本文關(guān)鍵詞： 聲脈沖彈性成像技術(shù) 聲觸診組織成像與定量 甲狀腺結(jié)節(jié) 超聲造影 剪切波速度　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討和比較聲脈沖彈性成像(ARFI)中聲觸診組織定量(VTQ)和聲觸診組織成像與定量(VTIQ)及超聲造影(CEUS)在甲狀腺TI-RADS4級結(jié)節(jié)中的鑒別診斷價(jià)值。方法:對83例患者的94個(gè)TI-RADS4級類甲狀腺結(jié)節(jié)分別行VTQ、VTIQ及CEUS檢查,獲取結(jié)節(jié)內(nèi)部剪切波速度值(SWV),算得SWV的中位數(shù)及平均值。繪制受試者操作特性(ROC)曲線確定一組準(zhǔn)確性最高的SWV,并獲得最佳診斷界值。再根據(jù)結(jié)節(jié)大小(≤1cm和1cm)比較兩者對大小不同結(jié)節(jié)的診斷效能。后行CEUS,觀察結(jié)節(jié)CEUS的增強(qiáng)表現(xiàn)。以病理結(jié)果為金標(biāo)準(zhǔn),評估和對比VTIQ及CEUS在診斷甲狀腺TI-RADS4級類結(jié)節(jié)中的準(zhǔn)確性。結(jié)果:94個(gè)TI-RADS4級類甲狀腺結(jié)節(jié)中包括53個(gè)良性結(jié)節(jié)和41個(gè)惡性結(jié)節(jié)。(1)VTQ中測量良性結(jié)節(jié)SWV的中位數(shù)、平均值分別為2.57±0.29m/s、2.59±0.29m/s,惡性結(jié)節(jié)的分別為2.95±0.41m/s、2.98±0.39m/s;VTIQ中,良性結(jié)節(jié)的中位數(shù)、平均值為2.74±0.35m/s、2.71±0.37m/s,惡性結(jié)節(jié)的為3.28±0.32m/s、3.24±0.29m/s,結(jié)果顯示良性組與惡性組的SWV有統(tǒng)計(jì)學(xué)差異。繪制ROC曲線,發(fā)現(xiàn)以平均值為取樣參數(shù)時(shí)曲線下面積(AUC)大于中位數(shù),但差異無統(tǒng)計(jì)學(xué)意義(P0.05),認(rèn)為SWV以平均值為取樣參數(shù)更佳,其診斷界值分別為2.83m/s、2.92m/s。(2)根據(jù)結(jié)節(jié)大小(≤1cm和1cm)分為兩組,繪制ROC曲線,得出結(jié)節(jié)≥1cm時(shí),VTQ、VTIQ的AUC分別為0.816、0.834;結(jié)節(jié)1cm,AUC分別為0.756、0.896,采用Z檢驗(yàn)比較曲線下面積,結(jié)節(jié)≥1cm時(shí),統(tǒng)計(jì)學(xué)無差異(P0.05),當(dāng)結(jié)節(jié)1cm時(shí),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)CEUS診斷甲狀腺結(jié)節(jié)時(shí),發(fā)現(xiàn)良性結(jié)節(jié)大多以環(huán)狀增強(qiáng)、高增強(qiáng)、等增強(qiáng)為主,惡性結(jié)節(jié)多以低增強(qiáng)為主。以此為依據(jù)診斷結(jié)節(jié)良惡性的敏感度、特異度、準(zhǔn)確率、陽性預(yù)測值、陰性預(yù)測值分別為75.6%、84.90%、82.97%、83.78%、82.45%。(4)采用卡方檢驗(yàn)比較VTIQ與CEUS的診斷效能,P0.05,認(rèn)為統(tǒng)計(jì)學(xué)無差異。結(jié)論:(1)ARFI技術(shù)與CEUS技術(shù)在TI-RADS4級類甲狀腺結(jié)節(jié)中均具有診斷價(jià)值,SWV用平均值為取樣參數(shù)時(shí)準(zhǔn)確性更高。(2)VTIQ較VTQ在診斷結(jié)節(jié)良惡性時(shí)效能更優(yōu),尤其是對≤1cm的病灶。(3)VTIQ與CEUS在甲狀腺TI-RADS4級類結(jié)節(jié)診斷效能相當(dāng)。
[Abstract]:Objective: to investigate and compare the differential value of acoustic palpation tissue quantification (VTQ) and acoustic palpation tissue imaging (VTIQ) and contrast-enhanced ultrasound (CEUs) in the diagnosis of thyroid TI-RADS4 grade nodules in ARFI. Methods: Eighty-three cases of thyroid TI-RADS4 nodule were studied. Patients with TI-RADS4 grade thyroid nodules were examined with VTQT IQ and CEUS, respectively. The median and average value of SWV was calculated by obtaining the velocity of shear wave inside the nodule. A set of SWVs with the highest accuracy was determined by drawing the operating characteristic curve of the subjects, and the best diagnostic limit was obtained. Then according to the nodule size (鈮，

本文編號：1515505