本文關鍵詞： 剪切波 彈性成像 盆腔腫物 彈性模量值 鑒別價值　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:通過應用超聲剪切波彈性成像技術定量測定女性盆腔腫物的彈性模量值,初步研究良惡性腫物及不同病理類型腫物間彈性模量值的統(tǒng)計學差異,并探討超聲彈性成像技術對女性盆腔腫物性質(zhì)判定的可行性及價值。方法:選取2015年11月到2016年11月期間于我院住院擬行手術,術前于我科行超聲檢查的女性盆腔腫物患者137例,其中實性腫物90例,囊實性腫物47例。采用philips i U22彩色多普勒超聲診斷儀,內(nèi)配置有SWE模式成像技術軟件,可進行腫物的彈性模量值的測定。對所有受檢者先行常規(guī)二維超聲掃查,觀察腫物基本情況,而后啟用SWE模式,對腫物進行多次多點測量并記錄其彈性模量最大值、最小值及平均值。追蹤每個受檢者的病理結果,以術后病理結果為金標準分組,對各自剪切波模量值進行分析。其中實性組分為類實性組、良性實性組和惡性實性組。類實性組共14例,按病理類型分為子宮內(nèi)膜異位囊腫組和出血性囊腫組,良性實性組共60例,按病理類型分為肌瘤組、特殊類型肌瘤組和性索間質(zhì)腫瘤組,惡性實性組共19例,按病理類型分為上皮性腫瘤組和肉瘤組。囊實性腫物也分為良性組和惡性組,良性組13例,按病理類型分為卵巢囊腺瘤組和成熟囊性畸胎瘤組,惡性組34例,按病理類型分為惡性腺癌組、未成熟畸胎瘤組和轉(zhuǎn)移性腫瘤組。所有數(shù)據(jù)采用SPSS21.0進行統(tǒng)計學分析,分別比較實性腫物組及囊實性腫物組良、惡性腫物間及不同病理類型腫物間的剪切波模量值是否有統(tǒng)計學差異。所有計量資料均以均數(shù)±標準差表示。以P0.05為差異有統(tǒng)計學意義。依據(jù)病理結果及剪切波模量值繪制ROC曲線,據(jù)此得出良惡性盆腔腫物鑒別的最佳剪切波模量值截斷值,并評價其敏感性、特異性。結果:1對類實性腫物組、良性實性腫物組、惡性實性腫物組平均、最大、最小彈性模量值分別進行兩兩比較,結果差異均具有統(tǒng)計學意義(P0.05),且認為良性實性腫物彈性模量值惡性實性腫物類實性腫物。2實性盆腔腫物不同病理類型間彈性模量值的比較:(1)良性實性腫物組:肌瘤組、性索間質(zhì)腫瘤組及特殊類型肌瘤組平均、最大、最小彈性模量分別比較,結果肌瘤組與性索間質(zhì)腫瘤組彈性模量值無明顯差別(P0.05),而兩者彈性模量值均大于特殊類型肌瘤組(P0.05)。(2)惡性實性腫物組:上皮性腫瘤組與肉瘤組平均、最大、最小彈性模量值分別比較,結果差異均具有統(tǒng)計學意義(P0.05),認為上皮性腫瘤組彈性模量值大于肉瘤組。(3)類實性腫物組:子宮內(nèi)膜異位囊腫與出血性囊腫彈性模量平均值、最大值、最小值分別比較,結果差異均具有統(tǒng)計學意義(P0.05),認為子宮內(nèi)膜異位囊腫彈性模量值大于出血性囊腫。3鑒別診斷截斷值:以病理結果為金標準,良、惡性實性盆腔腫物的彈性模量值為基礎,繪制ROC曲線,結果得出以彈性模量平均值12.56KP、最大值43.55KP、最小值6.8KP為截斷值時的準確率最高,分別是75.0%、61.84%、78.95%,三者比較差異具有統(tǒng)計學意義(P0.05),認為以最小彈性模量截斷值鑒別實性腫物的良惡性準確率更佳。以病理結果為金標準,實性盆腔腫物及類實性盆腔腫物彈性模量值為基礎繪制ROC曲線,結果得出以彈性模量平均值8.65KP、最大值17.62KP、最小值4.5KP為截斷值時的診斷準確率最高,分別是91.11%、84.44%、92.22%,三者比較差異無統(tǒng)計學意義(P0.05),認為平均、最大、最小彈性模量截斷值對鑒別腫物的囊、實性均有較高的準確率,無明顯差別。4常規(guī)超聲與剪切波彈性成像技術聯(lián)合診斷惡性實性盆腔腫物的敏感性為93.75%,特異性為91.67%,陽性預測值為75.0%,陰性預測值為98.21%,正確率為92.11%。單獨應用常規(guī)超聲正確診斷惡性盆腔腫物的靈敏度、特異度、陽性預測值、陰性預測值、準確率分別為81.25%、81.67%、54.17%、94.23%、81.58%。兩者準確率差異具有統(tǒng)計學意義(P0.05),認為超聲彈性成像聯(lián)合常規(guī)超聲診斷盆腔惡性腫物的準確率高于單獨應用常規(guī)超聲。5良性囊實性腫物組與惡性囊實性腫物組組間及組內(nèi)不同病理類型間平均、最大、最小彈性模量值分別比較,結果差異均無統(tǒng)計學意義(P0.05)。結論:超聲彈性成像技術對良性實性及惡性實性腫物,盆腔實性腫物及類實性的囊性腫物的鑒別均具有可行性及較高的潛在價值。在常規(guī)超聲的基礎上應用彈性成像技術可以進一步增強良、惡性實性盆腔腫物鑒別診斷的準確率。但其對囊實性盆腔腫物良惡性的鑒別意義不大。
[Abstract]:Objective: to determine the elastic modulus of female pelvic masses by using ultrasonic shear wave elastography quantitative values of benign and malignant tumor and different pathological types of tumors between the elastic modulus of the differences, and to explore the feasibility and value of ultrasound elastography to judge the nature of female pelvic tumor. Methods: from November 2015 to November 2016 during the our hospital underwent surgery, preoperative ultrasound examination in our department for female pelvic tumor in 137 cases, including 90 cases of solid tumor, solid cystic mass in 47 cases. The Philips I U22 color Doppler ultrasonic diagnostic apparatus, configuration software SWE mode imaging technology, determination of modulus of elasticity for mass value. All subjects received conventional two-dimensional ultrasound scan, the basic situation was observed, and then enable SWE mode of tumor multiple measure and record its elastic modulus The maximum, minimum and average values. The pathological results of tracking each of the subjects with postoperative pathological results as the gold standard for each packet, the shear wave modulus were analyzed. The solid component is a kind of real group, benign group and malignant solid solid solid class group. Group 14 according to the pathological types were divided into endometriosis group and hemorrhagic cyst group, benign solid group were 60 cases, according to the pathological types of leiomyoma group, cord stromal tumor group and the group of special types of leiomyoma, malignant solid group 19 cases, according to the pathological type is divided into epithelial tumor group and sarcoma group. Cystic tumors are divided into benign and malignant group and benign group 13 cases, according to the pathological types of ovarian cystadenoma and divided into groups of mature cystic teratoma group, malignant group 34 cases, according to the pathological types are divided into malignant adenocarcinoma group, immature teratoma group and metastasis group. All the data SPSS21.0 statistics Compared analysis, solid tumor group and cystic mass of benign and malignant tumor, shear wave modulus and different pathological types of tumors between values have significant difference. All measurement data are mean standard