本文選題：甲狀腺結(jié)節(jié) + 剪切波彈性成像�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:比較剪切波彈性成像(SWE)測得的各楊氏模量在甲狀腺結(jié)節(jié)良惡性鑒別診斷中的價值;建立以常規(guī)超聲征象及SWE楊氏模量為回歸參數(shù)的Logistic回歸模型,比較回歸模型與常規(guī)超聲在診斷甲狀腺惡性結(jié)節(jié)中的價值。方法:對擬行甲狀腺切除術(shù)或細(xì)針穿刺活檢術(shù)的104例患者共258個結(jié)節(jié)在術(shù)前行常規(guī)超聲及SWE檢查。記錄各結(jié)節(jié)常規(guī)超聲征象和楊氏模量(Emax、Emean、Emin、Esd、E-ratio)。對比甲狀腺結(jié)節(jié)的病理結(jié)果,繪制出常規(guī)超聲與SWE的ROC曲線,比較SWE與常規(guī)超聲的診斷甲狀腺惡性結(jié)節(jié)價值,并獲得各楊氏模量診斷甲狀腺惡性結(jié)節(jié)的最佳臨界值。通過Logistic回歸分析,比較與甲狀腺惡性結(jié)節(jié)相關(guān)超聲征象的價值,建立回歸模型。結(jié)果:(1)最終納入本研究的甲狀腺結(jié)節(jié)患者有89例,共有180個結(jié)節(jié),惡性者34個,良性者146個。(2)常規(guī)超聲征象的單因素分析中,甲狀腺惡性結(jié)節(jié)以縱橫比≥1、極低回聲、微鈣化、邊界不清、邊緣不規(guī)則、不規(guī)則聲暈、后方回聲衰減、甲狀腺被膜受侵等征象多見,但上述征象診斷甲狀腺惡性結(jié)節(jié)的價值有所局限。(3)SWE下,Emax、Emean及Esd在甲狀腺良惡性結(jié)節(jié)中有差異(P0.01)惡性結(jié)節(jié)較良性結(jié)節(jié)硬度大。(4)Emax、Emean及Esd診斷甲狀腺惡性結(jié)節(jié)的最佳臨界值分別為52.07kPa、32.4kPa、6.6kPa。(5)Emax、Esd的ROC曲線形下面積(AUC)較Emean更大,且有統(tǒng)計(jì)學(xué)差異(0.845、0.804Vs0.680,P0.001),但Emax與Esd之間無差異(0.845 Vs 0.804,P=0.170)。與常規(guī)超聲診斷甲狀腺惡性結(jié)節(jié)的AUC相比,Emax、Esd的AUC較小(0.845、0.804Vs0.882),但差異無統(tǒng)計(jì)學(xué)意義(PEmax=0.392,PEsd=0.058)。(6)Logistic回歸分析中,與甲狀腺惡性結(jié)節(jié)相關(guān)的獨(dú)立因素為形態(tài)、邊緣與Emax,并建立了回歸模型;(7)該回歸模型診斷甲狀腺惡性結(jié)節(jié)的特異度(95.89%Vs 82.19%)、準(zhǔn)確度(93.33%Vs 84.44%)及AUC高于常規(guī)超聲(0.958 Vs 0.882),且差異均有統(tǒng)計(jì)學(xué)意義(P≤0.002)。結(jié)論:常規(guī)超聲為診斷甲狀腺結(jié)節(jié)良惡性最重要的依據(jù),SWE為甲狀腺結(jié)節(jié)良惡性的診斷提供了新的參數(shù),其中以Emax和Esd診斷價值更高。常規(guī)超聲與SWE聯(lián)合評價甲狀腺結(jié)節(jié)的良惡性,可提高其診斷價值,減少誤診。
[Abstract]:Objective: to compare the value of Young's modulus measured by shear wave elastic imaging (SWE) in the differential diagnosis of benign and malignant thyroid nodules, and to establish a logistic regression model with conventional ultrasound signs and Young's modulus of SWE as regression parameters. To compare the value of regression model and conventional ultrasound in the diagnosis of malignant thyroid nodules. Methods: a total of 258 nodules of 104 patients undergoing thyroidectomy or fine needle biopsy were examined by conventional ultrasound and SWE before operation. The conventional ultrasound signs and the E / E ratio of Emaxus were recorded. By comparing the pathological results of thyroid nodules, the ROC curves of conventional ultrasound and SWE were drawn, the value of SWE and conventional ultrasound in the diagnosis of thyroid malignant nodules was compared, and the best critical value for the diagnosis of thyroid malignant nodules with Young's modulus was obtained. Logistic regression analysis was used to compare the value of ultrasound findings associated with thyroid malignant nodules and to establish a regression model. Results: (1) there were 89 patients with thyroid nodules, including 180 nodules, 34 malignant nodules and 146 benign thyroid nodules. (2) in univariate analysis of conventional ultrasound findings, thyroid nodule with aspect ratio 鈮，

本文編號：2070278