声脉冲辐射力成像技术在肾脏肿瘤诊断中的应用研究

发布时间：2018-06-12 18:38

本文选题：声触诊组织定量 + 声触诊组织成像　；参考：《复旦大学》2014年硕士论文

【摘要】：肾脏良恶性占位及肾细胞癌亚型的诊断及鉴别诊断是医学影像学的重点。治疗前明确肾肿瘤的类型有助于临床判断预后和决定治疗方法,为患者提供更安全有效的处理。目前彩色多普勒超声、超声造影、增强CT/MRI等为诊断肾肿瘤的主要影像手段,通过观察肿瘤形态,组成成分及血供情况判断肾肿瘤类型,而声脉冲辐射力成像技术(acoustic radiation force impulse, ARFI)能够反映肿瘤的硬度信息,并可进行定量分析,为肾肿瘤的诊断与鉴别诊断提供了一种新的方法。声脉冲辐射力成像是一种超声弹性成像技术,通过声脉冲辐射使组织产生纵向压缩及横向振动。以纵向位移为基础进行成像可直观反映组织弹性,以黑白表示组织相对硬度,称为声触诊组织成像技术(virtual touch tissue imaging, VTI)。横向振动以剪切波方式向周边传播,利用剪切波相邻波峰时间差及波长计算剪切波速度可间接反映组织弹性,对组织硬度进行定量评价,称为声触诊组织定量技术(virtual touch tissue quantification, VTQ)。本研究利用ARFI技术评估肾脏肿瘤硬度,探讨该技术在肾脏肿瘤诊断中的应用价值。第一部分声触诊组织定量技术在肾脏肿瘤诊断中的应用研究目的探讨声触诊组织定量技术在肾脏肿瘤诊断中的应用价值。方法199例患者共199个肾肿瘤行VTQ检查,全部病例均经手术及病理证实。检查时分别将感兴趣区置于肿瘤内及肾皮质内,测量剪切波速度(shear wave velocity, S WV)并记录,将肿瘤内与肾皮质内各10次测值取中位数后作为该例肿瘤与肾皮质的SWV值,将上述两值的比值(肿瘤SWV/肾皮质SWV)作为该病例的SWV比值,分析VTQ在肾脏应用中的稳定性、良恶性肿瘤的SWV差异及VTQ在肾脏肿瘤诊断中的价值。结果病理证实良性肾肿瘤43个(其中血管平滑肌脂肪瘤40个,中胚层肾瘤2个,嗜酸细胞型腺瘤1个),恶性肾肿瘤156个(其中透明细胞肾癌129个,乳头状肾癌11个,嫌色细胞肾癌9个,肾尿路上皮癌5个,间叶源性恶性肿瘤及肾母细胞瘤各1个)。不同深度肾皮质VTQ检测组内相关系数均大于0.75,不同深度肾皮质SWV值之间的差异有统计学意义。比较SWV值及SWV比值,良恶性肿瘤之间、恶性肿瘤各亚型之间的差异均有统计学意义。以SWV值2.120m/s为界值,诊断恶性肿瘤的敏感度为59.6%,特异度为65.1%,以SWV比值0.835为界值,诊断恶性肿瘤的敏感度为64.7%,特异度为69.8%。结论声触诊组织定量技术测量肾脏的稳定性较好,深度对测量值存在影响。VTQ可以提供肾脏肿瘤的弹性信息,在肾脏肿瘤的诊断中有一定应用价值,SWV比值的诊断意义大于SWV值。第二部分声触诊组织成像技术在肾脏肿瘤诊断中的应用研究目的探讨声触诊组织成像技术在肾脏肿瘤诊断中的应用价值。方法肾脏肿瘤患者124例共124个病灶,全部病例均经手术及病理证实。利用VTI技术取得肾脏肿瘤及其周围肾皮质的弹性图像,由2名医师观察图像中肿瘤与肾皮质的亮度,将亮度分级进行统计学分析比较观察者间差异及良恶性肿瘤间差异,并与同时测得的肿瘤SWV比值进行相关性分析。结果病理结果证实良性肿瘤27个,其中血管平滑肌脂肪瘤25个,中胚层肾瘤2个,恶性肿瘤97个,其中透明细胞癌79个,乳头状癌5个,嫌色细胞癌7个,尿路上皮癌5个,间叶源性恶性肿瘤1个。统计结果显示：2名观察者间没有显著性差异,一致性一般(Kappa=0.565)；VTI图像显示的肿瘤亮度在良、恶性肿瘤之间的差异没有统计学意义；VTI图像显示的肿瘤亮度与VTQ测得的SWV比值之间没有相关性。结论声触诊组织成像技术可以提供肾脏肿瘤的弹性信息,观察者间一致性一般,在肾脏良、恶性肿瘤的鉴别中意义不大。
[Abstract]:The diagnosis and differential diagnosis of the benign and malignant renal space and the subtype of renal cell carcinoma is the focus of medical imaging. The type of renal tumor before treatment can be used to determine the prognosis and determine the treatment and provide more safe and effective treatment for the patients. Current color Doppler ultrasound, ultrasound contrast, enhanced CT/MRI and so on are the main diagnosis of renal tumors. Image means, by observing tumor morphology, composition and blood supply to determine the type of renal tumor, and acoustic radiation force impulse (ARFI) can reflect the hardness information of the tumor, and can be quantified to provide a new method for the diagnosis and differential diagnosis of renal tumor. Force imaging is an ultrasonic elastic imaging technique, which produces longitudinal compression and transverse vibration through acoustic pulse radiation. Imaging based on longitudinal displacement can directly reflect tissue elasticity, in black and white to organize relative hardness, called virtual touch tissue imaging, VTI. Transverse vibration with shear wave. Virtual touch tissue quantification (VTQ) was used to evaluate the tissue hardness by using the shear wave adjacent wave peak time difference and wavelengths to calculate the shear wave velocity indirectly. The quantitative evaluation of tissue hardness was called acoustic palpation tissue quantitative technique (tissue quantification, VTQ). This study used ARFI technology to evaluate the hardness of renal tumors and to explore the technique in the kidney. The application value of the acoustic palpation tissue quantitative technique in the diagnosis of renal tumor. Objective to explore the application value of acoustic palpation tissue quantitative technique in the diagnosis