剪切波弹性成像技术在正常睾丸—附睾和急性附睾炎治疗前后应用价值的初步研究

发布时间：2018-09-10 05:54

【摘要】：【目的】基于组织应力分布的超声弹性成像技术是一种极具潜力的医学成像方式,已广泛应用在乳腺、甲状腺、前列腺等疾病的诊断。前期研究表明,超声弹性成像技术有可能在评估睾丸占位性病变中起着重要的作用,但是将弹性成像技术,尤其是剪切波弹性成像(Shear Wave Elastography,SWE)技术应用在正常睾丸和附睾中的研究极少。为探讨SWE技术应用于正常睾丸和附睾的方法学,我们研究了正常睾丸和附睾SWE成像特点,并对双侧睾丸和附睾丸内部不同区域、睾丸不同切面的SWE弹性模量做了对比研究,同时对影响睾丸和附睾硬度的相关因素进行了初步研究。【方法】筛选我院门诊110位正常男性受检者共计220只睾丸,对睾丸和附睾分别进行常规超声和超声弹性成像检查,并获得SWE声像图及弹性模量。首先,对睾丸(包括长轴、短轴切面)和附睾(包括附睾头、体、尾)依次进行二维灰阶、彩色多普勒常规超声检查。其次,分别将感兴趣区域(Region Of Interest,ROI)置于双侧睾丸和附睾同一区域,以及所有睾丸长轴切面的不同区域(中心区域和外周区域,其中外周区域包括上极包膜下、下极包膜下、前包膜下和后包膜下)、短轴切面中心区域、附睾不同区域(附睾头、尾),分别测量相应区域的SWE弹性模量。应用相应的统计学方法进行统计学分析,以P0.05为差异有统计学意义。【结果】正常睾丸和附睾SWE弹性图像基本呈现均一的蓝色,附睾的SWE弹性模量测值大于正常睾丸SWE弹性模量测值。睾丸长轴切面中心区域、上极包膜下、下极包膜下、前包膜下、后包膜下,短轴切面中心区域,SWE弹性模量测值分别为(3.20±0.57)Kpa、(3.94±0.90)Kpa、(3.94±0.97)Kpa、(6.27±1.58)Kpa、(5.96±1.46)Kpa、(3.44±0.51)Kpa。睾丸周边区域SWE弹性模量测值大于中心区域,短轴(中心区域)切面SWE弹性模量测值大于长轴(中心区域)切面,睾丸前包膜下SWE弹性模量测值大于后包膜下,而睾丸上、下极包膜下SWE弹性模量测值无明显差别。关于影响睾丸和附睾硬度的相关因素分析,结果显示:随着年龄的增加,睾丸硬度越来越大,而体积对睾丸硬度无明显影响;年龄对附睾硬度无明显影响。【结论】作为一项新的诊断技术,SWE技术在评估睾丸及附睾组织硬度的应用中可获得相对稳定的SWE弹性图像。睾丸硬度呈中心区域小而周边区域大的分布特点,睾丸短轴切面硬度大于长轴切面,睾丸硬度随年龄的增加而增大。本研究结论为进一步应用SWE技术对阴囊病变的诊断奠定了基础,尽管仍然需要大样本的临床研究来验证和支持以上数据和结论,但是SWE技术作为一种新的成像技术,有望应用于临床评估睾丸硬度以及阴囊相关疾病的诊断。【目的】探讨应用剪切波弹性成像(Shear Wave Elastography,SWE)技术在急性附睾炎治疗前后的临床应用价值。【方法】筛选2016年4月至2017年1月,在我院被诊断为急性附睾炎并接受规范化治疗患者24位,共计25个附睾尾部炎性包块,于治疗前、治疗后1周、2周、1月、2月及3月分别记录炎性包块的SWE弹性模量、包块大小及包块数量,对比附睾炎性包块SWE弹性模量变化与其相同时间段内大小和数量的变化。【结果】治疗前,平均硬度(50.15±16.90)KPa,平均大小(5.62±3.62)cm3,炎性包块25个;治疗后1周,平均硬度(43.29±25.55)KPa,平均大小(3.02±2.37)cm3,炎性包块23个;治疗后2周,平均硬度(35.82±23.97)KPa,平均大小(2.0±1.98)cm3,炎性包块20个;治疗后1月,平均硬度(23.42±13.25)KPa,平均大小(1.12±1.58)cm3,炎性包块13个;治疗后2月,炎性包块2个;治疗后3月,炎性包块全部消失。【结论】SWE技术可反映附睾炎性包块在规范化治疗过程中内部组织结构硬度的变化,即随着疗程的进展,附睾炎性包块SWE弹性模量逐渐减低,表明其硬度逐渐变小。
[Abstract]:[Objective] Ultrasound elastography based on tissue stress distribution is a potential medical imaging method, which has been widely used in the diagnosis of breast, thyroid, prostate and other diseases. In order to explore the methodology of applying SWE technique to normal testis and epididymis, we studied the SWE imaging characteristics of normal testis and epididymis, and performed different incisions of testis in different regions of bilateral testis and epididymis. The SWE elastic modulus of the testis and epididymis was studied comparatively, and the related factors affecting the hardness of testis and epididymis were studied preliminarily. First, the testis (including long axis, short axis section) and the epididymis (including the head, body and tail of the epididymis) were examined by two-dimensional gray scale and color Doppler ultrasonography. Secondly, the region of interest (ROI) was placed in the same area of the bilateral testis and epididymis, as well as in different areas (central area and peripheral area) of the long axis section of the testis. The SWE elastic modulus of different regions of the epididymis (head and tail of epididymis) were measured in the peripheral region, including subcapsular, subcapsular, subcapsular, subcapsular, central and short axis section. The SWE elastic images