本文選題：直腸腺瘤 + 直腸腺癌�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2014年博士論文

【摘要】：目的 1.評估應(yīng)變比值(Strain Ratio, SR)測量的可重復(fù)性。 2.對照病理結(jié)果,評價直腸腔內(nèi)彈性成像——彈性分級法(Elasticity Score,ES)及應(yīng)變比值法(SR)對直腸腺瘤惡變的診斷價值,并與結(jié)腸鏡活檢、常規(guī)ERUS進行比較。 3.探討直腸腔內(nèi)彈性成像診斷準確性的影響因素。 方法 2011年1月至2013年5月,對我院門診60例臨床診斷直腸腺瘤患者進行常規(guī)ERUS、直腸腔內(nèi)彈性成像檢查和結(jié)腸鏡活檢。應(yīng)用單向隨機效應(yīng)模型計算組內(nèi)相關(guān)系數(shù)(Intraclass correlation coefficient, ICC),評估應(yīng)變比值多次測量的重復(fù)性。對照手術(shù)病理結(jié)果,評估彈性分級法、應(yīng)變比值法的診斷價值,同時與常規(guī)ERUS、結(jié)腸鏡活檢相比較。 結(jié)果 在60例直腸腺瘤中,直腸腺瘤惡變即直腸腺癌40例,良性腺瘤20例。彈性分級法診斷腺瘤惡變的敏感性、特異性、準確性、陽性預(yù)測值、陰性預(yù)測值分別為85.0%,70.0%,80.0%,85%,70%。 應(yīng)變比值測量中,三次測量的重復(fù)性好(ICC：0.93～0.95)。直腸腺癌應(yīng)變比值的平均值2.82±1.81(0.76-10.77),良性腺瘤應(yīng)變比值的平均值1.23±0.57(0.62-2.65),二者的應(yīng)變比值有顯著統(tǒng)計學(xué)差異(p0.05)。應(yīng)變比值法診斷的ROC曲線下面積AUC為0.850。以應(yīng)變比值1.240為最佳診斷臨界點,彈性成像應(yīng)變比值法判斷直腸腺瘤惡變的敏感性、特異性、準確性、陽性預(yù)測值、陰性預(yù)測值分別為82.5%,75.0%,80.0%,86.8%,68.1%。 常規(guī)ERUS和結(jié)腸鏡活檢對直腸腺瘤惡變的診斷準確性分別為58.3%和63.3%。直腸腔內(nèi)彈性成像的診斷準確性明顯高于前兩者(p0.05),應(yīng)用彈性成像可將術(shù)前結(jié)腸鏡活檢的漏診率由55%下降至15%。 直腸腔內(nèi)彈性成像對不同大小、位置、基底情況的直腸腺瘤診斷準確性無顯著統(tǒng)計學(xué)差異p0.05)。 結(jié)論 1.直腸腔內(nèi)彈性成像通過彈性分級法(ES)及應(yīng)變比值法(SR)均可以較準確地診斷直腸腺瘤惡變,為臨床手術(shù)方式選擇提供可靠的術(shù)前影像學(xué)依據(jù)。 2.直腸腔內(nèi)彈性成像判斷直腸腺瘤惡變的診斷價值明顯優(yōu)于結(jié)腸鏡活檢和常規(guī)ERUS,應(yīng)用該方法可降低術(shù)前結(jié)腸鏡活檢的漏診率。 3.應(yīng)變比值(SR)測量重復(fù)性好,多次測量可以提供可靠的應(yīng)變比值。 4.直腸腔內(nèi)彈性成像的診斷準確性受病灶大小、位置、基底情況等因素影響少。 目的 1.評估直腸腔內(nèi)超聲彈性成像應(yīng)變比值(Strain Ratio,SR)判斷直腸癌新輔助治療后療效的臨床應(yīng)用價值 2.探討直腸癌新輔助治療后SR改變的病理學(xué)機制 方法 2011年1月至2013年12月,對我院收治的進展期直腸癌患者31例,在新輔助放化療前后,分別行常規(guī)ERUS和直腸腔內(nèi)彈性成像檢查。將放化療前后病灶SR差異,SR差值與病理改變相比較。比較常規(guī)ERUS、彈性成像判斷降期的準確性。應(yīng)用角蛋白AEl/AE3,對放化療后pTl-3期腫瘤殘留病灶行免疫組化染色,分析病灶的SR與AE1/AE3標記的殘留腫瘤面積的相關(guān)性。 結(jié)果 放化療后,29例(93.5%)直腸癌病灶SR值明顯下降(p0.05),另有2例(6.5%)SR值升高。pT0-2期的SR平均值為2.06±0.86,pT3期的SR平均值為3.23±0.91,兩者具有顯著性(p0.05)。以SR降幅≥34.90%判斷放化療后T分期降期的準確性為69%,高于常規(guī)ERUS的準確性(45.1%),但兩者差異不具有顯著性(p0.05)。結(jié)合SR降幅測定結(jié)果,常規(guī)ERUS準確診斷降期由7例升高至14例,較好地提高了降期的診斷準確性。殘留病灶的SR平均值為2.33±1.03(0.35～5.05),AE1/AE3標記的病灶面積平均值為43.2±51.6mm2(0.12～193.17),兩者之間呈直線正相關(guān)(p0.05)。 結(jié)論 1.彈性成像顯示放化療后直腸癌病灶SR值明顯下降,且不同pT期病灶SR具有差異,一定程度上反映了放化療后病灶內(nèi)部病理結(jié)構(gòu)變化。 2.應(yīng)用SR降幅可較好地判斷直腸癌臨床降期,優(yōu)于常規(guī)ERUS。 3. SR降幅可作為常規(guī)ERUS的輔助方法,增加了放化療后病灶內(nèi)部生物力學(xué)變化信息,提高直腸癌放化療后降期及腫瘤浸潤深度診斷準確性,為直腸癌新輔助放化療療效及預(yù)后評估提供了一種新型的較為可靠、無創(chuàng)、簡便的影像學(xué)方法。
