声触诊组织成像和定量技术及阻力指数在乳腺导管内癌的诊断价值

发布时间：2018-02-02 10:24

本文关键词： 声触诊组织成像和定量阻力指数乳腺导管内癌诊断　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过观察病灶常规二维声像图特征和病灶内部及周边血流阻力指数的大小,同时使用声触诊组织成像和定量剪切波弹性成像技术对乳腺病灶进行评估,探讨乳腺病灶血流阻力指数增高及VTIQ剪切波弹性成像技术对乳腺导管内癌的诊断价值。方法本研究共收集2015年6月～2016年11月在在我院行超声检查并手术切除病理证实的患者106个乳腺结节。病灶选取时满足以下任何一项者均纳入;1.病灶纵横比大于1;2.病灶边界模糊不清;3.病灶周边可见血流信号;4,病灶形态不规则;5.病灶大小适中。使用VTIQ技术进行测量时,选取病灶的最大切面,使用VTIQ技术对病灶内部剪切波速度(SWV)进行测量。在VTIQ速度模式下,多次对有效区域的SWV进行测量(5～7组),取均值,单位为m/s。R0I取样时,根据VTIQ二维剪切波弹性图像中不同色彩,将ROI分别置于病灶内部SWV最高区域、最低区域及周边和中央区域。重点观察病灶血供的类型及血流的丰富程度,并对病灶内部血流阻力指数进行测量,当病灶内多条血流信号者,取其阻力指数最高的进行测量,并记录其峰值流速。所有的常规超声图像及VTIQ图像均存贮于机器硬盘内,以备更进一步分析。以病理结果为金标准,比较乳腺导管内癌组与良性组SWV及血流阻力指数的差异,分析VTIQ技术及病灶血流阻力指数对于乳腺导管内癌的诊断价值。结果:据病理所示,106例乳腺病灶中37例为乳腺导管内癌,32例为导管内乳头状瘤,31例为乳腺增生伴腺瘤形成,6例为良性分叶状肿瘤。106例乳腺病灶中,有82例病灶有血流信号,其中血供类型为边缘型的有63例,穿支型的有19例。边缘型中有31例为导管内癌,32例为良性病变。穿支型中有4例为导管内癌,15例为良性病变。边缘型乳腺导管内癌的血流阻力指数为(0.704±0.05),边缘型乳腺良性病变血流阻力指数为(0.616±0.056),t值为-5.08,P值小于0.01,差异具有统计学意义。穿支型因病例数过少,缺乏统计学意义。乳腺导管内癌组的平均SWV值为(4.58±1.27),乳腺良性病变组的平均SWV值为(2.80±0.92),t值为10.33,P0.01,差异具有统计学意义,绘制ROC曲线,ROC曲线显示:VTIQ技术测得的SWV鉴别诊断乳腺肿块导管内癌与良性病变的阈值为4.09m/s,曲线下面积为0.827(95%CI:0.771～0.882,P0.001)。ROC曲线显示,VTIQ技术鉴别诊断乳腺肿块良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值、Youden指数分别为87.9%、83%、75.0%、78.5%、86.7%、0.61。结论病灶边缘区血流阻力指数对于鉴别乳腺导管内癌及良性病变来说有一定的指导价值。对于乳腺导管内癌的诊断来说,VTIQ剪切波技术具有一定的参考价值使用,对于乳腺导管内癌的检出可以提供帮助。因而,当二维超声无法鉴别肿块的良恶性时,使用VTIQ技术及测量病灶边缘区血流阻力指数可以为诊断提供参考价值。
[Abstract]:Objective to evaluate the lesions of breast by observing the characteristics of conventional two-dimensional sonography and the size of the internal and peripheral blood flow resistance index, and using acoustic palpation tissue imaging and quantitative shear wave elastography. To investigate the diagnostic value of high blood flow resistance index of breast lesions and VTIQ shear wave elastography in breast ductal carcinoma. Methods this study was performed in our hospital from June 2015 to November 2016. 106 breast nodules were examined by ultrasonography and surgically resected pathologically. 1. The aspect ratio of the lesion was greater than 1; 2.The boundary of lesion was blurred; 3. Blood flow signal was seen around the lesion. 4the shape of the lesion was irregular; 5. The size of the lesion was moderate. When VTIQ technique was used to measure the lesion, the largest section of the lesion was selected. The internal shear wave velocities of lesions were measured by VTIQ technique. In the VTIQ mode, the SWV in the effective region was measured several times, and the mean value was taken. According to the different colors of VTIQ two-dimensional shear wave elastic image, the ROI was placed in the highest area of SWV in the lesion. The lowest region and peripheral and central regions. The types of blood supply and the abundance of blood flow were observed, and the blood flow resistance index was measured when there were multiple blood flow signals in the lesions. The highest resistance index was measured and the peak velocity was recorded. All conventional ultrasound images and VTIQ images were stored in the machine hard disk for further analysis. The pathological results were taken as the gold standard. To compare the difference of SWV and blood flow resistance index between breast intraductal carcinoma group and benign group, and analyze the diagnostic value of VTIQ technique and focus blood flow resistance index in breast intraductal carcinoma. Of 106 breast lesions, 37 were intraductal carcinoma, 32 were intraductal papilloma, 31 were hyperplasia of mammary gland with adenoma, 6 were benign lobular tumor. There were 82 lesions with blood flow signal, including 63 cases with marginal type of blood supply, 19 cases with perforating branch type and 31 cases with intraductal carcinoma. 32 cases were benign lesions, 4 cases were intraductal carcinoma and 15 cases were benign lesions. The blood flow resistance index of marginal breast ductal carcinoma was 0.704 卤0.05). The blood flow resistance index of marginal breast benign lesions was 0.616 卤0.056 t = -5.08% P < 0.01, the difference was statistically significant, and the number of perforating type cases was too small. The average SWV value of breast intraductal carcinoma group was 4.58 卤1.27 and that of benign breast lesion group was 2.80 卤0.92). T value was 10.33% (P 0.01), the difference was statistically significant, and the ROC curve was drawn. The ROC curve showed that the threshold value of SWV for differential diagnosis of intraductal carcinoma and benign lesions in breast masses was 4.09 m / s. The area under the curve was 0.827 / 95. The sensitivity of VTIQ in differential diagnosis of benign and malignant breast masses was demonstrated by the curve of ROC. Specificity, accuracy, positive predictive value, negative predictive value and Youden index were 87.9% and 83.3%, respectively. Conclusion the blood flow resistance index in the marginal region of breast lesions is valuable in differentiating breast intraductal carcinoma from benign lesions, and is useful for the diagnosis of breast intraductal carcinoma. VTIQ shear wave technique has a certain reference value for the detection of breast intraductal carcinoma. Therefore, when two-dimensional ultrasound can not distinguish benign and malignant tumors. The use of VTIQ technique and the measurement of the blood flow resistance index in the marginal region of the lesion can provide a reference value for the diagnosis.
【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;R737.9

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