本文選題：雙重超聲造影(DCUS) + 胃部疾病��； 參考：《川北醫(yī)學院》2017年碩士論文

【摘要】：目的:探討胃雙重超聲造影(Double Contrast-enhanced Ultrasound DCUS)在胃良、惡性疾病診斷中的應用,以病理結果作為金標準,分析DCUS對胃良、惡性疾病的診斷價值,并總結不同類型胃部疾病的DCUS圖像特征及與相關造影參數(shù)的意義。方法:回顧分析自2014年6月至2016年6月就診于四川省人民醫(yī)院懷疑有胃部疾病的門診及住院患者150例,其中共103例行胃充盈檢查及雙重超聲造影后納入本研究,最終共計107個病灶進行分析研究。所有檢查結果分為惡性、良性疾病兩類,采用卡方檢驗比較US和DCUS對胃良、惡性疾病診斷準確性的差異,分別計算敏感度、特異度、準確率、陽性預測值(PPV)、陰性預測值(NPV)對兩種檢查方法的診斷效能進行比較;總結本研究涉及的四種不同病理類型病灶的造影特征,同時進行造影參數(shù)分析,病灶與周圍正常組織間采用配對t檢驗,病灶間造影參數(shù)的差異采用單因素方差分析,探討造影參數(shù)及造影增強特征在對鑒別不同類型胃部疾病中的價值。結果:本研究中所有進行DCUS檢查的患者在檢查過程中均未出現(xiàn)不良反應。經手術及切除病理活檢證實,75例惡性病灶(33例胃癌,42例胃間質瘤),32例良性病灶(11例炎性病灶,21例胃息肉);DCUS與US在鑒別胃良、惡性病灶時,敏感度(90.6%vs.70.6%)、特異度(75%vs.62.5%)、陽性預測值(89.5%vs.81.5%)、陰性預測值(77.4%vs.47.6%)均高于US檢查;DCUS診斷準確性85.9%,高于US準確性68.2%(P=0.01),差異有統(tǒng)計學意義;對造影參數(shù)進行分析的結果表明,胃癌與周圍正常胃壁組織比較時具有更快的到達時間(AT),更高的峰值強度(PI),更大的曲線下面積(AUC),均P0.05,差異具有統(tǒng)計學意義;胃間質瘤與胃炎性病灶都較周圍正常組織峰值強度高(P0.05);4種不同類型病灶造影參數(shù)分析結果表明,胃癌和GIST的到達時間均短于胃息肉(P0.05);在峰值強度方面,胃炎性病灶高于其它3類病灶,胃癌則高于胃間質瘤和胃息肉(P0.05);在曲線下面積的比較中,胃癌和炎性病灶均大于胃息肉和胃間質瘤(P0.05)。結論:1、超聲胃充盈檢查及雙重超聲造影均有助于鑒別胃良、惡性疾病;2、雙重超聲造影鑒別胃良、惡性疾病的敏感度和特異度明顯高于超聲胃充盈檢查,提高了超聲在胃部疾病診斷中的應用價值,值得臨床推廣應用;3、胃間質瘤造影后表現(xiàn)為特征性的“環(huán)狀”高增強,腫瘤內部則表現(xiàn)各異,可與其它3種類型病灶進行鑒別,可減少不必要的穿刺活檢。4、胃癌雙重超聲造影后,較周圍正常胃壁組織為快速的高增強,具有到達時間短,峰值強度高,曲線下面積大的特點;胃炎性病灶造影后,病灶的增強強度(PI)高于周圍正常胃壁組織,但與周圍正常組織到達時間無異;造影增強特征結合造影參數(shù)分析有助于鑒別胃癌及GIST惡性胃部疾病。
[Abstract]:Objective: to investigate the application of double Contrast-enhanced Ultrasound (DCUSS) in the diagnosis of gastric benign and malignant diseases, and to analyze the value of DCUS in the diagnosis of gastric benign and malignant diseases. The features of DCUS images of different types of gastric diseases and the significance of the relevant imaging parameters were summarized. Methods: from June 2014 to June 2016, 150 outpatients and inpatients with suspected gastric diseases in Sichuan Provincial people's Hospital were retrospectively analyzed. 103 cases were included in this study after gastric filling examination and dual contrast-enhanced ultrasonography. A total of 107 lesions were analyzed and studied. All the examination results were divided into malignant and benign diseases. The diagnostic accuracy of US and DCUS in gastric benign and malignant diseases was compared by chi-square test. Sensitivity, specificity and accuracy were calculated respectively. The positive predictive value (PPVV) and the negative predictive value (NPV) were compared between the two methods, and the imaging features of four different pathological types of lesions were summarized, and the parameters of the two methods were analyzed. The paired t test was used between the lesions and the surrounding normal tissues. The difference of the contrast parameters among the lesions was analyzed by single factor variance analysis. The value of the contrast parameters and contrast-enhanced features in the differential diagnosis of different types of gastric diseases was discussed. Results: no adverse reactions were observed in all patients undergoing DCUS in this study. 75 cases of malignant lesions 33 cases of gastric carcinoma 42 cases of gastric stromal tumors 32 cases of benign lesions 11 cases of inflammatory lesions 21 cases of gastric polyps with DCUS and US in the differential diagnosis of benign and malignant gastric lesions. The sensitivity of 90.6V s.70.6, the specificity of 75vs.62.5, the positive predictive value of 89.5vs.81.5 and the negative predictive value of 77.4vs.47.6were higher than that of US examination and the diagnostic accuracy of DCUS was 85.9, and the accuracy of US was 68.2P0.01.The difference was statistically significant. Compared with the normal gastric wall tissue, gastric cancer had a faster time of arrival, a higher peak intensity and a larger area under the curve (P 0.05). The peak intensity of gastric stromal tumors and gastritis lesions were higher than that of the surrounding normal tissues. The results showed that the arrival time of gastric cancer and GIST was shorter than that of gastric polyps, and the peak intensity of gastric cancer and GIST was lower than that of normal tissues. Gastritis lesions were higher than other three types of lesions, gastric cancer was higher than gastric stromal tumors and gastric polyps (P0.05), and under the curve, gastric cancer and inflammatory lesions were both larger than gastric polyps and gastric stromal tumors (P0.05). Conclusion: the sensitivity and specificity of ultrasound filling examination and dual contrast-enhanced ultrasonography are significantly higher than that of ultrasonography in differentiating gastric benign and malignant diseases from gastric benign and malignant diseases (P < 0. 05), and the sensitivity and specificity of dual contrast-enhanced ultrasonography in differentiating gastric benign and malignant diseases are significantly higher than that of ultrasonography. The value of ultrasound in the diagnosis of gastric diseases is improved, and it is worth popularizing in clinical application. Gastric stromal tumors are characterized by "annular" high enhancement after contrast examination, and the internal manifestations of the tumors are different, which can be distinguished from other three types of lesions. It can reduce unnecessary puncture biopsy. 4. After double contrast-enhanced gastric cancer, compared with the surrounding normal gastric wall tissue, it has the characteristics of short arrival time, high peak intensity and large area under the curve. The enhancement intensity of the lesion was higher than that of the surrounding normal gastric wall tissue, but the arrival time of the lesion was the same as that of the surrounding normal tissue, and the enhancement features of the lesion combined with the analysis of the parameters were helpful in differentiating the gastric cancer from the GIST malignant gastric disease.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R573

