本文選題：超聲彈性成像　切入點(diǎn)：橋本甲狀腺炎　出處：《吉林大學(xué)》2014年碩士論文

【摘要】：目的： 探討彈性成像應(yīng)變率比值法診斷橋本氏甲狀腺炎(HT)合并甲狀腺癌的最佳診斷臨界點(diǎn)。對(duì)比研究常規(guī)超聲、彈性成像應(yīng)變率比值法、常規(guī)超聲聯(lián)合彈性成像應(yīng)變率比值法三種方法對(duì)HT合并甲狀腺癌的診斷價(jià)值。 方法： 選取我院經(jīng)穿刺活檢或手術(shù)病理證實(shí)為HT合并甲狀腺結(jié)節(jié)的患者62例，共75個(gè)結(jié)節(jié)，分別行常規(guī)超聲及超聲彈性成像（UE）檢查。常規(guī)超聲檢查時(shí)將結(jié)節(jié)形態(tài)、邊界、回聲水平、回聲特點(diǎn)、內(nèi)部鈣化、后方回聲、有無(wú)頸部淋巴結(jié)腫大、血流分布情況等作為觀察指標(biāo)，多切面觀察并描述結(jié)節(jié)；UE檢查獲得彈性圖像后，采用應(yīng)變率比值法進(jìn)行評(píng)價(jià)，對(duì)照病理結(jié)果，繪制受試者工作特征(ROC)曲線，計(jì)算曲線下面積(AUC)，，得出最佳診斷臨界點(diǎn)。將常規(guī)超聲和彈性成像應(yīng)變率比值法聯(lián)合應(yīng)用，以二者均診斷為良性為良性，二者其一診斷為惡性為惡性作為診斷標(biāo)準(zhǔn)，對(duì)75個(gè)結(jié)節(jié)進(jìn)行評(píng)價(jià)。采用SPSS17.0統(tǒng)計(jì)軟件，以病理診斷為金標(biāo)準(zhǔn)分別與常規(guī)超聲、彈性成像應(yīng)變率比值法、常規(guī)超聲聯(lián)合彈性成像應(yīng)變率比值法三種方法的診斷結(jié)果進(jìn)行對(duì)照，繪制三種方法的ROC曲線，采用Z檢驗(yàn)比較AUC。計(jì)量資料采用t檢驗(yàn)。 結(jié)果： 1.常規(guī)超聲檢查診斷HT合并甲狀腺癌的敏感度為65.3%，特異度為79.6%，準(zhǔn)確度為74.7%。 2.彈性成像應(yīng)變率比值法測(cè)得HT合并良性結(jié)節(jié)的SR為2.29±1.36，HT合并惡性結(jié)節(jié)的SR為5.44±2.59， HT合并惡性結(jié)節(jié)的SR明顯高于HT合并良性結(jié)節(jié)，經(jīng)t檢驗(yàn)，二者具有顯著差異(P＜0.01)。對(duì)照病理結(jié)果，繪制ROC曲線，AUC為0.863±0.047，根據(jù)約登指數(shù)最大的切點(diǎn)值，確定3.945為最佳診斷臨界點(diǎn)。彈性成像應(yīng)變率比值法診斷HT合并甲狀腺癌的敏感度為76.9%、特異度為85.7%、準(zhǔn)確度為82.7%。 3.常規(guī)超聲聯(lián)合彈性成像應(yīng)變率比值法診斷HT合并甲狀腺癌的敏感度為92.3%、特異度為79.6%、準(zhǔn)確度為84.0%。 4.ROC曲線顯示：常規(guī)超聲、彈性成像應(yīng)變率比值法、常規(guī)超聲聯(lián)合彈性成像應(yīng)變率比值法的AUC分別為0.725、0.813、0.859，均具有較高的診斷準(zhǔn)確性，常規(guī)超聲聯(lián)合應(yīng)變率比值法的診斷準(zhǔn)確性最高。采用Z檢驗(yàn)兩兩對(duì)比，常規(guī)超聲聯(lián)合彈性成像應(yīng)變率比值法與常規(guī)超聲ROC曲線下面積之間的差異存在統(tǒng)計(jì)學(xué)意義。 結(jié)論： 1.彈性成像應(yīng)變率比值法以半定量的方式客觀的反映HT合并結(jié)節(jié)的相對(duì)硬度，具有較高的診斷價(jià)值。 2.常規(guī)超聲聯(lián)合彈性成像應(yīng)變率比值法對(duì)HT合并甲狀腺癌的診斷價(jià)值高于常規(guī)超聲及彈性成像應(yīng)變率比值法。
[Abstract]:Objective:. To explore the best critical point for the diagnosis of HTH (Hashimoto's thyroiditis) combined with thyroid carcinoma by strain rate ratio method of elastic imaging. Diagnostic value of conventional ultrasound combined with elastic imaging strain rate ratio method for HT with thyroid carcinoma. Methods:. Sixty-two patients (75 nodules) with HT complicated with thyroid nodules confirmed by puncture biopsy or surgery and pathology in our hospital were examined by conventional ultrasound and ultrasonic elastography respectively. The shape, boundary and echo level of the nodules were measured by conventional ultrasound. Echo characteristics, internal calcification, posterior echo, neck lymphadenopathy and blood flow distribution were used as indicators. Compared with the pathological results, the operating characteristics of the subjects were drawn, the area under the curve was calculated and the optimal diagnostic critical point was obtained. The