本文選題：剪切波彈性成像　切入點(diǎn)：超聲造影　出處：《遵義醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:利用多因素Logistic回歸分析的方法評(píng)價(jià)剪切波彈性成像、超聲造影以及兩種診斷方法結(jié)合對(duì)乳腺腫塊的診斷價(jià)值。方法:乳腺腫塊由一位有5年乳腺超聲檢查經(jīng)驗(yàn)的醫(yī)師根據(jù)二維聲像圖進(jìn)行BI-RADS(Breast Imaging-Reporting and Data System)分類,當(dāng)腫塊分為3或4類時(shí)分別行剪切波彈性成像(Shear Wave Elastography,SWE)及超聲造影(Contrast-enhanced Ultrasound,CEUS)檢查,并與超聲引導(dǎo)下粗針活檢(Ultrasound Guided-Core Needle Biopsy,UG-CNB)病理結(jié)果或手術(shù)病理結(jié)果對(duì)照。納入標(biāo)準(zhǔn):①患者年滿18周歲;②腫塊未經(jīng)過任何處理或治療。排除標(biāo)準(zhǔn):①患者本人不愿或不能簽署知情同意書;②乳腺內(nèi)有植入物;③孕期或哺乳期婦女;④BI-RADS 1、2或5、6類的腫塊;⑤腫塊同側(cè)乳腺既往接受過外科手術(shù);⑥常規(guī)超聲檢查未見明顯腫塊;⑦超聲造影劑過敏史;⑧心、肺功能不全或嚴(yán)重高血壓等不適宜進(jìn)行超聲造影的患者;⑨完全沒有造影劑進(jìn)入的囊性腫塊。SWE采集各定量指標(biāo)并繪制ROC曲線比較各定量指標(biāo)的診斷價(jià)值;CEUS造影劑選用意大利Bracco公司生產(chǎn)的聲諾維Sonovue,經(jīng)肘正中靜脈團(tuán)注其混懸液4.8ml,觀察并記錄腫塊的造影定性指標(biāo)并進(jìn)行卡方檢驗(yàn)分析比較各定性指標(biāo)在良惡性腫塊間的差異。采用多因素Logistic回歸分析SWE與CEUS中各指標(biāo)的診斷價(jià)值并建立回歸方程,運(yùn)用ROC曲線比較SWE、CEUS及二者結(jié)合對(duì)乳腺腫塊的診斷效能。結(jié)果:62個(gè)乳腺腫塊中良性腫塊30個(gè),惡性腫塊32個(gè);腫塊最大徑線4.30~37.40mm,平均(17.02±7.48mm);BI-RADS 3類6個(gè)(9.7%),4A類21個(gè)(33.9%),4B類26個(gè)(41.9%),4C類9個(gè)(14.5%)。①單因素分析結(jié)果:SWE中,除Emean_avg(腫塊彈性平均值的測(cè)量均值)與Emean_d(腫塊與周圍正常脂肪組織彈性平均值的差值)外,其余各彈性指標(biāo)在乳腺良惡性腫塊之間 的差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),其中Emax_d(腫塊與周圍脂肪組織彈性最大值的差值)曲線下面積最大,為0.882(95%CI=0.798~0.966)。CEUS中,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)的指標(biāo)為增強(qiáng)時(shí)相、達(dá)峰強(qiáng)度、增強(qiáng)后腫塊大小和“太陽(yáng)征”。②多因素分析結(jié)果:將SWE中各項(xiàng)指標(biāo)進(jìn)行多因素Logistic回歸分析,進(jìn)入Logistic回歸方程的是Emax_avg和Emin_d,用上述模型預(yù)測(cè)乳腺惡性腫塊的敏感性為81.3%、特異性為86.7%、準(zhǔn)確性為83.9%。將CEUS中各項(xiàng)指標(biāo)進(jìn)行多因素Logistic回歸分析,進(jìn)入Logistic回歸方程的是增強(qiáng)后腫塊大小、校正增強(qiáng)時(shí)相和校正達(dá)峰強(qiáng)度,用上述模型預(yù)測(cè)乳腺惡性腫塊的敏感性為84.4%、特異性為86.7%、準(zhǔn)確性為85.5%。將SWE與CEUS中各項(xiàng)指標(biāo)進(jìn)行多因素Logistic回歸分析,進(jìn)入Logistic回歸方程的是增強(qiáng)后腫塊大小和Emax_avg,用上述模型預(yù)測(cè)乳腺惡性腫塊的敏感性為87.5%、特異性為90.0%、準(zhǔn)確性為88.7%。③ROC曲線分析:BI-RADS分類方法、SWE、CEUS以及SWE與CEUS結(jié)合繪制的ROC曲線,其曲線下面積分別為0.821、0.915、0.920和0.941。上述結(jié)果顯示:①剪切波彈性成像、超聲造影對(duì)乳腺良惡性腫塊的診斷效能均高于BI-RADS分類方法;②超聲造影對(duì)乳腺良惡性腫塊的診斷效能與剪切波彈性成像相近,而兩種方法結(jié)合后的診斷效能高于單一診斷方法。結(jié)論:剪切波彈性成像的定量指標(biāo)與超聲造影的定性指標(biāo)的多因素Logistic回歸分析具有良好的可操作性與實(shí)用性。剪切波彈性成像與超聲造影的診斷方法能較好地預(yù)測(cè)乳腺腫瘤的良惡性,二者的診斷效能均高于BI-RADS分類方法。而將兩種診斷方法結(jié)合對(duì)乳腺惡性腫瘤的預(yù)測(cè)敏感性、特異性、準(zhǔn)確性以及診斷效能均優(yōu)于單一診斷方法,并具有安全、快速、可操作性強(qiáng)、重復(fù)性高的特點(diǎn),值得在臨床上推廣應(yīng)用。
[Abstract]:Objective: using the multi factor Logistic regression analysis to evaluate the shear wave elastography, ultrasonography and two diagnosis method combined with diagnosis of breast tumors. Methods: breast masses by a 5 years inspection experience of breast ultrasound physicians according to two-dimensional ultrasound (Breast BI-RADS Imaging-Reporting and Data System), when the mass divided into 3 or 4 classes respectively for shear wave elastography (Shear Wave, Elastography, SWE) and contrast-enhanced ultrasound (Contrast-enhanced Ultrasound, CEUS), and ultrasound guided coarse needle biopsy (Ultrasound Guided-Core Needle Biopsy, UG-CNB) pathological results or surgical pathology. Inclusion criteria: patients 18 years of age; II. The mass did not undergo any treatment or treatment. Exclusion criteria: the patients themselves are unwilling or unable to sign the informed consent; the breast implants; the pregnancy or lactation The 1,2 or BI-RADS women; 5,6 class mass; the mass of ipsilateral breast had received surgery; the routine ultrasound examination, no obvious tumor; ultrasound contrast agent allergy history; the heart and lung dysfunction or severe hypertension is not suitable for ultrasound angiography were taken; no diagnostic value of contrast agent enter the cystic