本文選題：甲狀腺癌 + 甲狀腺結(jié)節(jié)　； 參考：《天津醫(yī)科大學》2014年碩士論文

【摘要】：目的 1、探討常規(guī)超聲對甲狀腺實性結(jié)節(jié)的診斷價值。 2、應(yīng)用聲脈沖輻射力彈性成像(ARFI)技術(shù)評估甲狀腺結(jié)節(jié)硬度,探討其在甲狀腺實性結(jié)節(jié)良惡性定性方面的價值。 3、探討常規(guī)超聲與ARFI技術(shù)聯(lián)合應(yīng)用對甲狀腺實性結(jié)節(jié)的診斷價值。資料與方法 選取2012年12月～2013年6月在我院因甲狀腺結(jié)節(jié)而住院的患者106例,共121個結(jié)節(jié),所有結(jié)節(jié)均經(jīng)手術(shù)病理學證實。 應(yīng)用Siemens S2000彩色多普勒超聲診斷儀,內(nèi)置聲脈沖輻射力彈性成像技術(shù)及軟件,使用9L4多功能探頭,探頭頻率為7-12MHz。 患者仰臥位,后仰頭部,充分暴露頸部,平靜呼吸。首先行甲狀腺常規(guī)超聲掃查,記錄甲狀腺結(jié)節(jié)的位置、大小、形態(tài)、邊緣、縱橫比、內(nèi)部回聲、周邊有無聲暈、內(nèi)部鈣化特點及血流情況等。然后切換為聲觸診組織成像(Virtual touch tissue imaging, VTI)模式,縱向掃查獲得結(jié)節(jié)最大切面,囑患者屏住呼吸,對甲狀腺結(jié)節(jié)行VTI彈性成像檢查,觀察結(jié)節(jié)彈性分布情況。之后對結(jié)節(jié)及結(jié)節(jié)周邊等深度正常甲狀腺組織行聲觸診組織定量(Virtual touch tissue quantification,VTQ)檢查,讀取并記錄感興趣區(qū)組織及周邊相同深度正常組織剪切波速度值(Shear wave velocity, S WV)和取樣深度值,重復(fù)以上操作6次,剔除最大值、最小值,余4值取平均值進行統(tǒng)計。本研究由2名超聲醫(yī)師進行檢查并獨立做出評估與診斷,取得一致意見,意見不同時經(jīng)協(xié)商達成一致。 數(shù)據(jù)統(tǒng)計采用SPSS13.0統(tǒng)計軟件分析,計量資料以x±s表示,采用卡方檢驗比較良惡性甲狀腺結(jié)節(jié)常規(guī)超聲聲像圖特征差異。采用t檢驗比較甲狀腺良惡性結(jié)節(jié)SWV值差異,以P0.05表示差異具有統(tǒng)計學意義。繪制ROC曲線,尋找VTI彈性分級、剪切波速度鑒別甲狀腺結(jié)節(jié)良惡性的最佳界點。以病理結(jié)果為金標準,計算常規(guī)超聲、VTI技術(shù)、VTQ技術(shù)、常規(guī)超聲+VTI技術(shù)、常規(guī)超聲+VTQ技術(shù)診斷甲狀腺實性結(jié)節(jié)的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值及準確性。 結(jié)果 在121個甲狀腺結(jié)節(jié)中,良性結(jié)節(jié)55個,惡性結(jié)節(jié)66個。 1、常規(guī)超聲診斷甲狀腺良惡性結(jié)節(jié)的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、準確性分別為74.2%、80%、81.6%、72.1%、76.8%。 2、以VTI彈性分級≥IV級作為診斷甲狀腺惡性結(jié)節(jié)的診斷界點,VTI診斷的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、準確性分別為89.3%、92.7%、93.6%、87.9%、90.9%。 3、甲狀腺良性結(jié)節(jié)的SWV平均值為(2.61±1.15)m/s,甲狀腺惡性結(jié)節(jié)SWV平均值為(3.96±1.31)m/s,兩者比較具有顯著性差異(P0.05)。通過繪制ROC曲線得出SWV最佳診斷臨界點為2.85m/s,曲線下面積為0.92,對應(yīng)敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、準確性分別為84.8%、83.6%、86.1%、82.1%、84.2%。 4、常規(guī)超聲結(jié)合VTI技術(shù)對甲狀腺良惡性結(jié)節(jié)鑒別診斷的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、準確性分別為90.9%、92.7%、93.7%、89.4%、91.7%。 5、常規(guī)超聲結(jié)合VTQ技術(shù)對甲狀腺良惡性結(jié)節(jié)鑒別診斷的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值、準確性分別為87.8%、85.4%、87.8%、85.4%、86.7%。 6、五種方法診斷甲狀腺實性結(jié)節(jié)的敏感性、特異性、準確性兩兩比較,常規(guī)超聲結(jié)合VTI技術(shù)診斷甲狀腺結(jié)節(jié)良惡性的敏感性、特異性最高,且差異具有統(tǒng)計學意義,兩者聯(lián)合應(yīng)用對甲狀腺實性結(jié)節(jié)性質(zhì)的診斷具有重要價值。 結(jié)論 1、VTI可以直觀的反映甲狀腺結(jié)節(jié)的整體彈性特征,以VTI彈性分級1V級作為鑒別甲狀腺良惡性的界點,具有較高的敏感性、特異性及準確性。 2、甲狀腺良惡性結(jié)節(jié)SWV值差異具有統(tǒng)計學意義,惡性結(jié)節(jié)的SWV值明顯高于良性結(jié)節(jié)。以SWV值=2.85m/s作為最佳診斷界點,可提高甲狀腺良惡性結(jié)節(jié)診斷的準確性。 3、VTI技術(shù)與常規(guī)超聲聯(lián)合應(yīng)用敏感性、特異性最高,兩種方法聯(lián)合應(yīng)用有利于甲狀腺實性結(jié)節(jié)良惡性的鑒別診斷。
[Abstract]:objective
1, to investigate the diagnostic value of conventional ultrasound for solid thyroid nodules.
