本文關(guān)鍵詞： 甲狀腺結(jié)節(jié) 超聲檢查 TI-RADS分級 實時剪切波彈性成像　出處：《鄭州大學》2014年碩士論文　論文類型：學位論文

【摘要】：背景與目的： 根據(jù)流行病學顯示，在人群中隨機抽查，經(jīng)超聲檢查發(fā)現(xiàn)甲狀腺結(jié)節(jié)的可能性為19％—67％，而發(fā)現(xiàn)甲狀腺癌的可能性為5％—10％，并有顯著增加的趨勢。超聲檢查逐漸變?yōu)槔袡z查良性和惡性甲狀腺結(jié)節(jié)的識別方法，但不同超聲醫(yī)生的知識不同，故不同結(jié)節(jié)描述也不同，影響了甲狀腺科醫(yī)生對甲狀腺結(jié)節(jié)的判斷。為了讓甲狀腺結(jié)節(jié)的超聲描述可以有一個一致的標準，讓甲狀腺科大夫更準確的判斷甲狀腺結(jié)節(jié)的信息，更好地治療甲狀腺結(jié)節(jié)，2009年Horvath等借鑒美國放射學會制定的乳腺影像報告和數(shù)據(jù)系統(tǒng)(Breast imagingreporting and data system，BI-RADS)超聲分級診斷標準，同樣給甲狀腺結(jié)節(jié)的超聲描述制定了一個標準，即甲狀腺影像報告與數(shù)據(jù)系統(tǒng)（TI—RADS）分級。甲狀腺結(jié)節(jié)超聲圖像特征多變，良惡性病灶之間存在相似的二維聲像圖特征，而且不同超聲醫(yī)生診斷經(jīng)驗不同，對同一病灶可能給予不同分級。剪切波超聲彈性成像(SWE)是一種可以直觀定量測得組織硬度數(shù)值的新的超聲診斷技術(shù)。本研究的研究目的是通過探討TI—RADS分級、剪切波彈性成像各自在區(qū)分良性和惡性甲狀腺結(jié)節(jié)時是否有診斷價值,并探索一種將SWE與TI-RADS聯(lián)合的調(diào)整方法，以進一步提高TI-RADS分級診斷價值，看是否有助于減少TI—RADS分級在診斷甲狀腺結(jié)節(jié)是良性還是惡性時的假陽性率及假陰性率，與病理結(jié)果盡量一致，更準確地為臨床診斷和治療甲狀腺結(jié)節(jié)提供信息。 資料與方法 1.第一部分研究對象是128例患者從2013年6月到2013年12月行超聲體檢發(fā)現(xiàn)了甲狀腺病灶，每位患者均行手術(shù)獲得病理結(jié)果，82例女性患者，46例男性患者，年齡17—78歲，平均(38.2±18.3)歲，，病灶最大徑3—31mm，平均（13.02±6.54）mm。所有結(jié)節(jié)術(shù)前均采用Horvath等提出的TI—RADS分級診斷標準進行評價，術(shù)后與病理結(jié)果對照。為了更好地與病理結(jié)果對照，本研究僅入選甲狀腺結(jié)節(jié)TI—RADS分級為3—5級，灰階超聲表現(xiàn)為單發(fā)實性結(jié)節(jié)，故總共128個病灶。將TI—RADS分級與病理結(jié)果比較，畫出ROC曲線以AUC來評估TI—RADS分級對鑒別診斷甲狀腺結(jié)節(jié)良性和惡性是否有價值。 2.第二部分對第一部分中的128例患者，128個病灶術(shù)前及35例正常對照組行實時剪切波彈性成像檢查，得到甲狀腺良性結(jié)節(jié)、惡性結(jié)節(jié)與正常甲狀腺組織的楊氏模量平均值，與病理結(jié)果對照畫出ROC曲線，以AUC來評估楊氏模量平均值是否對甲狀腺結(jié)節(jié)良性和惡性有價值，并得出劃分甲狀腺結(jié)節(jié)良性和惡性界點值。 3.參考本研究第二部分的研究結(jié)果獲得的區(qū)分甲狀腺結(jié)節(jié)良性和惡性的分界值，對于當SWE楊氏模量平均值＞參考界值時，TI—RADS分級為3級的結(jié)節(jié)上升至4a級， TI—RADS分級為4a級的結(jié)節(jié)上升至4b級；當SWE楊氏模量平均值≤參考界值時，TI—RADS分級為4b級的結(jié)節(jié)下降至4a級；對于TI—RADS分級為5級的結(jié)節(jié)不做調(diào)整。與病理結(jié)果對照畫出ROC曲線，根據(jù)AUC的不同，通過Z檢驗，比較結(jié)合SWE后改良的TI—RADS分級與原TI—RADS分級診斷標準對甲狀腺結(jié)節(jié)的診斷價值。 結(jié)果 1.128個甲狀腺結(jié)節(jié)中，73個惡性結(jié)節(jié)中甲狀腺乳頭狀癌55個，微小乳頭狀癌18個；55良性結(jié)節(jié)中結(jié)甲36個，甲狀腺腺瘤19個。根據(jù)TI—RADS分級與病理結(jié)果對照繪制ROC曲線，AUC為0.866，敏感度為83.6%，特異度為82%。 2.良性結(jié)節(jié)組、惡性結(jié)節(jié)組及正常甲狀腺對照組的楊氏模量平均值分別是（23.92±15.5）Kpa、（80.47±29.39）Kpa和（16.34±4.77）Kpa，組間比較差異有統(tǒng)計學意義，P0.05；甲狀腺結(jié)節(jié)楊氏模量平均值診斷甲狀腺結(jié)節(jié)良惡性病變的AUC為0.89，以楊氏模量平均值52.85kPa為界點，其診斷敏感度為95.9%，特異度為71.7%。 3.根據(jù)改良TI—RADS分級與病理結(jié)果對照畫出ROC曲線，AUC為0.931，，敏感度為90.4%，特異度為92.7%。經(jīng)Z檢驗，改良后的TI—RADS分級與原TI—RADS分級AUC比較差異有統(tǒng)計學意義。 結(jié)論 1.TI—RADS分級可以幫助臨床醫(yī)師通過超聲報告直觀地看出甲狀腺結(jié)節(jié)是良性還是惡性，并且進一步指導了臨床醫(yī)師下一步對甲狀腺結(jié)節(jié)作何治療。 2.剪切波彈性成像可以以具體的數(shù)值來反應(yīng)甲狀腺組織的硬度，測得的楊氏模量平均值可以幫助區(qū)分甲狀腺結(jié)節(jié)是良性還是惡性。 3.剪切波彈性成像聯(lián)合TI—RADS分級診斷標準對區(qū)分甲狀腺結(jié)節(jié)是良性還是惡性的診斷價值高于原TI—RADS分級，減少了TI—RADS分級中的假陽性及假陰性率，更加提高了TI—RADS分級對臨床的指導意義。