conventional ultrasound and the strain rate ratio method of elastic imaging were used together, and both were diagnosed as benign. In the first case, 75 nodules were evaluated according to the diagnostic criteria of malignant or malignant. The SPSS17.0 statistical software was used to evaluate 75 nodules. The pathological diagnosis as gold standard was compared with conventional ultrasound and strain rate ratio of elastic imaging. The diagnostic results of the three methods of conventional ultrasound combined with elastic imaging strain rate ratio method were compared, the ROC curves of the three methods were drawn, and the AUC was compared by Z test and t test. Results:. 1. The sensitivity, specificity and accuracy of conventional ultrasonography in diagnosing HT with thyroid carcinoma were 65.3, 79.6 and 74.7 respectively. 2. The SR of HT with benign nodules was 2.29 鹵1.36 by strain rate ratio of elastic imaging. The SR of HT with malignant nodules was 5.44 鹵2.59.The SR of HT with malignant nodules was significantly higher than that of HT with benign nodules, and there was significant difference between them by t test (P < 0.01). The ROC curve is 0.863 鹵0.047. According to the maximum value of Jorden index, 3.945 is the best critical point for diagnosis. The sensitivity, specificity and accuracy of elastic imaging strain rate ratio method for diagnosing HT with thyroid carcinoma are 76. 9%, 85. 7% and 82. 7% respectively. 3. The sensitivity, specificity and accuracy of conventional ultrasound combined with elastic imaging strain rate ratio in the diagnosis of HT complicated with thyroid carcinoma were 92.3, 79.6 and 84.0 respectively. The 4.ROC curves showed that the AUC of conventional ultrasound, elastic imaging strain rate ratio method and conventional ultrasound combined with elastic imaging strain rate ratio method were 0.725 ~ 0.813 ~ 0.859, respectively. The diagnostic accuracy of the conventional ultrasound combined with strain rate ratio method was the highest. The difference between the conventional ultrasound combined with elastic imaging strain rate ratio method and the area under the conventional ultrasound ROC curve was statistically significant by using Z test. Conclusion:. 1. The elastic imaging strain rate ratio method can objectively reflect the relative hardness of HT with nodule in a semi-quantitative manner, which is of high diagnostic value. 2. The diagnostic value of conventional ultrasound combined with elastic imaging strain rate ratio method for HT with thyroid carcinoma was higher than that of conventional ultrasound and elastic imaging strain rate ratio method.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R581.4;R736.1;R445.1

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