本文關(guān)鍵詞： 超聲彈性成像 甲狀腺彌漫性病變 診斷　出處：《川北醫(yī)學院》2015年碩士論文　論文類型：學位論文

【摘要】：目的:探討超聲實時組織彈性成像(Real-time Tissue Elastography,RTE)對甲狀腺彌漫性病變的診斷及鑒別診斷價值。方法:選擇2014年2月至2014年10月在本院檢查發(fā)現(xiàn)的甲狀腺彌漫性病變患者156例作為病例組,其中毒性彌漫性甲狀腺腫(Graves’disease,GD)組46例,橋本氏甲狀腺炎(Hashimoto’s thyroiditis,HT)組94例,亞急性甲狀腺炎(Subacute thyroiditis,SAT)組16例,另選擇60例正常對照組。對病例組及正常組進行常規(guī)超聲及超聲實時組織彈性成像(RTE)檢查,獲得彈性分級評分及彈性參數(shù),各病變組與正常組間進行常規(guī)及彈性成像比較,各組彈性參數(shù)MEAN值與實驗室指標進行相關(guān)性分析,以臨床診斷為標準,繪制受試者操作特征曲線(Receiver Operating Characteristic curve,ROC曲線)尋找鑒別不同的甲狀腺彌漫性病變的界值點。結(jié)果:1.正常組及GD組腺體較軟,彈性圖像以綠色為主,夾雜少許紅色及藍色,彈性分級以1級為主(52/60,36/46),差異無統(tǒng)計學意義;HT組稍硬,彈性圖像以藍綠夾雜多見,彈性分級以2級為主(62/94);SAT組較硬,彈性圖像以藍色為主,彈性分級以3級及4級為主(6/16,10/16)。2.病例組與正常組的彈性參數(shù)比較,相對應(yīng)變均數(shù)(MEAN)依次為GD組正常組HT組SAT組,感興趣區(qū)域(Region of interest,ROI)藍色面積比例(%AREA)依次為SAT組HT組GD組正常組。除了GD組與正常組組間比較P0.05,其余各組組間比較P0.05。各組MEAN值與%AREA呈高度負相關(guān),Pearson相關(guān)系數(shù)r=-0.947,P0.001。3.根據(jù)ROC曲線下面積(Area under the curve,AUC)可知,GD組與HT組比較,AUC為0.958,GD的MEAN值高于HT組,當MEAN的界值點為119.6時,準確診斷出GD36例(共46例)診斷敏感性82.6%,特異性96.8%;SAT組與HT組比較,AUC為0.984,SAT組的MEAN值低于HT組,差異有統(tǒng)計學意義,當MEAN的界值點為60.6時,準確診斷出SAT15例(共16例),診斷敏感性95.7%,特異性93.3%。4.正常甲狀腺血流信號呈散在稀疏的點狀及短棒狀血流信號,均為1級(60/60);GD組血流信號明顯增多,部分呈“火海征”,分級以3級及4級為主(24/46,18/46);HT組大部分血流信號增多(79/94);SAT組病變區(qū)域血流信號多正常或稍減少,正常區(qū)域血流信號正�；蛏栽龆�,以1級為主(12/16)。5.甲狀腺血管搏動感在GD患者中常見,可作為特征性指標。6.甲狀腺彌漫性病變GD、HT、SAT的MEAN值與FT3、FT4呈低度正相關(guān),與TSH、Tg Ab、TPOAb無明顯相關(guān)性。7.常規(guī)超聲診斷GD、HT、SAT的準確率分別為78.3%、85.1%、87.5%,結(jié)合RTE準確率分別提高至91.3%、93.6%、100%。結(jié)論:超聲實時彈性成像(RTE)對甲狀腺彌漫性病變診斷與鑒別診斷有一定幫助,但對于聲像圖必須綜合分析,聯(lián)合常規(guī)超聲能提高診斷的準確率。
[Abstract]:Objective: to evaluate the value of real-time Tissue Elastography (RTE) in the diagnosis and differential diagnosis of diffuse thyroid lesions. Methods: from February 2014 to October 2014, the patients with diffuse thyroid lesions were selected. 156 cases as case groups, Among them, there were 46 cases in the GDgroup, 94 cases in the Hashimoto's thyroiditis group and 16 cases in the subacute thyroiditis subacute thyroiditis group, among which there were 46 cases in the GDgroup, 94 cases in the Hashimoto's thyroiditis group and 16 cases in the subacute thyroiditis group. In addition, 60 cases of normal control group were examined by conventional ultrasound and real-time tissue elastography (RTEs), and the elastic grading and elastic parameters were obtained. The conventional and elastic imaging were compared between each pathological group and the normal group. The correlation between the MEAN value of elastic parameters and the laboratory indexes was analyzed, and the clinical diagnosis was used as the standard. The receiver Operating Characteristic curve (ROC curve) was drawn to find the threshold points for distinguishing different diffuse thyroid lesions. Results: 1. The glands in normal group and GD group were soft, the elastic images were green and a little red and blue. The elastic grading was based on grade 1 (52 / 60 / 36 / 46). The difference was not statistically significant in HT group. Blue and green inclusions were more common in elastic images. In elastic grading, 62 / 94 / SAT group was more rigid, and blue was dominant in elastic images. The elastic grade of grade 3 and grade 4 were 6 / 16 / 10 / 16 / 16 路2.Compared with the normal group, the relative strain mean (RMSM) was GD group (HT group), HT group (SAT group), and normal group (P < 0.05). The blue area ratio of region of interest to area of interest is SAT group HT group GD group normal group, except GD group and normal group comparison P 0.05. The MEAN value of each group is highly negatively correlated with Ara and Pearson correlation coefficient rnr ~ 0.947 P 0.001.3.The value of MEAN in each group is negatively correlated with that of normal group (r = 0.947, P = 0.001. 3, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05, P = 0. 05). Under the ROC curve, the area under the MEAN value of GD group was higher than that of HT group, and the MEAN value of GD group was higher than that of HT group. When the threshold value of MEAN was 119.6, the diagnostic sensitivity of 46 cases of GD36 was 82.6, and the MEAN value of the group with specificity 96.8T was lower than that of the HT group. The difference was statistically significant when the threshold of MEAN was 60.6. Accurate diagnosis of SAT15 (16 cases, sensitivity 95.7m, specificity 93.3.4.The normal thyroid blood flow signal was scattered in sparse point and short rod blood flow signal, the blood flow signal was increased obviously in the GD group of grade 1 60 / 60%, the normal thyroid blood flow signal was scattered in the sparse point shape and short rod shape, all of which were grade 1 / 60 / 60 + GD group, the normal thyroid blood flow signal was increased obviously. Some of them showed "fire sign", and most of the blood flow signals were increased in 24 / 46 / 46 / 46 / 46 ~ (-1) HT group with grade 3 and grade 4. Most of the blood flow signals in the diseased area of the SAT group were normal or slightly decreased, but the blood flow signals in the normal area were normal or slightly increased. Thyroid vascular pulsation was common in GD patients, and could be used as a characteristic index. The MEAN value of GDT in diffuse thyroid lesions was positively correlated with FT3 / FT4. There was no significant correlation between T#en0# and T#en0#. 7. the accuracy of conventional ultrasound in the diagnosis of GDHT TPOSAT was 78.3% and 87.5%, respectively. The accuracy of RTE was improved to 91.3% and 93.66%, respectively. Conclusion: real time elastography is helpful in the diagnosis and differential diagnosis of diffuse thyroid lesions. But the sonogram must be analyzed synthetically, and the diagnostic accuracy can be improved by combining conventional ultrasound.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R445.1;R581