[Abstract]:Background and purpose:
According to epidemiological studies have shown that random sampling in the crowd, the ultrasonic inspection found the possibility of thyroid nodules was 19% - 67%, and found the possibility of thyroid cancer is 5% - 10%, and a significant increase trend. Ultrasound gradually becomes a recognition method of routine inspection of benign and malignant thyroid nodules, but different ultrasound doctors knowledge different, so different nodules description is different, the effect of thyroid doctors for thyroid nodules. In order to make the judgment ultrasound of thyroid nodules can be described with a consistent standard, let the doctor thyroid thyroid nodules more accurate information, better treatment of thyroid nodules, Horvath in 2009 from the American College of Radiology Breast imaging reporting setting and data system (Breast imagingreporting and data system, BI-RADS) ultrasonic diagnostic criteria grading, the same to super thyroid nodules Acoustic description to develop a standard, namely the thyroid imaging reporting and data system (TI - RADS) classification. Characteristics of thyroid nodule in ultrasound images and two-dimensional sonographic features are similar between benign and malignant lesions, and different ultrasound doctors experience is different, the same lesions may give different levels of shear wave elastography. (SWE) is a direct and quantitative measured technology new diagnostic ultrasound hardness value. The purpose of this study is to investigate the TI by RADS classification, shear wave elastography respectively in distinguishing between benign and malignant thyroid nodules are of diagnostic value, and to explore a kind of adjusting method of joint SWE with TI-RADS, in order to further improve the diagnostic value of TI-RADS classification, to see whether it helps reduce the TI RADS classification in the diagnosis of thyroid nodules are benign or malignant when the false positive rate and false negative rate, and disease The results are as consistent as possible and provide more accurate information for the clinical diagnosis and treatment of thyroid nodules.
