常规的二维超声及彩色多普勒血流成像对于早期诊断并鉴别肿块的良、恶性显示了良好的应用价值。
[Abstract]:Objective: to evaluate and differentiate benign and malignant lung tumors and tumor-like lesions by using acoustic pulse radiation-force elastic imaging, and to provide a convenient and reliable basis for clinicians to formulate a reasonable treatment plan as soon as possible. Methods: from October 2011 to October 2012, 74 patients (74 lesions) with peripheral pulmonary masses diagnosed and hospitalized by chest X-ray or CT were collected from the first affiliated Hospital of Henan University of Science and Technology. General selection of the site to be performed ultrasound interventional operation puncture), preoperative color ultrasound routine examination, patients can be fully exposed to the appropriate position of the diseased area, repeated scanning of the mass site, select a suitable area of interest, First, conventional ultrasound was performed to observe the location, size, shape, boundary, internal echo, attenuation of the posterior echo and aspect ratio of the tumor. The blood supply around and inside the tumor was observed by color energy Doppler. Finally, the shear wave velocity of the mass was measured quantitatively by using the acoustic pulse radiation force elastic imaging function. During the sampling process, the patient was told to hold breath, to keep the probe perpendicular to the scanning site, and to repeat the measurements at different depths and parts for 5 times. If there is liquefaction and necrosis in the tumor, the region of interest is placed in the solid part of the tumor, and the rest is placed in the position where the echo of the tumor is relatively uniform. The characteristics of elastic imaging and shear wave velocities of lung tumors of different pathological types were statistically analyzed. At the same time, the ROC curve was used to evaluate the value of shear wave velocities in the differential diagnosis of benign and malignant peripheral lung masses, and the truncation point was determined. Results: there were 44 malignant lesions and 30 benign lesions, including squamous cell carcinoma in 20 cases, adenocarcinoma in 17 cases, small cell lung cancer in 6 cases, primitive neuroectodermal tumor in 1 case and solitary fibrous tumor in 1 case. Inflammatory 29 cases. The shear wave velocities of benign lesions (0.91 卤0.32) m / s were significantly lower than those of malignant lesions (1.54 卤0.44) m / s. The results of SPASS19.0 software showed that the shear wave velocities of benign lesions were (0.000 卤0.32) m / s lower than those of malignant lesions (P < 0.05). The shear wave velocities of lung adenocarcinoma and squamous cell carcinoma in malignant group were compared [(1.38 卤0.43) m / s VS (1.40 卤0.41) m / s]. The results of SPASS19.0 statistical software showed that the velocity of shear wave was 0.92 > 0.05, there was no significant difference. The tumor was divided into benign group and malignant group. The ROC curve was established, and the truncation value of benign and malignant lesions was obtained by using 1.2m/s as the cutoff point for differentiating benign and malignant lesions, indicating the sensitivity, specificity and positive predictive value of malignant tumor. The negative predictive values were 77.3 and 84.3, respectively. Conclusion: it is feasible to evaluate benign and malignant peripheral lung tumors and tumor-like lesions by using acoustic pulse power elastic imaging, combined with conventional two-dimensional ultrasound and color Doppler flow imaging, for early diagnosis and differential diagnosis of benign tumors. Malignancy shows good application value.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R445.1;R563

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