【參考文獻】

相關(guān)期刊論文 前10條

1 劉鳳菊;勇強;陶虹;;超聲實時組織彈性成像技術(shù)在甲狀腺彌漫性病變中的應(yīng)用[J];臨床超聲醫(yī)學雜志;2012年11期

2 余珊珊;韓東剛;王華;李小鵬;孫曉力;周琦;;局灶性亞急性甲狀腺炎的超聲診斷價值[J];臨床超聲醫(yī)學雜志;2013年01期

3 馬蘇亞;;超聲彈性成像技術(shù)在臨床上的應(yīng)用[J];現(xiàn)代實用醫(yī)學;2013年07期

4 羅葆明;歐冰;智慧;曾婕;楊海云;;改良超聲彈性成像評分標準在乳腺腫塊鑒別診斷中的價值[J];現(xiàn)代臨床醫(yī)學生物工程學雜志;2006年05期

5 羅建文,白凈;超聲彈性成像的研究進展[J];中國醫(yī)療器械信息;2005年05期

6 ;中國甲狀腺疾病診治指南——甲狀腺功能亢進癥[J];中華內(nèi)科雜志;2007年10期

7 羅葆明;曾婕;歐冰;智慧;;乳腺超聲彈性成像檢查感興趣區(qū)域大小對診斷結(jié)果影響[J];中國醫(yī)學影像技術(shù);2007年09期

8 俞清;徐智章;王文平;毛楓;黃備建;;甲狀腺占位性病變的實時超聲彈性成像表現(xiàn)[J];中國醫(yī)學影像技術(shù);2007年11期

9 林子梅;房世保;王建紅;孫詠梅;;聲觸診組織定量技術(shù)對甲狀腺彌漫性疾病的診斷價值[J];中華臨床醫(yī)師雜志(電子版);2013年01期

10 章晶;徐輝雄;張一峰;徐軍妹;劉暢;郭樂杭;劉琳娜;;聲輻射力脈沖彈性成像在甲狀腺單發(fā)實性結(jié)節(jié)良惡性鑒別診斷中的應(yīng)用價值[J];中華醫(yī)學超聲雜志(電子版);2013年05期

，

本文編號：1500993