本文關(guān)鍵詞： 彈性應(yīng)變率比值(SR) 細(xì)針穿刺細(xì)胞學(xué)檢查(FNAC) 甲狀腺結(jié)節(jié) 甲狀腺影像數(shù)據(jù)報告與評分系統(tǒng)(TI-RADS)4-6類　出處：《南京醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：【目的】探討超聲彈性應(yīng)變率比值(SR)、細(xì)針穿刺細(xì)胞學(xué)檢查(FNAC)在TI-RADS 4-6類甲狀腺結(jié)節(jié)診斷和鑒別診斷中的應(yīng)用價值。【方法】常規(guī)超聲觀察303例(共324個結(jié)節(jié))甲狀腺結(jié)節(jié)的大小、邊界、內(nèi)部回聲、是否有鈣化、縱橫比、是否合并基礎(chǔ)病變及周邊血流情況等。依據(jù)甲狀腺影像數(shù)據(jù)報告與評分系統(tǒng)(TI-RADS)對甲狀腺結(jié)節(jié)進(jìn)行分類,所有結(jié)節(jié)均進(jìn)行超聲彈性成像并記錄彈性應(yīng)變率比值,繪制ROC曲線,確定鑒別診斷甲狀腺良惡性結(jié)節(jié)的彈性應(yīng)變率比值最佳界值。將137個TI-RADS 4-6類甲狀腺結(jié)節(jié)分組:Ⅰ組TI-RADS 4A類,Ⅱ組TI-RADS 4B類,Ⅲ組TI-RADS 5-6類(6類中除去已經(jīng)病理證實者),三組病例均進(jìn)行了彈性成像和FNAC,以病理結(jié)果為金標(biāo)準(zhǔn),分析彈性應(yīng)變率比值、FNAC在三組中良惡性結(jié)節(jié)之間是否有差異,并計算三組的敏感度、特異度、準(zhǔn)確性、陽性預(yù)測值。建立logistic模型,分析影響彈性應(yīng)變率比值鑒別診斷甲狀腺結(jié)節(jié)的因素�！窘Y(jié)果】彈性應(yīng)變率比值最佳診斷界值為0.54,彈性應(yīng)變率比值在Ⅰ組中差異無統(tǒng)計學(xué)意義,在Ⅱ、Ⅲ組中差異具有統(tǒng)計學(xué)意義。彈性應(yīng)變率比值鑒別診斷Ⅱ組和Ⅲ組的敏感性、特異性、準(zhǔn)確性、陽性預(yù)測值分別為90.9%、75.0%、87.5%、93.0%和85.7%、80.0%、84.6%、94.7%。通過Logistic回歸模型可知,甲狀腺結(jié)節(jié)的大小、鈣化、是否合并彌漫性病變與彈性應(yīng)變率比值的大小密切相關(guān),并且彈性應(yīng)變率比值在不合并鈣化、小于1cm、不合并彌漫性病變的甲狀腺結(jié)節(jié)中應(yīng)用價值較大。超聲引導(dǎo)下FNAC的準(zhǔn)確性、敏感性、特異性、陽性預(yù)測值三組分別為Ⅰ組:74.4%、73.3%、75.0%、64.7%;Ⅱ組:83.9%、87.5%、71.4%、91.3%;Ⅲ組:89.2%、91.7%、75.0%、95.6%。超聲引導(dǎo)下FNAC對Ⅰ組、Ⅱ組的陽性預(yù)測值高于TI-RADS分類標(biāo)準(zhǔn),差異有統(tǒng)計學(xué)意義,對Ⅲ組的陽性預(yù)測值與TI-RADS分類標(biāo)準(zhǔn)相近,差異無統(tǒng)計學(xué)意義�！窘Y(jié)論】對于Ⅱ、Ⅲ組中不合并鈣化、小于1cm、不合并彌漫性病變的患者,彈性應(yīng)變率比值具有較高的應(yīng)用價值;對于Ⅰ組,Ⅱ、Ⅲ組中合并鈣化、大于1cm、合并彌漫性病變患者彈性應(yīng)變率比值的應(yīng)用價值有限,對此類患者建議應(yīng)聯(lián)合應(yīng)用進(jìn)行細(xì)針穿刺,并同時結(jié)合其他相關(guān)檢查,早期做出明確診斷。
[Abstract]:[objective] to study the ultrasonic elastic strain rate ratio (SRR). The value of fine needle aspiration cytology in the diagnosis and differential diagnosis of TI-RADS 4-6 thyroid nodules. The size of a thyroid nodule. Boundary, internal echo, calcification, aspect ratio. The thyroid nodules were classified according to the thyroid imaging data reporting and scoring system (TI-RADS). All the nodules were examined by elastography and the ratio of elastic strain rate was recorded and the ROC curve was drawn. The best value of elastic strain rate ratio for differential diagnosis of benign and malignant thyroid nodules was determined. 137 TI-RADS 4-6 thyroid nodules were classified as group 鈪，

本文編號：1454561