[Abstract]:objective
1. evaluate repeatability of Strain Ratio (SR) measurements.
2. the value of Elasticity Score (ES) and strain ratio method (SR) in the diagnosis of rectal adenoma malignancy was evaluated by the pathological results of the rectum, and compared with the colonoscopy and routine ERUS.
3. to explore the influencing factors of diagnostic accuracy of rectal elastography.
Method
From January 2011 to May 2013, 60 patients with rectal adenoma in our hospital were treated with routine ERUS, rectal elastography and colonoscopy. The correlation coefficient (Intraclass correlation coefficient, ICC) was calculated by the one-way random effect model, and the repeatability of the repeated measurements of the strain ratio was evaluated. Results the diagnostic value of elastic grading method and strain ratio method was evaluated and compared with conventional ERUS and colonoscopy.
Result
Among 60 rectal adenomas, rectal adenomas were malignant changes in 40 cases of rectal adenocarcinoma and 20 of benign adenomas. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive values of the diagnosis of adenoma malignancy were 85%, 70%, 80%, 85%, 70%., respectively.
In the strain ratio measurement, the repeatability of the three measurements was good (ICC:0.93 to 0.95). The average value of the strain ratio of the rectal adenocarcinoma was 2.82 + 1.81 (0.76-10.77), the average value of the strain ratio of the benign adenoma was 1.23 + 0.57 (0.62-2.65), the strain ratio of the two was statistically significant (P0.05). The area under the ROC curve diagnosed by the strain ratio method was 0.850.. The ratio of variable ratio 1.240 was the best critical point. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the elastography strain ratio method were 82.5%, 75%, 80%, 86.8%, 68.1%., respectively, to determine the malignant change of rectal adenoma.
