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

【摘要】：目的：探討多模式超聲技術(shù)在甲狀腺結(jié)節(jié)良惡性鑒別診斷的臨床應(yīng)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(jié)節(jié)患者，該438名患者均于我院行外科手術(shù)治療，術(shù)前均在我科進(jìn)行常規(guī)超聲（Ultrasound,US）檢查、實(shí)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(dǎo)下細(xì)針穿刺活檢（Ultrasound-guided Fine-Needle Aspiration Biopsy, US-FNAB）。回顧性分析438名患者常規(guī)超聲檢查、RE檢查、CEUS檢查及US-FNAB結(jié)果，以術(shù)后病理為金標(biāo)準(zhǔn)，與多模式超聲檢查結(jié)果進(jìn)行對比性研究。US檢查，通過觀察甲狀腺結(jié)節(jié)的形態(tài)、內(nèi)部回聲、邊界、血運(yùn)及是否存在鈣化等特點(diǎn)，依據(jù)超聲TI-RADS分類標(biāo)準(zhǔn)，將檢查的甲狀腺結(jié)節(jié)分為兩類即惡性結(jié)節(jié)和良性結(jié)節(jié)，與自身術(shù)后病理結(jié)果進(jìn)行對比性研究，通過對其靈敏度、特異度及準(zhǔn)確度的計(jì)算，評估單純應(yīng)用常規(guī)超聲檢查鑒別診斷甲狀腺結(jié)節(jié)良惡性的價值；結(jié)合US檢查結(jié)果，進(jìn)行RE檢查，根據(jù)超聲彈性評分標(biāo)準(zhǔn)，對檢查的結(jié)節(jié)進(jìn)行評分并分類，將彈性評分為1-3分的結(jié)節(jié)定為良性結(jié)節(jié)，將彈性評分為4-5分的結(jié)節(jié)定為惡性結(jié)節(jié)，與自身術(shù)后病理結(jié)果進(jìn)行對比性研究，通過對其靈敏度、特異度及準(zhǔn)確度的計(jì)算，評估在應(yīng)用US及RE檢查后，在鑒別診斷甲狀腺良惡性結(jié)節(jié)中的應(yīng)用價值；結(jié)合US加RE檢查結(jié)果，進(jìn)行CEUS檢查，根據(jù)不同結(jié)節(jié)造影模式不同的特點(diǎn)，將甲狀腺結(jié)節(jié)造影檢查結(jié)果分為4種類型，分類結(jié)果中1-3類定為良性結(jié)節(jié)，，4類定為惡性結(jié)節(jié)，與其術(shù)后病理結(jié)果進(jìn)行對比，通過計(jì)算其靈敏度、特異度及準(zhǔn)確度，評價在聯(lián)合應(yīng)用常規(guī)超聲檢查、超聲彈性成像技術(shù)檢查及甲狀腺超聲造影檢查后對甲狀腺結(jié)節(jié)良惡性鑒別診斷的臨床意義；結(jié)合US、RE加CEUS檢查結(jié)果，進(jìn)行US-FNAB檢查，根據(jù)病理結(jié)果將結(jié)節(jié)分別定為惡性及良性，與術(shù)后病理進(jìn)行對比性研究，通過其靈敏度、特異度及準(zhǔn)確度，判斷該方法在鑒別甲狀腺良惡性結(jié)節(jié)中的應(yīng)用價值。 結(jié)果： 1.手術(shù)病理證實(shí)良性病變124例，惡性病變314例。多模式超聲技術(shù)診斷結(jié)果顯示良性病變129例，惡性病變309例。 2. US檢查甲狀腺結(jié)節(jié)的靈敏度、特異度及準(zhǔn)確度分別為53.18%、75.00%、59.36%；US檢查結(jié)合RE檢查后，甲狀腺結(jié)節(jié)診斷的靈敏度、特異度及準(zhǔn)確度分別為62.42%、79.84%、67.35%；US檢查、RE檢查結(jié)合CEUS檢查后，甲狀腺結(jié)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(jié)合US-FNAB檢查后，甲狀腺結(jié)節(jié)診斷的靈敏度、特異度及準(zhǔn)確度分別為96.50%、95.16%、96.12%。超聲引導(dǎo)下甲狀腺多模式診斷的靈敏度、特異度及準(zhǔn)確度分別為98.41%、100%、98.86%。 3.單純應(yīng)用US檢查，其診斷甲狀腺結(jié)節(jié)良惡性時靈敏度、特異度及準(zhǔn)確度最低，多模式超聲技術(shù)診斷判斷甲狀腺結(jié)節(jié)良惡性的靈敏度、特異度及準(zhǔn)確度最高。在增加檢查手段的同時，對甲狀腺結(jié)節(jié)良惡性鑒別的靈敏度、特異度及準(zhǔn)確度逐漸提高的。 4.應(yīng)用US檢查、US加RE檢查、US加RE加CEUS檢查及多模式超聲技術(shù)鑒別診斷甲狀腺結(jié)節(jié)良惡性間差異有統(tǒng)計(jì)學(xué)意義（P0.01）。 結(jié)論： 1.多模式超聲技術(shù)可以作為鑒別甲狀腺結(jié)節(jié)良惡性的有效手段。 2.多模式超聲技術(shù)顯著提高了甲狀腺良惡性結(jié)節(jié)鑒別診斷的靈敏度、特異度及準(zhǔn)確度。 3.多模式超聲技術(shù)為臨床甲狀腺結(jié)節(jié)的鑒別診斷提供可靠依據(jù)，具有廣泛應(yīng)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(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R736.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 袁冰;譚瑩;黃小平;丁葦;;甲狀腺實(shí)性結(jié)節(jié)的超聲造影表現(xiàn)[J];實(shí)用醫(yī)學(xué)雜志;2013年13期

2 張毅;王燕;楊鎮(zhèn);;甲狀腺結(jié)節(jié)的診斷與外科治療進(jìn)展[J];醫(yī)學(xué)綜述;2010年12期

3 劉芳;肖螢;;超聲彈性應(yīng)變率值在甲狀腺良惡性結(jié)節(jié)診斷中的應(yīng)用[J];中華醫(yī)學(xué)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(jié)節(jié)的SonoVue超聲造影增強(qiáng)模式[J];中國醫(yī)學(xué)影像技術(shù);2010年05期

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

6 詹維偉;徐上妍;;甲狀腺結(jié)節(jié)超聲檢查新進(jìn)展[J];中華醫(yī)學(xué)超聲雜志(電子版);2013年02期

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

本文編號：1743166