本文關(guān)鍵詞：超聲造影聲觸診組織定量技術(shù)在胰腺局灶性病變中的應(yīng)用研究　出處：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 胰腺局灶性病變 超聲造影 時(shí)間-強(qiáng)度曲線 三維超聲造影 聲觸診組織定量 剪切波速 胰腺占位 鑒別診斷

【摘要】：目的1.觀察胰腺局灶性病變的超聲造影特征。2.評價(jià)超聲造影及時(shí)間-強(qiáng)度曲線定量參數(shù)對胰腺局灶性病變的診斷與鑒別診斷價(jià)值。3.探討利用三維超聲造影重建胰周動(dòng)脈血管的可行性。方法2014年1月至2015年1月,對胰腺局灶性病變患者72例,共計(jì)72個(gè)病灶的超聲造影特征進(jìn)行前瞻性研究。觀察病灶的常規(guī)超聲和超聲造影表現(xiàn),利用5分評分法分別對病灶進(jìn)行良、惡性診斷評分,并對診斷結(jié)果進(jìn)行ROC曲線分析,比較常規(guī)超聲和超聲造影對胰腺局灶性病變良惡性的鑒別診斷價(jià)值；同時(shí)對胰腺實(shí)性(包括以實(shí)性為主囊實(shí)性)局灶性病變的超聲造影動(dòng)態(tài)圖像進(jìn)行TIC定量分析,對不同定量參數(shù)鑒別胰腺局灶性病變良惡性的價(jià)值進(jìn)行評估；利用三維超聲造影(three-dimensional contrast-enhanced ultrasound,3D-CEUS)對17例胰腺局灶性病變患者的胰周動(dòng)脈血管進(jìn)行重建,并觀察重建血管的管腔與走行情況。結(jié)果1.36例胰腺惡性病變中,75.0%表現(xiàn)為不均勻增強(qiáng)；23例實(shí)性或以實(shí)性為主囊實(shí)性良性病變中,26.1%表現(xiàn)為不均勻增強(qiáng)；13例囊性良性病變,76.9%表現(xiàn)為囊壁及分隔強(qiáng)化,23.1%無強(qiáng)化；良、惡性組問的增強(qiáng)方式有顯著的統(tǒng)計(jì)學(xué)差異(P0.05)。2.具有明確病理診斷的胰腺癌中,77.3%表現(xiàn)為持續(xù)低增強(qiáng),22.7%表現(xiàn)為動(dòng)脈相等增強(qiáng),靜脈相低增強(qiáng)。以低增強(qiáng)(不包括伴有明確環(huán)狀增強(qiáng)者)診斷胰腺癌的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值及準(zhǔn)確率分別為96.6%、90.7%、87.5%、97.5%和93.1%。3.62.5%的神經(jīng)內(nèi)分泌源性腫瘤表現(xiàn)為動(dòng)脈相高增強(qiáng),以動(dòng)脈相高增強(qiáng)診斷神經(jīng)內(nèi)分泌源性腫瘤的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值及準(zhǔn)確率分別為62.5%、96.9%、71.4%、95.4%和93.1%。4.利用超聲造影或常規(guī)超聲、超聲造影兩者聯(lián)合診斷,診斷結(jié)果評分為3分者明顯少于常規(guī)超聲；而評分為1分、5分者明顯多于常規(guī)超聲。常規(guī)超聲與超聲造影對胰腺良、惡性病灶的診斷評分有顯著性差異(P=0.000)；而超聲造影與兩者聯(lián)合診斷對胰腺良、惡性病灶的診斷評分無顯著差異(P0.05)。常規(guī)超聲、超聲造影及兩者聯(lián)合診斷的ROC曲線下面積分別為0.681、0.931、0.958。5.對胰腺局灶性病變的TIC定量參數(shù)進(jìn)行比較,得出胰腺惡性病灶的始增時(shí)間晚于相鄰胰腺實(shí)質(zhì),差異有統(tǒng)計(jì)學(xué)意義(P0.05)；良性病灶與相鄰胰腺實(shí)質(zhì)的始增時(shí)間無統(tǒng)計(jì)學(xué)差異(P0.05)。胰腺癌(pancreatic cancer, PC)、胰腺神經(jīng)內(nèi)分泌源性腫瘤(pancreatic neuroendocrine tumors, pNETs)、胰腺炎性病變(pancreatic inflammatory lesion, PIL)及胰腺其他良性病變(other benign tumors, OBTs) 的灌入斜率比較：PCPILOBTspNETs (P0.05);1分鐘洗出斜率比較：PILPCpNETsOBTs(P0.05);峰值強(qiáng)度與曲線下面積的比較：PCPILOBTspNETs(P0.05)。6.利用3D-CEUS對17例胰周動(dòng)脈血管進(jìn)行重建,重建成功率為94.1%。并通過任意角度的旋轉(zhuǎn)觀察,提示了2例動(dòng)脈血管受累。結(jié)論1.結(jié)合常規(guī)超聲的宏觀圖像和超聲造影的微循環(huán)灌注信息,可以有效地提高胰腺局灶性病變的診斷準(zhǔn)確率。2.利于TIC定量參數(shù)可以增加超聲造影診斷胰腺局灶性病變的診斷信息的客觀性。3.3D-CEUS可以實(shí)現(xiàn)對胰周動(dòng)脈血管的立體化顯示,與CT三維重建契合度較高,其臨床應(yīng)用價(jià)值仍有待進(jìn)一步研究。目的1.評估剪切波速(SWV)測量的可重復(fù)性。2.對照病理或臨床診斷結(jié)果,探討SWV在胰腺局灶性實(shí)性病變良惡性鑒別診斷中的臨床應(yīng)用價(jià)值。3.評估SWV預(yù)測晚期胰腺癌輔助治療的療效。方法2014年1月至2015年1月,對我院51例胰腺占位患者進(jìn)行常規(guī)超聲和聲輻射力脈沖成像(ARFI)。應(yīng)用單向隨機(jī)效應(yīng)模型計(jì)算組內(nèi)相關(guān)系數(shù)(Intraclass correlation coefficient, ICC),評估SWV測量的可重復(fù)性。對照病理結(jié)果或臨床診斷,評估病灶SWV、相鄰胰腺實(shí)質(zhì)SWV及SWV差值在胰腺實(shí)性病變中的鑒別診斷價(jià)值。對獲得穿刺細(xì)胞/組織學(xué)診斷,并后續(xù)進(jìn)行輔助治療的晚期胰腺癌患者,進(jìn)行隨訪研究,觀察病灶的大小變化情況。