本文選題：聲輻射力脈沖成像技術(shù)　切入點(diǎn)：BI-RADS　出處：《蘇州大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:1.探討聲輻射力脈沖成像技術(shù)(acoustic radiation force impulse,ARFI),包括聲觸診組織成像(virtual touch tissue imaging,VTI)技術(shù)和聲觸診組織定量(virtual touch tissue quantification,VTQ)技術(shù)在乳腺良惡性腫塊鑒別診斷中的應(yīng)用價值。2.以乳腺腫塊內(nèi)部區(qū)域的剪切波速度(shear wave velocity,SWV)平均值,構(gòu)建受試者工作特性曲線(receiver operator characteristic curve,ROC)獲得SWV最佳截斷值,為乳腺病變良惡性鑒別提供新的觀察指標(biāo)。3.探討舊版及新版BI-RADS分級對乳腺腫塊良惡性鑒別的診斷價值。4.ARFI技術(shù)聯(lián)合新版BI-RADS分級診斷標(biāo)準(zhǔn)對乳腺腫塊良惡性鑒別的診斷價值。資料與方法:本研究入選2014年11月~2015年7月于無錫第二人民醫(yī)院就診發(fā)現(xiàn)有乳腺腫塊的女性患者107例,共123個腫塊。所有病例均手術(shù)或穿刺活檢后經(jīng)病理證實(shí),其中良性腫塊76個,惡性腫塊47個。超聲診斷儀:Siemens Acuson S2000,具備聲輻射力脈沖成像技術(shù)。所有腫塊均先在二維超聲模式下觀察乳腺腫塊的大小、形態(tài)、內(nèi)部回聲、周圍組織情況等,然后進(jìn)入彩色多普勒觀察乳腺腫塊及周邊的血流情況,用頻譜多普勒超聲技術(shù)測量乳腺腫塊阻力指數(shù)。對腫塊進(jìn)行bi-rads分級后,運(yùn)用vti技術(shù)獲取乳腺腫塊vti圖像,對腫塊進(jìn)行評分。再用vtq技術(shù)分別測量腫塊內(nèi)部、腫塊邊緣處及周圍正常乳腺腺體的swv值,各測量5次,取平均值,對以上數(shù)據(jù)應(yīng)用統(tǒng)計學(xué)軟件進(jìn)行統(tǒng)計分析,判斷vtq技術(shù)對乳腺腫塊良惡性的診斷價值,p0.05為差異有統(tǒng)計學(xué)意義。研究結(jié)果:1.vti技術(shù)評分法評分1~3分判斷為良性,4~5分判斷為惡性,鑒別診斷乳腺腫塊的準(zhǔn)確性、敏感性、特異性分別為87.00%(107/123)、85.11%(40/47)、88.16%(67/76)。vtq技術(shù)乳腺良性腫塊組腫塊內(nèi)部、邊緣及正常乳腺swv平均值分別為2.66±0.99m/s、2.55±0.78m/s、1.92±0.48m/s;乳腺惡性腫塊組腫塊內(nèi)部、邊緣及正常乳腺swv平均值分別為5.75±2.11m/s、4.43±1.78m/s、2.46±0.57m/s。乳腺良性腫塊組與乳腺惡性腫塊組腫塊內(nèi)部的swv平均值比較具有統(tǒng)計學(xué)差異(p0.01)。2.以病理結(jié)果為金標(biāo)準(zhǔn),以乳腺腫塊內(nèi)部區(qū)域的swv均值構(gòu)建roc,所得的曲線下面積(areaundercurve,auc)為0.911,約登指數(shù)最大值為0.809,該點(diǎn)所對應(yīng)的swv最佳診斷臨界值為3.795m/s,其診斷乳腺腫塊的準(zhǔn)確性89.43%(110/123)、敏感性80.85%(38/47)、特異性94.74%(72/76)。3.舊版bi-rads分級鑒別診斷乳腺腫塊良惡性的準(zhǔn)確性79.67%(98/123)、敏感性89.36%(42/47)、特異性73.68%(56/76);新版BI-RADS分級鑒別診斷乳腺腫塊良惡性的準(zhǔn)確性86.99%(107/123)、敏感性82.98%(39/47)、特異性89.47%(68/76)。新版BI-RADS與舊版BI-RADS分級診斷的準(zhǔn)確性、特異性之間有統(tǒng)計學(xué)差異(P0.05)。4.ARFI技術(shù)(VTI技術(shù)+VTQ技術(shù))聯(lián)合新版BI-RADS分級診斷標(biāo)準(zhǔn)鑒別診斷乳腺腫塊良惡性的準(zhǔn)確性、敏感性分別為89.43%、91.49%,均高于單一一種方法,但相互間兩兩比較均無統(tǒng)計學(xué)意義。結(jié)論:1.ARFI技術(shù)作為二維超聲的有效補(bǔ)充,在乳腺良惡性腫塊的鑒別診斷方面有較高的臨床應(yīng)用價值,ARFI技術(shù)能客觀定量定性評價腫塊硬度信息,VTI技術(shù)可定性鑒別乳腺腫塊的良惡性,VTQ技術(shù)SWV平均值以3.795m/s為界,可區(qū)分乳腺良、惡性腫塊。2.新版BI-RADS分級診斷乳腺良惡性腫塊的準(zhǔn)確性、特異性高于舊版BI-RADS分級。3.ARFI技術(shù)與新版BI-RADS聯(lián)合診斷后,可提高對乳腺腫塊良惡性的鑒別診斷能力。
[Abstract]:Objective: 1. to investigate the acoustic radiation force impulse imaging technology (acoustic radiation force impulse, ARFI), including virtual touch tissue imaging (virtual touch tissue imaging, VTI) technology and virtual touch tissue (virtual touch tissue quantification quantitative, VTQ) application value of.2. in differential diagnosis of benign and malignant breast tumors using shear internal region of breast mass velocity (shear wave velocity, SWV) on average, construct the receiver operating characteristic curve (receiver operator characteristic curve, ROC SWV) to obtain the optimal cut-off value, provide a new observation index of.3. for differentiating malignant from benign breast lesions and to investigate the diagnostic value and classification of the old version of the new version of BI-RADS in the diagnosis of breast cancer diagnosis the value of.4.ARFI technology combined with the new BI-RADS classification criteria for the differential diagnosis of breast tumors. Materials and methods: This study selected in November 2014 ~2015 In July Second People's Hospital of Wuxi were found in 107 cases of female patients with breast tumors, a total of 123 tumors. All cases after surgery or biopsy confirmed by pathology, including 76 benign lesions, 47 were malignant. Ultrasonic diagnostic instrument: Siemens Acuson S2000, with