本文選題：多模式診斷 + 甲狀腺結節(jié)　； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：探討多模式超聲技術在甲狀腺結節(jié)良惡性鑒別診斷的臨床應用價值。 方法：本文選取我院自2012年10月至2013年12月438例甲狀腺結節(jié)患者，該438名患者均于我院行外科手術治療，術前均在我科進行常規(guī)超聲（Ultrasound,US）檢查、實時超聲彈性成像（Real-time Elastosongraphy,RE）檢查、超聲造影（Contrast-Enhanced Ultrasound,CEUS）檢查及超聲引導下細針穿刺活檢（Ultrasound-guided Fine-Needle Aspiration Biopsy, US-FNAB）�；仡櫺苑治�438名患者常規(guī)超聲檢查、RE檢查、CEUS檢查及US-FNAB結果，以術后病理為金標準，與多模式超聲檢查結果進行對比性研究。US檢查，通過觀察甲狀腺結節(jié)的形態(tài)、內部回聲、邊界、血運及是否存在鈣化等特點，依據超聲TI-RADS分類標準，將檢查的甲狀腺結節(jié)分為兩類即惡性結節(jié)和良性結節(jié)，與自身術后病理結果進行對比性研究，通過對其靈敏度、特異度及準確度的計算，評估單純應用常規(guī)超聲檢查鑒別診斷甲狀腺結節(jié)良惡性的價值；結合US檢查結果，進行RE檢查，根據超聲彈性評分標準，對檢查的結節(jié)進行評分并分類，將彈性評分為1-3分的結節(jié)定為良性結節(jié)，將彈性評分為4-5分的結節(jié)定為惡性結節(jié)，與自身術后病理結果進行對比性研究，通過對其靈敏度、特異度及準確度的計算，評估在應用US及RE檢查后，在鑒別診斷甲狀腺良惡性結節(jié)中的應用價值；結合US加RE檢查結果，進行CEUS檢查，根據不同結節(jié)造影模式不同的特點，將甲狀腺結節(jié)造影檢查結果分為4種類型，分類結果中1-3類定為良性結節(jié)，，4類定為惡性結節(jié)，與其術后病理結果進行對比，通過計算其靈敏度、特異度及準確度，評價在聯合應用常規(guī)超聲檢查、超聲彈性成像技術檢查及甲狀腺超聲造影檢查后對甲狀腺結節(jié)良惡性鑒別診斷的臨床意義；結合US、RE加CEUS檢查結果，進行US-FNAB檢查，根據病理結果將結節(jié)分別定為惡性及良性，與術后病理進行對比性研究，通過其靈敏度、特異度及準確度，判斷該方法在鑒別甲狀腺良惡性結節(jié)中的應用價值。 結果： 1.手術病理證實良性病變124例，惡性病變314例。多模式超聲技術診斷結果顯示良性病變129例，惡性病變309例。 2. US檢查甲狀腺結節(jié)的靈敏度、特異度及準確度分別為53.18%、75.00%、59.36%；US檢查結合RE檢查后，甲狀腺結節(jié)診斷的靈敏度、特異度及準確度分別為62.42%、79.84%、67.35%；US檢查、RE檢查結合CEUS檢查后，甲狀腺結節(jié)診斷的靈敏度及特異度分別為71.01%、82.26%、74.20%；US檢查、RE檢查、CEUS檢查結合US-FNAB檢查后，甲狀腺結節(jié)診斷的靈敏度、特異度及準確度分別為96.50%、95.16%、96.12%。超聲引導下甲狀腺多模式診斷的靈敏度、特異度及準確度分別為98.41%、100%、98.86%。 3.單純應用US檢查，其診斷甲狀腺結節(jié)良惡性時靈敏度、特異度及準確度最低，多模式超聲技術診斷判斷甲狀腺結節(jié)良惡性的靈敏度、特異度及準確度最高。在增加檢查手段的同時，對甲狀腺結節(jié)良惡性鑒別的靈敏度、特異度及準確度逐漸提高的。 4.應用US檢查、US加RE檢查、US加RE加CEUS檢查及多模式超聲技術鑒別診斷甲狀腺結節(jié)良惡性間差異有統(tǒng)計學意義（P0.01）。 結論： 1.多模式超聲技術可以作為鑒別甲狀腺結節(jié)良惡性的有效手段。 2.多模式超聲技術顯著提高了甲狀腺良惡性結節(jié)鑒別診斷的靈敏度、特異度及準確度。 3.多模式超聲技術為臨床甲狀腺結節(jié)的鑒別診斷提供可靠依據，具有廣泛應用前景。
[Abstract]:Objective: To explore the clinical value of multimode ultrasound in differential diagnosis of thyroid nodules.
Methods: We selected in our hospital from October 2012 to December 2013, 438 patients with thyroid nodules, the 438 patients in our hospital underwent surgical treatment in our department were routine ultrasound before operation (Ultrasound, US), real-time ultrasound elastography (Real-time Elastosongraphy, RE), Ultrasound (Contrast-Enhanced, CEUS, ultrasound) examination and ultrasound guided fine needle aspiration biopsy (Ultrasound-guided Fine-Needle Aspiration Biopsy, US-FNAB). A retrospective analysis of 438 patients with conventional ultrasound examination, RE examination, CEUS examination and US-FNAB results, using surgical pathology as the gold standard, comparative study of.US examination and multi mode ultrasonic examination results, through the observation of thyroid nodules morphology, boundary, internal echo, blood supply and the presence of calcification and other characteristics, on the basis of ultrasonic TI-RADS classification standard of thyroid nodule examination will be divided into two categories namely malignant node Section and benign nodules, and comparative research of postoperative pathological results, the sensitivity, specificity and accuracy of the calculation, evaluate the application value of conventional ultrasound in differential diagnosis of benign and malignant thyroid nodules; combined with US examination, RE examination, according to the standard for evaluation of ultrasound elastography score and classification of. Check the nodules, the elastic score of 1-3 nodules as benign nodules, the elastic score of 4-5 nodules as malignant nodules, and comparative study of pathological results after operation, the sensitivity, specificity and accuracy of the calculation and evaluation on the application of US and RE after