本文選題：超聲造影 + 甲狀腺結(jié)節(jié)　； 參考：《濱州醫(yī)學(xué)院》2014年碩士論文

【摘要】：探討超聲造影(CEUS)在微波消融術(shù)前對甲狀腺結(jié)節(jié)的診斷及鑒別診斷、甲狀腺結(jié)節(jié)范圍確定的應(yīng)用價(jià)值；評價(jià)CEUS對甲狀腺結(jié)節(jié)微波消融術(shù)適時(shí)結(jié)束的指導(dǎo)作用及在術(shù)后隨訪中療效評估中的應(yīng)用價(jià)值。對2012年3月-2013年7月于我院超聲科行微波消融治療的甲狀腺結(jié)節(jié)患者56例(71個(gè)病灶),術(shù)前先行二維超聲(2DUS)及彩色多普勒超聲(CDFI)檢查,后行超聲造影(CEUS)檢查,全過程動(dòng)態(tài)觀察病灶,從造影劑進(jìn)入至消退,應(yīng)用ACQ軟件對其進(jìn)行時(shí)間-強(qiáng)度曲線分析,術(shù)后獲取病理診斷。對在我院超聲科行微波消融治療的甲狀腺結(jié)節(jié)患者76例(91個(gè)病灶),微波消融術(shù)后即刻先行2DUS及CDFI檢查,評估消融是否徹底,后行CEUS檢查,觀察造影劑灌注情況,對CEUS顯示腫瘤滅活不全的部位調(diào)整針道后進(jìn)行補(bǔ)充治療。對在我院超聲科行微波消融治療后的甲狀腺結(jié)節(jié)患者12例(16個(gè)病灶),于術(shù)后1、3、6和12個(gè)月進(jìn)行2DUS、CDFI和CEUS檢查,觀察結(jié)節(jié)大小、回聲、血流信號(hào)和造影劑灌注變化,后于消融灶內(nèi)、瘤周腺體組織、正常腺體組織內(nèi)部各選擇一個(gè)感興趣區(qū),采用ACQ軟件對其進(jìn)行時(shí)間-強(qiáng)度曲線分析。(1)微波消融術(shù)前CEUS結(jié)果顯示：結(jié)節(jié)性甲狀腺腫CEUS多呈等增強(qiáng)及低增強(qiáng),少數(shù)為高增強(qiáng)；腺瘤CEUS多表現(xiàn)為“快進(jìn)慢退”,呈高增強(qiáng)”；甲狀腺癌多表現(xiàn)為不均勻等增強(qiáng)及低增強(qiáng),且消退早于周邊腺體實(shí)質(zhì)。微波消融術(shù)前結(jié)節(jié)范圍確定方面,甲狀腺惡性結(jié)節(jié)最大直徑CEUS測量值較二維超聲測量值大。(2)微波消融結(jié)束前即刻2DUS結(jié)合CDFI顯示91個(gè)結(jié)節(jié)回聲均呈不同程度增強(qiáng),血流信號(hào)減少或消失,兩者結(jié)合檢出7個(gè)結(jié)節(jié)(7/91：7.7%)有殘留；CEUS顯示91個(gè)結(jié)節(jié)均可見不同程度無增強(qiáng)區(qū),而檢出有殘留結(jié)節(jié)15個(gè)(15/91,16.5%)(p0.05)。在界定消融后即刻結(jié)節(jié)大小研究中,本研究結(jié)果顯示2DUS最大直徑為2.67±3.16cm；CEUS最大直徑為2.33±2.67cm。(p0.05)。(3)甲狀腺結(jié)節(jié)微波消融治療術(shù)后1、3、6及12個(gè)月CEUS隨訪病例數(shù)分別為3、2、4及3例。CEUS檢查結(jié)節(jié)內(nèi)可見不同程度的無增強(qiáng)區(qū)。隨訪觀察16個(gè)甲狀腺結(jié)節(jié)消融病灶,2DUS顯示消融灶體積大小平均為1.07±2.38cm3,CEUS顯示消融灶體積大小平均為1.00±2.22cm3(p0.05)。(1)CEUS可以實(shí)時(shí)、有效顯示甲狀腺結(jié)節(jié)血管和血流灌注情況,對微波消融術(shù)前甲狀腺結(jié)節(jié)良惡性的鑒別診斷、囊實(shí)性判定及確定惡性結(jié)節(jié)范圍大小方面均提供了更多的信息,對確保甲狀腺結(jié)節(jié)微波消融療效有重要應(yīng)用價(jià)值。(2)CEUS能敏感的顯示甲狀腺結(jié)節(jié)內(nèi)血流灌注情況,有助于甲狀腺結(jié)節(jié)微波消融術(shù)后即刻發(fā)現(xiàn)殘存病灶,準(zhǔn)確確定消融范圍,對超聲引導(dǎo)下甲狀腺結(jié)節(jié)微波消融治療具有重要指導(dǎo)意義。(3)甲狀腺結(jié)節(jié)微波消融術(shù)后病例應(yīng)用CEUS檢查進(jìn)行隨訪觀察,可較準(zhǔn)確確定病灶毀損范圍,有效發(fā)現(xiàn)殘存結(jié)節(jié)并可判定甲狀腺結(jié)節(jié)微波消融術(shù)后血流動(dòng)力學(xué)方面的變化,對評價(jià)消融療效具有重要意義。
[Abstract]:To investigate the diagnostic and differential diagnosis of thyroid nodules before microwave ablation by contrast-enhanced ultrasound (CEUs). Objective: to evaluate the value of CEUS in guiding the end of microwave ablation of thyroid nodules and its application in postoperative follow-up. From March 2012 to July 2013, 56 patients with thyroid nodules (71 lesions) underwent microwave ablation in our hospital from March 2012 to July 2013. 2DUSS and CDFI were performed before operation, and then contrast-enhanced ultrasonography (CEUSS) was performed. The focus was observed dynamically from contrast medium to extinction. The time-intensity curve was analyzed by ACQ software and the pathological diagnosis was obtained after operation. Sixty-six patients (91 lesions) with thyroid nodules treated by microwave ablation in our hospital were examined with 2DUS and CDFI immediately after microwave ablation to evaluate whether the ablation was complete or not, and