本文選題：甲狀腺結(jié)節(jié) + 剪切波彈性成像(SWE)��； 參考：《南京醫(yī)科大學》2017年碩士論文

【摘要】：[目的]探討超聲實時剪切波彈性成像(shearwaveelastography,SWE)楊氏模量最大值(Emax)在甲狀腺實性結(jié)節(jié)良惡性鑒別診斷中的應用價值。[方法]采用Supersonic Imagine Aixplorer型彩色多普勒超聲診斷儀(法國),線陣探頭L15-4(頻率為4-15MZ)。常規(guī)超聲觀察并詳細記錄252例患者的297個甲狀腺結(jié)節(jié)的大小、形態(tài)、內(nèi)部回聲、邊界、縱橫比、是否有鈣化、周邊及內(nèi)部血流及有無淋巴結(jié)轉(zhuǎn)移等。依據(jù)甲狀腺影像數(shù)據(jù)報告及評分系統(tǒng)(TI-RADS)對甲狀腺結(jié)節(jié)進行分類,所有結(jié)節(jié)進行剪切波彈性成像并記錄楊氏模量值,以病理為金標準,采用對數(shù)正態(tài)分布統(tǒng)計模型對甲狀腺結(jié)節(jié)Emax值進行擬合。根據(jù)Emax值的期望值和95%概率值的統(tǒng)計學意義,提出了鑒別診斷甲狀腺結(jié)節(jié)病變良惡性性質(zhì)的Emax值的界值范圍,并計算出界值范圍對甲狀腺結(jié)節(jié)良惡性診斷的特異性和敏感性。將其中TI-RADS3-4類的186個甲狀腺結(jié)節(jié)分為兩組,Ⅰ組:結(jié)節(jié)直徑≤1Omm組,共74個結(jié)節(jié);Ⅱ組:直徑10mm組,共112個結(jié)節(jié)。以病理結(jié)果為金標準,繪制ROC曲線,計算甲狀腺結(jié)節(jié)Emax值最佳界值,并計算出SWE在不同大小的TI-RADS3-4類甲狀腺結(jié)節(jié)以及合并橋本甲狀腺炎的甲狀腺結(jié)節(jié)鑒別診斷中的敏感性、特異性和準確性。[結(jié)果]當甲狀腺結(jié)節(jié)楊氏模量最大值Emax45kPa,甲狀腺結(jié)節(jié)良性概率大于惡性概率,此區(qū)間內(nèi)良性結(jié)節(jié)的可能性大于50%;45kPa≤Emax70kPa,甲狀腺結(jié)節(jié)可疑異常病變,此區(qū)間內(nèi)良惡性結(jié)節(jié)概率各占50%左右;70kPa≤Emax120 kPa,甲狀腺惡性結(jié)節(jié)可能性大于良性,此區(qū)間內(nèi)惡性結(jié)節(jié)的概率大于50%;Emax≥120kPa,甲狀腺結(jié)節(jié)高度可疑惡性,結(jié)節(jié)為良性的可能性小于5%;其中,31%甲狀腺良性結(jié)節(jié)和37%惡性結(jié)節(jié)中不能采用Emax值直接判斷結(jié)節(jié)性質(zhì);在可以判別性質(zhì)的結(jié)節(jié)中:甲狀腺良性結(jié)節(jié)的特異性78%,假陰性率22%;甲狀腺惡性結(jié)節(jié)的敏感性76%,假陽性率24%。甲狀腺結(jié)節(jié)Emax值最佳診斷界值為52.5kPa,Ⅰ組和Ⅱ組的敏感性、準確性及特異性分別為57.4%、66.2%及90%和87.5%、79.5%及68.8%。合并橋本甲狀腺炎的甲狀腺結(jié)節(jié)Emax值最佳診斷界值為54.4kPa,其敏感性、特異性及準確性分別為64.4%、68.4%及65.62%。[結(jié)論]實時剪切波彈性成像楊氏模量最大值Emax值對甲狀腺結(jié)節(jié)的良惡性鑒別有統(tǒng)計學意義,同時在評估甲狀腺結(jié)節(jié)良惡性的風險中具有較高的臨床意義。在Ⅰ、Ⅱ組中,SWE對Ⅱ組(10mm)甲狀腺結(jié)節(jié)更有鑒別診斷價值;對Ⅰ組(≤10mm)及合并橋本甲狀腺炎的甲狀腺結(jié)節(jié)診斷價值有限,對此類患者建議應聯(lián)合其他相關(guān)檢查,盡早明確診斷。
[Abstract]:[objective] to evaluate the value of Emax in differential diagnosis of benign and malignant solid thyroid nodules.[methods] using Supersonic Imagine Aixplorer color Doppler ultrasound diagnostic instrument (France), linear array probe L15-4 (frequency 4-15 MZD).The size, shape, internal echo, boundary, aspect ratio, calcification, peripheral and internal blood flow and lymph node metastasis of 297 thyroid nodules were observed and recorded by conventional ultrasound.Thyroid nodules were classified according to the thyroid imaging data reporting and scoring system (TI-RADS). All the nodules were examined with shear wave elastic imaging and the Young's modulus was recorded.The logarithmic normal distribution statistical model was used to fit the Emax value of thyroid nodules.According to the statistical significance of the expected value of Emax value and 95% probability value, the boundary value range of Emax value for differential diagnosis of benign and malignant nature of thyroid nodule disease was put forward, and the specificity and sensitivity of the range of Emax value for the diagnosis of benign and malignant thyroid nodule were calculated.One hundred and eighty-six thyroid nodules of TI-RADS3-4 type were divided into two groups: group 鈪，

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