2, we assessed the hardness of thyroid nodules by acoustic impulse radiation force elastography (ARFI), and explored its value in qualitative and malignant aspects of solid thyroid nodules.
3, to explore the diagnostic value of combined conventional ultrasound and ARFI for solid thyroid nodules.
From December 2012 to June 2013, 106 patients with thyroid nodules were hospitalized in our hospital. There were 121 nodules. All the nodules were confirmed by surgery and pathology.
Using Siemens S2000 color Doppler ultrasound diagnostic instrument, built in acoustic pulse radiation force elastic imaging technology and software, using 9L4 multi-function probe, the probe frequency is 7-12MHz.
The patients were lying on the back and back in the head to fully expose the neck and calm the breath. First, the thyroid nodules were recorded by routine ultrasound scan to record the position of thyroid nodules, size, shape, edge, longitudinal and transverse ratio, internal echoes, the peripheral corona, internal calcification and blood flow, and then switched to Virtual touch tissue imaging, VTI The model, longitudinal scan obtained the maximum section of nodules, asked the patients to hold their breath, the thyroid nodules were examined by VTI elastic imaging, and the elastic distribution of nodules was observed. Then the acoustic palpation tissue quantitative (Virtual touch tissue quantification, VTQ) examination of nodules and peripheral nodules and other deep normal thyroid tissues was examined and read and recorded. The value of shear wave velocity (Shear wave velocity, S WV) and sampling depth of the same deep normal tissue in the region and around the region were repeated 6 times, and the maximum value, minimum value, and the remaining 4 values were eliminated. This study was checked by 2 ultrasonic physicians and made the evaluation and diagnosis independently, and the agreement was not agreed at the same time. The opinions were not cooperated at the same time. The business reached agreement.
The data statistics were analyzed by SPSS13.0 statistical software. The measurement data were expressed in X + s, and the difference between the benign and malignant thyroid nodules was compared by the chi square test. The difference of SWV value between the benign and malignant thyroid nodules was compared with the t test, and the difference was statistically significant by P0.05. The ROC curve was drawn to find the elastic classification of VTI and the shear wave. Velocity identification of the best boundary of benign and malignant thyroid nodules. Using the pathological results as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of conventional ultrasound, VTI, VTQ, conventional +VTI, and conventional ultrasound +VTQ were used to diagnose the thyroid nodules.
Result
Of the 121 thyroid nodules, 55 were benign nodules and 66 were malignant nodules.
1, the sensitivity, specificity, positive predictive value and negative predictive value of conventional ultrasound in diagnosing benign and malignant thyroid nodules were 74.2%, 80%, 81.6%, 72.1%, 76.8%. respectively.
2, the diagnostic boundary of thyroid malignant nodules was diagnosed by VTI elastic classification or IV grade. The sensitivity, specificity, positive predictive value and negative predictive value of VTI diagnosis were 89.3%, 92.7%, 93.6%, 87.9%, 90.9%., respectively.
3, the average value of SWV of thyroid benign nodules was (2.61 + 1.15) m/s, and the average value of SWV of thyroid malignant nodules was (3.96 + 1.31) m/s, and there was a significant difference between them (P0.05). By plotting the ROC curve, the optimal critical point of SWV diagnosis was 2.85m/s, the area under the curve was 0.92, corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. The sex was 84.8%, 83.6%, 86.1%, 82.1%, 84.2%., respectively.
4, the sensitivity, specificity, positive predictive value and negative predictive value of conventional ultrasound combined with VTI technique in the differential diagnosis of thyroid benign and malignant nodules were 90.9%, 92.7%, 93.7%, 89.4%, 91.7%., respectively.
5, the sensitivity, specificity, positive predictive value and negative predictive value of conventional ultrasound combined with VTQ technique in the differential diagnosis of thyroid benign and malignant nodules were 87.8%, 85.4%, 87.8%, 85.4%, 86.7%., respectively.
6, the sensitivity, specificity and accuracy of the diagnosis of thyroid nodules by five methods are compared. The sensitivity of conventional ultrasound combined with VTI technique in the diagnosis of benign and malignant thyroid nodules is of the highest specificity, and the difference is statistically significant. The combination of the two methods is of great value for the diagnosis of the properties of thyroid nodules.
conclusion
1, VTI can directly reflect the overall elastic characteristics of thyroid nodules, and the VTI elastic classification of 1V level as a boundary point for the identification of thyroid benign and malignant, with high sensitivity, specificity and accuracy.
2, the difference of SWV value of thyroid benign and malignant nodules is statistically significant, and the SWV value of malignant nodules is significantly higher than that of benign nodules. The SWV value =2.85m/s is the best diagnostic point, which can improve the accuracy of the diagnosis of thyroid benign and malignant nodules.
3, the sensitivity and specificity of the combination of VTI and conventional ultrasound are the highest. The combination of the two methods is beneficial to the differential diagnosis of benign and malignant thyroid nodules.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R736.1;R445.1

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