of testis and epididymis were basically uniform blue, and the SWE elastic modulus of epididymis was higher than that of normal testis. The SWE elastic modulus of testis in the central region of long axis section, under epipolar capsule, under epipolar capsule, under anterior capsule, under posterior capsule, and in the central region of short axis section were (3.20.57) Kpa and (3.94.90) Kpa, respectively. Kpa, (3.94 + 0.97) Kpa, (6.27 + 1.58) Kpa, (5.96 + 1.46) Kpa, (3.44 + 0.51) Kpa. The measured values of SWE elastic modulus in the periphery of testis were greater than those in the central region, the measured values of SWE elastic modulus in the short axis (central region) were greater than those in the long axis (central region), the SWE elastic modulus under the anterior capsule of testis was greater than that under the posterior capsule, and SWE elastic modulus in the upper and lower capsule of testis. There was no significant difference in the values of sexual modulus. The results showed that testicular stiffness increased with age, but volume had no significant effect on testicular stiffness. Age had no significant effect on epididymal stiffness. [Conclusion] As a new diagnostic technique, SWE was used to evaluate testicular and epididymal stiffness. Relatively stable SWE elastic images can be obtained in the application of tissue hardness. Testicular hardness is characterized by a small central area and a large peripheral area. The hardness of the short axis section of the testis is greater than that of the long axis section. Testicular hardness increases with age. Large-scale clinical studies are still needed to validate and support these data and conclusions, but SWE, as a new imaging technique, is expected to be used in clinical evaluation of testicular stiffness and scrotal-related diseases. [Objective] To explore the application of Shear Wave Elastography (SWE) in the treatment of acute epididymitis. [Methods] From April 2016 to January 2017, 24 patients with acute epididymitis who received standardized treatment in our hospital were selected and 25 inflammatory masses in the caudal epididymis were recorded before treatment, 1 week, 2 weeks, 1 month, 2 months and 3 months after treatment. The SWE elastic modulus of epididymal inflammatory mass was compared with that of its size and quantity in the same time period. [Results] Before treatment, the average hardness (50.15 65 The average hardness was (35.82 +23.97) KPa, with an average size of (2.0 +1.98) cm 3 and 20 inflammatory masses; the average hardness was (23.42 +13.25) KPa, with an average size of (1.12 +1.58) cm 3 and 13 inflammatory masses at 1 month after treatment; the inflammatory masses were 2 at 2 months and all disappeared at 3 months after treatment. During the course of treatment, SWE elastic modulus of epididymal inflammatory mass decreased gradually, which indicated that the hardness of epididymal inflammatory mass decreased gradually.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R697.22

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