結(jié)果剪切波速值測量中,病灶與胰腺實(shí)質(zhì)五次測量的平均組內(nèi)相關(guān)系數(shù)分別為0.895和0.869。惡性組的病灶與相鄰胰腺實(shí)質(zhì)的SWV均值分別為2.39±125 m/s(0.60-4.39m/s)和1.59±0.63 m/s(0.76-3.22 m/s)；良性組的病灶與相鄰胰腺實(shí)質(zhì)的SWV均值分別為2.06±1.08 m/s(0.79-4.00 m/s)和1.44±0.41 m/s(0.80-2.23 m/s),兩組內(nèi)病灶與相鄰胰腺實(shí)質(zhì)的SWV均值均存在顯著的統(tǒng)計(jì)學(xué)差異(P0.05)。病灶SWV、相鄰胰腺實(shí)質(zhì)SWV及SWV差值在良惡性組間無明顯統(tǒng)計(jì)學(xué)差異(P=0.320、0.352、0.581)。病灶的SWV與病灶大小不相關(guān)(r=0.253,P0.05)；病灶的SWV與ROI深度呈負(fù)相關(guān)(r=-0.413,P0.05)。9例接受輔助治療的晚期胰腺癌患者,病情延緩組與病情無改善或惡化組的病灶的SWV均值分別為2.92±0.80 m/s和0.92±0.32m/s,兩組問存在明顯的統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.剪切波速(SWV)測量重復(fù)性好,多次測量可提供更加可靠的結(jié)果。2.聲輻射力脈沖成像(ARFI)技術(shù)利用SWV定量鑒別診斷胰腺局灶性病變良惡性的價(jià)值有待進(jìn)一步的研究。3.SWV大小與病灶大小無明確相關(guān)性,但隨ROI深度的增加,SWV變小。4.初始病灶的SWV具有預(yù)測晚期胰腺癌輔助治療療效的潛在臨床應(yīng)用價(jià)值。
[Abstract]:To investigate the feasibility of three-dimensional contrast-enhanced ultrasound reconstruction of peripancreatic arteries in the diagnosis and differential diagnosis value of.3. intensity curve quantitative parameters of focal lesions of pancreas to observe 1. focal lesions of pancreas with contrast-enhanced ultrasonography and time characteristics of.2. evaluation. Methods from January 2014 to January 2015, 72 cases of patients with focal lesions of pancreas. A prospective study of a total of 72 lesions with contrast-enhanced ultrasonography. Conventional ultrasound and contrast-enhanced ultrasound to observe the lesions, with a score of 5 of lesions were benign, malignant diagnostic score, and the diagnosis results by ROC curve analysis, compared with conventional ultrasound and contrast-enhanced ultrasound in focal lesions of pancreas benign and malignant at the same time value; pancreatic solid (including constant mainly cystic) dynamic contrast-enhanced ultrasound images of focal lesions of TIC quantitative analysis and quantitative identification of different parameters Evaluate the focal lesions of pancreas benign and malignant value; using three-dimensional contrast-enhanced ultrasound (three-dimensional contrast-enhanced, ultrasound, 3D-CEUS) were reconstructed in 17 patients with focal lesions of pancreas and peripancreatic arteries, vascular reconstruction were observed and the market condition. The results of 1.36 cases of malignant pancreatic lesions, 75% showed no enhancement uniform; 23 cases were solid or solid mainly cystic benign lesions, 26.1% showed inhomogeneous enhancement; 13 cases of cystic benign lesions, 76.9% showed cystic wall and septum enhancement, no enhancement in 23.1%; benign and malignant group, enhance the way asked there is a statistically significant difference (P0.05) with clear.2. the pathological diagnosis of pancreatic carcinoma, 77.3% showed low enhancement, 22.7% showed equal arterial venous phase enhancement, low enhanced. With