增强超声内镜定量分析在良恶性淋巴结鉴别诊断中的作用

发布时间：2018-02-14 01:31

本文关键词： 超声内镜淋巴结对比增强时间强度曲线　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:淋巴结是癌症TMN分期非常重要的评价因素,影响着癌症病人的手术方式的决策及预后的判断,因此良恶淋巴结的鉴别诊断在临床实践中起着至关重要的作用。影像学技术在纵隔及腹腔内疾病诊断中的发展为淋巴结诊断的相关研究带了更多的可能性。电子计算机断层扫描(CT)与磁共振成像(MRI)对淋巴结诊断的准确率往往很低。正电子发射计算机断层显像(PET-CT)由于其价格昂贵,并未得到广泛应用。第二代造影剂声诺维与低机械指数(MI)超声成像技术的结合使得增强超声内镜(CE-EUS)更加广泛地应用于临床。CE-EUS作为一种无创性检查方法对于诊断无法行超声内镜引导下细针穿刺(EUS-FNA)或获得组织量较少的淋巴结异常患者占据着举足轻重的位置,并可以提高EUS-FNA诊断准确率。时间-强度曲线(TIC)能够通过描绘血流灌注的参数标准地量化灌注模式,从而提高诊断准确率。目前并没有CE-EUS定量分析在良恶淋巴结鉴别诊断中的相关研究。研究目的:本文采用旨在通过前瞻性研究比较纵隔及腹腔良恶淋巴结在CE-EUS下血流灌注模式的不同,并采用TIC分析法比较两者血流灌注的参数。材料和方法:本研究为前瞻性研究。选取2015年10月至2016年12月行CT、MRI、腹部超声、PET-CT等检查发现不明原因淋巴结异常于山东大学齐鲁医院消化内镜室行超声内镜检查患者48例,观察淋巴结共50枚。以EUS-FNA病理或细胞学结果、手术病理及随访结果为最终诊断标准,分析良恶淋巴结CE-EUS增强模式以及TIC表现上的不同,并评价CE-EUS定量分析诊断良恶淋巴结的准确性。结果:50枚淋巴结中23枚淋巴结最终诊断为恶性,19枚为良性,8枚为正常淋巴结。恶性淋巴结的血流灌注模式为不均匀增强或不增强,大多数良性淋巴结表现为均匀增强,正常淋巴结均表现为不增强血流灌注模式。恶性淋巴结的TIC特点为低峰值、平缓的上升支及下降支,而良性淋巴结表现为高峰值、陡峭的上升支及下降支,正常淋巴结近似一条直线。良性与恶性淋巴结TIC参数中峰值、最大强度获得值、增强速度以及消退速度4种TIC参数的差别具有统计学意义(P0.05)。TIC参数鉴别良恶性淋巴结的敏感性、特异性、阳性预测值、阴性预测值最高可至94%、82.6%、82.9%、93.3%,其敏感性、阴性预测值明显高于EUS-FNA,但特异性与阳性预测值较低。结论:CE-EUS能够有效地鉴别良恶淋巴结。不均匀增强血流灌注或不增强血流灌注模式对诊断恶性淋巴结具有提示意义。在CE-EUS定量分析中,恶性淋巴结表现为低峰值、慢增强速度以及慢消退速度。TIC量化分析法并不能替代EUS-FNA在良恶淋巴结鉴别诊断的作用,但是可以作为一种辅助手段能够有效提高EUS-FNA诊断的准确率。
[Abstract]:Background: lymph nodes are very important factors in evaluating the TMN staging of cancer, which affect the surgical decision and prognosis of cancer patients. Therefore, the differential diagnosis of benign and malignant lymph nodes plays an important role in clinical practice. The development of imaging techniques in mediastinal and intra-abdominal diseases may lead to more research on the diagnosis of lymph nodes. The accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of lymph nodes is often very low. The combination of the second generation contrast agent with low mechanical index (MII) ultrasound imaging makes enhanced EUS (CE-EUS) more widely used in clinic as a noninvasive method for diagnosis. Patients with EUS-FNA-FNA-EUS guided by endoscopic ultrasound or lymph node abnormalities with less tissue play an important role. It can improve the diagnostic accuracy of EUS-FNA. The time-intensity curve can quantify the perfusion pattern by describing the parameters of blood perfusion. In order to improve the diagnostic accuracy, there is no CE-EUS quantitative analysis in the differential diagnosis of benign and malignant lymph nodes. Objective: to compare mediastinal and abdominal benign and malignant lymph nodes under CE-EUS by prospective study. Different blood flow patterns, Materials and methods: this study is a prospective study. Selected from October 2015 to December 2016, CTT MRI, abdominal ultrasound, PET-CT and other examinations found unknown cause lymph node abnormalities in Shandong Province. Forty-eight patients underwent endoscopic ultrasonography in the digestive endoscopy room of Qilu Hospital. A total of 50 lymph nodes were observed. The final diagnostic criteria were the pathological or cytological results of EUS-FNA, surgical pathology and follow-up results. The enhancement mode of CE-EUS and the difference of TIC manifestations in benign and malignant lymph nodes were analyzed. The accuracy of quantitative analysis of CE-EUS in the diagnosis of benign and malignant lymph nodes was evaluated. Results 23 of 50 lymph nodes were diagnosed as malignant, and 8 were benign and 8 were normal. The perfusion pattern of malignant lymph nodes was inhomogeneous or non-enhanced. Most of the benign lymph nodes showed homogeneous enhancement, while the normal lymph nodes showed no enhancement of blood flow perfusion. The TIC of malignant lymph nodes was characterized by low peak value, gentle ascending and descending branches, and high peak value of benign lymph nodes. Steep ascending and descending branches, normal lymph nodes approximating a straight line. Peak value in TIC parameters of benign and malignant lymph nodes, maximum intensity obtained, The differences of four TIC parameters of enhancement speed and regression speed were statistically significant. The sensitivity, specificity, positive predictive value, negative predictive value and negative predictive value of the four TIC parameters for differentiating benign and malignant lymph nodes were statistically significant. The negative predictive value was significantly higher than that of EUS-FNA.The specificity and positive predictive value of the negative predictive value were lower. Conclusion: CE-EUS can effectively distinguish benign and malignant lymph nodes. The pattern of uneven enhancement of blood flow perfusion or non-enhancement of blood flow perfusion pattern may be helpful in the diagnosis of malignant lymph nodes. In CE-EUS quantitative analysis, The quantitative analysis of EUS-FNA can not replace the role of EUS-FNA in the differential diagnosis of benign and malignant lymph nodes, but it can effectively improve the accuracy of diagnosis of EUS-FNA as an auxiliary method.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R730.44

【相似文献】