acoustic radiation force impulse imaging technology. The masses were first in the two-dimensional ultrasound mode observation of breast tumor size, shape, internal echo, surrounding tissues, and then enter the color Doppler to observe the blood flow of breast masses and the surrounding, with spectral Doppler ultrasound measurement of breast mass technical resistance index. BI-RADS classification of tumor of breast masses, obtaining VTI images using VTI Technology wasassessed by vtq technology. Mass were measured within the mass, mass at the edge and surrounding normal breast glands SWV values, measured 5 times, taking the average value, the data should be Statistical analysis was performed using SPSS software, determine the value of vtq in the diagnosis of benign and malignant breast tumors, P0.05 was considered significant. Results: 1.vti scoring 1~3 points to judge benign, 4~5 judgment of malignant, the accuracy of diagnosis of breast masses sensitivity and specificity were 87% (107/123). 85.11% (40/47), 88.16% (67/76).Vtq group of benign breast tumor and normal breast lumps inside edge of the average value of SWV was 2.66 + 0.99m/s, 2.55 + 0.78m/s, 1.92 + 0.48m/s; breast tumor group and normal breast lumps inside edge of the average value of SWV was 5.75 + 2.11m/s, 4.43 + 1.78m/s, 2.46 0.57m/s. + benign breast tumor group and malignant tumor of breast tumor group internal SWV average value was statistically difference (P0.01).2. with pathological results as the gold standard to construct the ROC internal region of breast masses SWV mean, The area under the curve (areaundercurve, AUC) is 0.911, the maximum value of Youden's index was 0.809, the corresponding SWV optimal diagnostic critical value was 3.795m/s, the diagnosis of breast tumor with accuracy of 89.43%, sensitivity of 80.85% (110/123) (38/47), specificity 94.74% (72/ 76).3. the old version of the BI-RADS classification of differential diagnosis the accuracy of benign and malignant breast tumors 79.67% (98/123), the sensitivity was 89.36%, specificity 73.68% (42/47) (56/76); the new BI-RADS classification of differential diagnosis of benign and malignant breast tumors and the accuracy of 86.99%, sensitivity of 82.98% (107/123) (39/47), specificity 89.47% (68/76). The accuracy of the new BI-RADS with the old version of the BI-RADS classification. There were significant differences in the specificity between (P0.05).4.ARFI (VTI +VTQ) with a new version of the BI-RADS grading diagnosis standard in differential diagnosis of benign and malignant breast tumors of the accuracy, the sensitivity were 89.43%, 91.49%, were higher than that of a single Among the 22 methods, but the difference was not statistically significant. Conclusion: 1.ARFI technology is an effective supplement to two-dimensional ultrasound, high in differential diagnosis of benign and malignant breast tumors and the clinical application value, ARFI technology can objectively and quantitatively assess the mass hardness information, VTI technology can be qualitative identification of breast tumor, VTQ technology the average value of SWV to 3.795m/s, can distinguish between breast benign and malignant tumors,.2. version of the BI-RADS classification accuracy in diagnosis of benign and malignant breast tumors that is more specific than the old version of the BI-RADS.3.ARFI technology combined with the new version of the BI-RADS grading diagnosis, can improve the differential diagnosis of benign and malignant breast masses.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R445.1;R737.9

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