low enhancement (excluding anidentifiable ring enhancement) sensitivity of diagnosis of pancreatic adenocarcinoma, The specificity, positive predictive value, negative predictive value and accuracy rate were 96.6%, 90.7%, 87.5%, 97.5% neuroendocrine tumors and 93.1%.3.62.5% in the arterial phase enhancement in arterial phase, Gao Zengqiang sensitivity, diagnosis of neuroendocrine tumors of the specificity, positive predictive value, negative predictive value and accuracy were 62.5%, 96.9%, 71.4%, 95.4% and 93.1%.4. by using contrast-enhanced ultrasound or ultrasound, contrast-enhanced ultrasound combined diagnosis, diagnostic results score was 3 less than conventional ultrasound; and the score is 1 points, 5 points more than conventional ultrasound. Conventional ultrasound and contrast-enhanced ultrasound in benign pancreatic, there was significant difference in diagnosis malignant lesion score (P=0.000); ultrasound combined with the diagnosis of pancreatic benign and malignant lesions, there was no significant difference between the score (P0.05). Conventional ultrasound, CEUS and ROC curves of the two combined diagnosis of Compare the area were 0.681,0.931,0.958.5. of focal lesions of pancreas TIC quantitative parameters, the malignant pancreatic lesions enhancement beginning time later than the adjacent pancreatic parenchyma, the difference was statistically significant (P0.05); benign lesions and adjacent parenchyma enhancement beginning time no statistical difference (P0.05). Pancreatic cancer (pancreatic cancer, PC), pancreatic neuroendocrine tumors (pancreatic neuroendocrine, tumors, pNETs), pancreatitis (pancreatic inflammatory lesions lesion, PIL) and other pancreatic benign lesions (other benign, tumors, OBTs) into slope comparison: PCPILOBTspNETs (P0.05); 1 min washout slope: PILPCpNETsOBTs (P0.05); compared the area of peak intensity and under the curve: PCPILOBTspNETs (P0.05).6. using 3D-CEUS to reconstruct 17 cases of peripancreatic arteries, reconstruction of 94.1%. power and the arbitrary rotation angle The observation, 2 cases of arterial vascular involvement. Conclusion 1. combined with microcirculation information macro image of conventional ultrasound and contrast-enhanced ultrasound, can effectively improve the objectivity of.3.3D-CEUS diagnosis of focal lesions of pancreas to the accuracy of.2. TIC quantitative parameters can increase the diagnostic information of contrast-enhanced ultrasound in diagnosis of focal lesions of pancreas can be three-dimensional for peripancreatic arteries display, three-dimensional reconstruction and CT high fit, its clinical application needs further study. 