mass.SWE acquisition of the quantitative index and ROC curve comparison of the quantitative index; CEUS contrast agent of Italy Bracco company's Sonovue SonoVue, cubital intravenous bolus injection of its suspension 4.8ml, observe and record the mass contrast qualitative indexes and compares the qualitative indexes in the difference between benign and malignant among the masses. The chi square test using multivariate Logistic regression analysis of diagnostic value of each index in SWE and CEUS and the regression equation, using ROC curve SWE, CEUS and the combination of the two of breast lumps The diagnostic efficacy. Results: 62 breast masses in 30 benign lesions, 32 were malignant; the maximal diameter of mass line 4.30~37.40mm, the average (17.02 + 7.48mm); 3 BI-RADS 6 (9.7%), 4A 21 (33.9%), 4B 26 (41.9%), 4C (9 14.5%). Single factor analysis results: SWE, except Emean_avg (mean average elastic mass measurement) and Emean_d (difference between the tumor and the surrounding normal tissue elasticity average), the rest of the elastic index were statistically significant differences between the benign and malignant breast tumors (P0.05), including Emax_d (the largest tumor and surrounding fat tissue elasticity difference) area under the curve of maximum, 0.882 (95%CI=0.798~0.966).CEUS, the difference was statistically significant (P0.05) index for the enhanced phase, peak intensity, enhancement of tumor size and the "sun sign". The results of multivariate analysis: the indexes of SWE in because Logistic regression analysis, the regression equation of the Logistic into Emax_avg and Emin_d, using the model to predict the sensitivity of malignant breast masses was 81.3%, the specificity was 86.7%, accuracy was 83.9%. Logistic multivariate regression analysis of the indexes of CEUS, Logistic entered the regression equation is tumor size after enhancement, enhanced phase correction correction the peak intensity, using the model to predict the sensitivity of malignant breast masses was 84.4%, the specificity was 86.7%, accuracy was 85.5%. Logistic multivariate regression analysis of the indexes of SWE and CEUS, into the Logistic regression equation is enhanced after the tumor size and the Emax_avg, using the model to predict the sensitivity of malignant breast masses was 87.5%, specificity as of 90%, the analysis accuracy of 88.7%. ROC curve: BI-RADS classification, SWE, CEUS, SWE and CEUS combined with ROC curve, the area under the curve 0.821,0.915,0.920 and 0.941. respectively. The results show that the shear wave elastography, effectiveness of contrast-enhanced ultrasonography in diagnosis of benign and malignant breast tumors were higher than that of the BI-RADS classification method; II ultrasound diagnostic efficacy on benign and malignant breast tumors and shear wave elastography are similar, and the diagnostic efficacy of combination of the two methods was higher than single diagnosis method. Conclusion Logistic: multi factor quantitative index and qualitative index of contrast-enhanced ultrasound shear wave elastography in the regression has good maneuverability and practicability of the analysis. The diagnosis method of shear wave elastography and contrast enhanced ultrasound can better predict the benign and malignant breast tumors, two were higher than the diagnostic efficacy of BI-RADS classification method and the two. A diagnosis method combining predictive sensitivity of malignant breast tumor specificity, accuracy of single diagnosis method and diagnosis efficiency are superior, and has safety, It is fast, maneuverable and repeatable. It is worth popularizing in clinical practice.

【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R445.1;R737.9

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