Information and methods
The 1. part is the research object in 128 patients from June 2013 to December 2013 underwent ultrasound examination found thyroid lesions, each patient underwent surgical pathological results, 82 cases of female patients and 46 male patients, aged 17 - 78 years old, the average (38.2 + 18.3) years old, and the maximum diameter of the lesions was 3 31mm (average. 13.02 + 6.54) mm. all nodules before surgery were proposed by Horvath and TI - RADS classification standards to evaluate the postoperative results compared with pathology. In order to better control results and pathology, this study selected TI RADS classification of thyroid nodules was 3 - 5, ultrasound showed solitary solid nodule. Therefore, a total of 128 lesions. The TI RADS classification and compared with pathological results, draw ROC curves with AUC to assess the TI RADS classification in differential diagnosis of benign and malignant thyroid nodules is valuable.
2. the second part of the first part of 128 cases in patients with normal control group underwent real-time shear wave elastography examination 128 lesions before surgery and 35 cases were benign thyroid nodules, the young's modulus of malignant nodules and normal thyroid tissue on average, compared with the pathological results to draw ROC curves, using AUC to evaluate the average young's modulus if the value of benign and malignant thyroid nodules have value, and draw the division of benign and malignant thyroid nodules cut-off point.
Study on the 3. reference to the second part of the study results of thyroid nodules to differentiate between benign and malignant boundary value for SWE, when the average young's modulus, cut-off values, TI RADS classification for nodules increased to 4A level 3, TI - RADS grade nodules increased to 4B level 4a; when SWE the average young's modulus is less than or equal to the reference value of community, TI - RADS grade nodules decreased to 4A 4B level; no adjustment for TI - RADS grade 5 nodules. Compared with pathologic results and draw ROC curve, according to the different AUC, through the Z test, compared with the value of TI and RADS classification the original TI diagnostic criteria of RADS classification of thyroid nodules in diagnosis of SWE after improvement.
Result
In 1.128 thyroid nodules and 73 malignant nodules in thyroid papillary carcinoma in 55, papillary microcarcinoma 18; a 36 node 55 benign nodules in thyroid adenoma, 19. According to the TI RADS classification and pathologic findings were the ROC curve, AUC was 0.866, the sensitivity was 83.6%, specificity 82%.
2. groups of benign nodules, the young's modulus of malignant nodules and normal thyroid control group mean values were (23.92 + 15.5) Kpa, (80.47 + 29.39) Kpa and (16.34 + 4.77) Kpa, the difference between groups was statistically significant, P0.05; the average young's modulus of thyroid nodule diagnosis of benign and malignant thyroid nodules AUC is 0.89, with the average young's modulus of 52.85kPa is bounded, the diagnostic sensitivity was 95.9%, specificity was 71.7%.
3. according to the improved TI RADS classification and pathological results, ROC curve was drawn, AUC was 0.931, sensitivity was 90.4%, specificity was 92.7%., after Z test, the modified TI RADS classification had a statistically significant difference compared with the original TI RADS classification AUC.
conclusion
1.TI RADS grading can help clinicians to see whether thyroid nodules are benign or malignant through ultrasound reports, and further guide clinicians to further treat thyroid nodules.
2., shear wave elastography can reflect the hardness of thyroid tissue with specific values. The average value of Young's modulus can help distinguish thyroid nodules from benign or malignant ones.
3. shear wave elastography combined with TI diagnostic criteria of RADS classification to distinguish thyroid nodules are benign or malignant diagnosis value higher than the original TI RADS classification, reduce the false positive and false negative rate of TI - RADS grade, more to improve the TI RADS classification of clinical significance.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1

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