1. objective assessment of shear wave velocity (SWV) pathological or clinical diagnosis results of the measurement repeatability of.2., investigate the clinical value of.3. evaluation of SWV in differential diagnosis of focal pancreatic lesions benign and malignant SWV prediction in treatment of advanced pancreatic cancer adjuvant therapy. Methods from January 2014 to January 2015, were examined by conventional ultrasound and acoustic radiation force in our hospital 51 cases of pancreatic lesions Pulse imaging (ARFI). The application of the one-way random effects model to calculate the intraclass correlation coefficient (Intraclass correlation, coefficient, ICC, SWV) to evaluate the repeatability of the measurement. The pathology or clinical diagnosis, assessment of lesion of SWV, SWV and SWV value of adjacent pancreatic parenchyma difference differential diagnosis in pancreatic lesions. The puncture cell / tissue diagnosis, follow-up and adjuvant therapy in patients with advanced pancreatic cancer, were studied, to observe the changes of the size of the lesion. The results of shear wave velocity measurement, the average lesion with the pancreatic parenchyma of five measurements in the correlation coefficients were 0.895 lesions and adjacent pancreatic parenchyma and 0.869. in malignant group mean SWV were 2.39 + 125 and 1.59 + m/s (0.60-4.39m/s) 0.63 m/s (0.76-3.22 m/s); the lesion and the adjacent pancreatic benign group mean SWV were 2.06 + 1.08 m/s (0.79-4.00 m/s) and 1.4 4 + 0.41 m/s (0.80-2.23 m/s), two groups of lesions and adjacent pancreatic parenchyma SWV mean there was a statistically significant difference (P0.05). SWV lesions, adjacent pancreatic parenchyma SWV and SWV difference no statistically significant differences between groups in benign and malignant lesions (P=0.320,0.352,0.581). The SWV is not related with the size of the lesion (r=0.253 P0.05); SWV was negatively correlated with the depth of ROI lesions (r=-0.413, P0.05).9 patients received adjuvant therapy for patients with advanced pancreatic cancer, the disease and illness without delay group improvement or deterioration group lesions mean SWV were 2.92 + 0.80 and 0.92 + two m/s 0.32m/s group asked the obvious statistical difference (P0.05 1.). Conclusion the shear wave velocity (SWV) measurement repeatability, multiple measurements can provide more reliable results of.2. acoustic radiation force impulse imaging (ARFI) technique using the value of SWV quantitative differential diagnosis of benign and malignant focal lesions of pancreas to be studied further.3.S The size of WV is not correlated with the size of lesion, but with the increase of ROI depth, SWV is decreased. The SWV of.4. initial lesion has potential clinical value in predicting the efficacy of adjuvant therapy for advanced pancreatic cancer.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R445.1;R735.9

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