The accuracy of the diagnosis of rectal adenoma malignancy by conventional ERUS and colonoscopy is 58.3% and 63.3%. in the rectal cavity, respectively. The accuracy of the diagnosis is significantly higher than that of the previous two (P0.05). The use of elastography can reduce the missed diagnosis rate from 55% to 15%. by the preoperative colonoscopy.
There was no significant difference in the diagnostic accuracy of rectal elastography for rectal adenoma of different size, location and basal condition. P0.05).
conclusion
1. the elastic imaging of the rectum can be used to diagnose the malignant change of rectal adenoma accurately by the elastic classification (ES) and the strain ratio method (SR). It provides a reliable preoperative imaging basis for the selection of surgical methods.
2. the diagnostic value of rectal elastography to determine rectal adenoma malignancy is better than that of colonoscopy and routine ERUS. The application of this method can reduce the missed diagnosis rate of preoperative colonoscopy.
3. strain ratio (SR) measurements are repeatable, and multiple measurements can provide reliable strain ratios.
4. the diagnostic accuracy of elastography in the rectum is less affected by the size of the lesion, location, and basal condition.
objective
1. evaluate the clinical value of Strain Ratio (SR) in evaluating the efficacy of neoadjuvant therapy for rectal cancer.
2. to explore the pathological mechanism of SR changes after neoadjuvant therapy for rectal cancer.
Method
From January 2011 to December 2013, 31 patients with advanced rectal cancer treated in our hospital were treated with conventional ERUS and rectal elastography before and after neoadjuvant radiotherapy. The difference of the lesion SR before and after radiotherapy, the difference between the SR and the pathological changes, was compared with the pathological changes. Comparison of the conventional ERUS, the accuracy of the elastography, and the application of keratin AEl/AE3, Immunohistochemical staining was performed on residual tumor in pTl-3 phase after radiotherapy and chemotherapy, and the correlation between SR and AE1/AE3 residual tumor area was analyzed.
Result
After radiotherapy and chemotherapy, the SR value of 29 cases (93.5%) of rectal cancer was significantly decreased (P0.05), and 2 cases (6.5%) SR value increased.PT0-2 SR average value of 2.06 + 0.86, pT3 phase SR average value was 3.23 + 0.91, both were significant (P0.05). The accuracy of T stage descending after radiotherapy and chemotherapy was 69%, higher than the accuracy of conventional ERUS (45.1%). However, the difference was not significant (P0.05). Combined with the results of SR reduction, the accurate diagnosis of ERUS was raised from 7 to 14, which improved the accuracy of the diagnosis. The average SR of the residual focus was 2.33 + 1.03 (0.35 ~ 5.05), and the average value of the focus surface product of the AE1/AE3 marker was 43.2 + 51.6mm2 (0.12 to 193.17). Linear positive correlation (P0.05).
conclusion
1. elastography showed that the SR value of the lesion of rectal cancer was significantly decreased after radiotherapy and chemotherapy, and the difference of SR in different pT phases was shown to some extent, and to some extent, the pathological changes of the internal pathological structure of the lesion after radiotherapy and chemotherapy were reflected.
2. the application of SR decreased the clinical decline of rectal cancer better than conventional ERUS..
The 3. SR drop can be used as an auxiliary method of conventional ERUS, increasing the information on the internal biomechanical changes of the lesion after radiotherapy and chemotherapy, improving the accuracy of the diagnosis of rectal cancer after radiotherapy and chemotherapy and the depth of tumor infiltration. It provides a new and more reliable, noninvasive and simple imaging method for the evaluation of the curative effect and prognosis of neoadjuvant radiotherapy and chemotherapy for rectal cancer.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R735.37

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相關(guān)期刊論文 前1條

1 羅建文,白凈;超聲彈性成像仿真的有限元分析[J];北京生物醫(yī)學(xué)工程;2003年02期

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本文編號：1825619