of renal tumors. Methods a total of 199 renal tumors in 199 patients were examined by VTQ, all cases were confirmed by operation and pathology. The region of interest was placed within the tumor and in the renal cortex, the shear wave velocity (shear wave velocity, S WV) was measured and the median of the 10 values in the tumor and renal cortex were taken as the SWV value of the tumor and renal cortex. The ratio of the above two values (tumor SWV/ renal cortex SWV) was used as the SWV ratio of the case, and VTQ in the renal application was analyzed. SWV differences in benign and malignant tumors and the value of VTQ in the diagnosis of renal tumors. Results pathology confirmed 43 benign renal tumors (including 40 angiomyolipomas, 2 mesoderm nephroma, 1 eosinophilic adenomas) and 156 malignant renal tumors (including 129 transparent cell renal carcinoma, 11 papillary renal carcinoma, and 9 suspected chromophore kidney cancer). There were 5 renal urothelial carcinoma, mesenchymal malignant tumor and 1 nephroblastoma. The correlation coefficient of VTQ detection group in different depth of renal cortex was more than 0.75, and the difference of SWV values between different depths of renal cortex was statistically significant. The difference of SWV value and SWV ratio, between benign and malignant tumor, and among the different subtypes of malignant tumor were statistically significant. The sensitivity of the SWV value 2.120m/s was 59.6%, the specificity was 65.1%, the SWV ratio 0.835 was the boundary value, the sensitivity of the malignant tumor was 64.7%, the specificity was 69.8%., the sound palpation tissue quantitative technique was used to measure the stability of the kidney, and the depth to the measurement value had the influence of.VTQ to provide renal tumor. The diagnostic value of SWV ratio is more valuable than SWV value. The application of second part acoustic palpation tissue imaging technique in the diagnosis of renal tumor. Objective to discuss the value of acoustic palpation tissue imaging in the diagnosis of renal tumor. Methods 124 cases of renal tumor patients were 124. All cases were confirmed by operation and pathology. VTI technique was used to obtain the elastic images of renal tumor and its surrounding renal cortex. The brightness of the tumor and renal cortex in the image was observed by 2 doctors. The difference of the luminance classification and the difference between the benign and malignant tumor, and the SWV ratio measured at the same time were compared. The results showed that there were 27 benign tumors, including 25 angiomyolipomas, 2 mesoderm tumors and 97 malignant tumors, including 79 transparent cell carcinoma, 5 papillary carcinoma, 7 chromophobe cell carcinoma, 5 urothelial carcinoma and 1 inter leaf malignancy. The statistical results showed that 2 observers had no significant difference. There is no statistically significant difference in the brightness between benign and malignant tumors in the VTI image, and there is no correlation between the tumor brightness of the VTI image and the SWV ratio measured by the VTQ. Conclusion the acoustic palpation tissue imaging technique can provide the elastic information of the renal tumor and the consensus among the observers is consistent. Generally speaking, it is of little significance in differentiating benign and malignant renal tumors.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R737.11

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