then CEUS was performed to observe the perfusion of contrast media. After adjusting the needle path, the CEUS showed that the tumor was inactivated. Twelve patients (16 lesions) with thyroid nodules treated by microwave ablation in our hospital were examined with 2DUSU CDFI and CEUS at 1 and 12 months postoperatively. The size, echo, blood flow signal and perfusion of contrast media were observed. ACQ software was used to analyze the time-intensity curve. The results of CEUS before microwave ablation showed that the CEUS of nodular goiter showed equal enhancement and low enhancement. Most of adenoma CEUS showed "fast advance and slow regression" with high enhancement. Thyroid carcinoma showed uneven enhancement and low enhancement, and subsided earlier than peripheral glandular parenchyma. In the determination of the range of nodules before microwave ablation, the maximum diameter of thyroid nodules measured by CEUS was larger than that of two-dimensional ultrasound.) immediately before microwave ablation, 2DUS combined with CDFI showed that the echo of 91 nodules was enhanced in varying degrees. Blood flow signal decreased or disappeared, 7 / 91: 7 (7 / 91: 7) residual CEUs showed that 91 nodules showed different degrees of no enhancement, while 15 / 91 / 16. 5% of residual nodules were detected. In the study of defining the size of nodules immediately after ablation, The results showed that the maximum diameter of 2DUS was 2.67 鹵3.16 cm, CEUS was 2.33 鹵2.67 cm. Follow-up study showed that the mean volume size of ablation focus was 1.07 鹵2.38 cm ~ (-3) CEUs was 1.00 鹵2.22cm3(p0.05).(1)CEUS in 16 thyroid nodule ablation foci with 2DUS, and it could be used to display the blood vessel and blood flow perfusion of thyroid nodule in real time. More information was provided on the differential diagnosis of benign and malignant thyroid nodules before microwave ablation, the determination of cysts and solid, and the determination of the size of malignant nodules. It has important application value to ensure the curative effect of microwave ablation of thyroid nodule. It can sensitively display the blood flow perfusion in thyroid nodule, which is helpful to discover the residual focus immediately after microwave ablation of thyroid nodule, and to determine the ablation range accurately. It is important to guide the treatment of thyroid nodule by microwave ablation under the guidance of ultrasound. (3) CEUS examination can be used to follow up the patients after microwave ablation of thyroid nodules, which can accurately determine the extent of lesion lesion. The effective detection of residual nodules and the determination of hemodynamic changes after microwave ablation of thyroid nodules are of great significance in evaluating the efficacy of ablation.
【學(xué)位授予單位】：濱州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R581

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 岳雯雯;王淑榮;;超聲造影在甲狀腺結(jié)節(jié)射頻消融治療中的應(yīng)用[J];中華醫(yī)學(xué)超聲雜志(電子版);2012年05期

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本文編號(hào)：1825205