deviation. In P0.05 the difference was statistically significant. According to the pathological results and the value of the modulus of shear wave the ROC curve, the optimal shear wave modulus to derive the identification of benign and malignant pelvic tumors and to evaluate the value of the cutoff value, sensitivity and specificity. Results: 1 kinds of solid tumor group, benign lesions and malignant solid tumor group, group average, maximum, the small elastic modulus values were 22 comparison results all the differences were statistically significant (P0.05), and that of malignant solid tumors of solid tumor.2 of pelvic tumor in different pathological types between the elastic modulus of the elastic modulus of benign solid tumors: (1) benign lesions group: myoma group And sex cord stromal tumor group and special types of leiomyoma group average, maximum and minimum elastic modulus were compared, the results of myoma group and sex cord stromal tumor group had no significant difference in elastic modulus (P0.05), and the two elastic modulus values are higher than the special types of leiomyoma group (P0.05). (2) malignant solid tumors group: epithelial tumor group and sarcoma group average, maximum and minimum values of elastic modulus were compared, the results were statistically significant difference (P0.05), that the epithelial tumor group elastic modulus value is greater than the sarcoma group. (3) class of solid tumor group: Endometriosis cyst with hemorrhagic cysts, the average elastic modulus. The maximum value, the minimum value were compared, the results were statistically significant difference (P0.05), that the endometriosis elastic modulus value is greater than the hemorrhagic cyst.3 differential diagnosis cut-off value: with pathological results as the gold standard of benign, malignant solid tumor in pelvic cavity elasticity The value of the modulus based on ROC curve, the result shows that the average elastic modulus 12.56KP, maximum 43.55KP and minimum 6.8KP for the accuracy of truncation values of the highest, respectively is 75%, 61.84%, 78.95%, a statistically significant difference between the three groups (P0.05), that identification of solid mass with the minimum elastic modulus of truncation the value of the accuracy is better. In the benign and malignant pathological results as the gold standard, solid pelvic mass elastic modulus of solid tumor and pelvic value ROC curve as the foundation, the result shows that the average elastic modulus 8.65KP, maximum 17.62KP and minimum 4.5KP for the diagnosis of truncation value when the highest accuracy rate were 91.11% 84.44%, 92.22%, there was no significant difference between the three groups (P0.05), that the average, maximum, minimum value of elastic modulus of truncated mass identification accuracy of sac, solid were high, there was no significant difference between the.4 and the conventional ultrasonic shear wave The sensitivity of combined diagnosis of malignant solid tumor in pelvic cavity imaging was 93.75%, specificity was 91.67%, the positive predictive value was 75%, the negative predictive value was 98.21%, the correct rate of sensitivity, 92.11%. single conventional ultrasound correctly diagnosed malignant pelvic tumor specificity, positive predictive value, negative predictive value, accuracy was 81.25% 81.67%, 54.17%, 94.23%, 81.58%., the accuracy rate of the difference was statistically significant (P0.05), that the accuracy rate of ultrasound elastography and conventional ultrasound in diagnosis of pelvic malignant tumor is higher than that of different pathological types of single conventional ultrasonic.5 of benign cystic solid tumors and malignant cystic tumor group and between groups in the group average, maximum the minimum elastic modulus were compared, and the results showed no significant difference (P0.05). Conclusion: ultrasound elastography in benign and malignant solid lesions, pelvic solid tumor and class The potential value of differential solid cystic masses were feasible and high. Application of elasticity imaging technique based on conventional ultrasound can further enhance the accuracy of differential diagnosis of benign and malignant solid tumor in pelvic cavity. But the identification of significant malignant cystic benign pelvic mass.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R737.3

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