the inspection application the value in the differential diagnosis of benign and malignant thyroid nodules; combined with US and RE examination, CEUS examination, according to the different characteristics of different patterns of contrast nodules, nodules of thyroid angiography results will be divided into 4 types Type, classification results of 1-3 kinds of benign nodules, 4 kinds of malignant nodules, and postoperative pathological results were compared by calculating the sensitivity, specificity and accuracy of the evaluation, in combination with conventional ultrasound, ultrasound elastography examination and thyroid ultrasound examination on the clinical significance of differential diagnosis of thyroid nodules benign and malignant; combined with US, RE and CEUS examination, US-FNAB examination, according to the pathological results were classified as malignant and benign nodules, comparative study and postoperative pathology, the sensitivity, specificity and accuracy of the method, determine the application value in the diagnosis of benign and malignant thyroid nodules.
Result:
1. the pathology confirmed 124 cases of benign lesions and 314 cases of malignant lesions. The results of multi mode ultrasound diagnosis showed that 129 cases of benign lesions and 309 cases of malignant lesions.
The sensitivity of 2. US examination of thyroid nodules, specificity and accuracy were 53.18%, 75%, 59.36%; US examination combined with RE examination in the diagnosis of thyroid nodules, sensitivity, specificity and accuracy were 62.42%, 79.84%, 67.35%; US examination, RE examination combined with CEUS examination, and sensitivity in the diagnosis of thyroid nodules degrees were 71.01%, 82.26%, 74.20%; US examination, RE examination, CEUS examination combined with US-FNAB examination in the diagnosis of thyroid nodules, sensitivity, specificity and accuracy were 96.50%, 95.16%, 96.12%. sensitivity under ultrasound guided thyroid model diagnosis, specificity and accuracy were 98.41%, 100%, 98.86%.
3. simple application of US examination, the diagnosis of benign and malignant thyroid nodules the sensitivity, specificity and accuracy of the lowest, multi mode ultrasound technique in diagnosis of benign and malignant thyroid nodules to determine the sensitivity, specificity and accuracy. The highest increase in the examination at the same time, the sensitivity in differentiating benign and malignant thyroid nodules, specificity and accuracy of gradually to improve.
4. the difference between benign and malignant thyroid nodules was statistically significant (P0.01) by US examination, US plus RE, US plus RE plus CEUS and multi mode ultrasound in differential diagnosis of thyroid nodules.
Conclusion:
1. multi mode ultrasound can be used as an effective means to differentiate between benign and malignant thyroid nodules.
2. multimode ultrasound significantly improves the sensitivity, specificity and accuracy of the differential diagnosis of thyroid benign and malignant nodules.
3. multi mode ultrasound provides a reliable basis for the differential diagnosis of clinical thyroid nodules, and has a wide application prospect.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R445.1;R736.1

【參考文獻】

相關期刊論文 前7條

1 袁冰;譚瑩;黃小平;丁葦;;甲狀腺實性結節(jié)的超聲造影表現[J];實用醫(yī)學雜志;2013年13期

2 張毅;王燕;楊鎮(zhèn);;甲狀腺結節(jié)的診斷與外科治療進展[J];醫(yī)學綜述;2010年12期

3 劉芳;肖螢;;超聲彈性應變率值在甲狀腺良惡性結節(jié)診斷中的應用[J];中華醫(yī)學超聲雜志(電子版);2010年04期

4 張波;姜玉新;戴晴;楊萌;高嬪;;前瞻性觀察甲狀腺結節(jié)的SonoVue超聲造影增強模式[J];中國醫(yī)學影像技術;2010年05期

5 喬曉玲;張新源;;B超與ECT檢查在甲狀腺結節(jié)診斷中的臨床價值[J];醫(yī)學綜述;2012年23期

6 詹維偉;徐上妍;;甲狀腺結節(jié)超聲檢查新進展[J];中華醫(yī)學超聲雜志(電子版);2013年02期

7 向盈;魏軍平;;甲狀腺結節(jié)診斷方法述評[J];醫(yī)學綜述;2014年04期

本文編號：1743166