【參考文獻】

相關期刊論文 前10條

1 李婷婷;盧漫;宋軍;吳平;蔡志清;馬懿;;雙重超聲造影在胃腸間質瘤中的應用價值[J];實用醫(yī)院臨床雜志;2016年02期

2 李婷婷;盧漫;陸文明;蔡志清;馬懿;宋軍;吳平;;胃隆起樣病變的胃充盈下CEUS特征分析研究[J];中國超聲醫(yī)學雜志;2015年12期

3 王倩;周華玲;張東東;李強;;超聲雙重造影對胃癌術前分期的診斷意義[J];中華危重癥醫(yī)學雜志(電子版);2015年02期

4 張艷兵;李丕宏;盧明東;李利義;王飛海;鄭志強;;雙重超聲造影與胃增強CT在診斷早期胃癌中的應用[J];溫州醫(yī)科大學學報;2014年08期

5 陳海良;姚桂昌;陳彩女;;超聲造影檢查胃部疾病的臨床應用分析[J];醫(yī)學影像學雜志;2013年11期

6 沈琳;李健;秦叔逵;王堅;葉穎江;周燁;張波;吳欣;張信華;;中國胃腸間質瘤診斷治療共識(2013年版)[J];臨床腫瘤學雜志;2013年11期

7 楊紅梅;趙小東;饒靜;何燕;馮國雋;;超聲造影在胃癌診斷中的應用價值[J];臨床超聲醫(yī)學雜志;2013年10期

8 姬亞敏;陸文明;戴元穎;范曉華;;胃腔超聲造影在胃癌診斷及分期診斷中的應用[J];臨床超聲醫(yī)學雜志;2013年09期

9 ;Double contrast-enhanced two-dimensional and three-dimensional ultrasonography for evaluation of gastric lesions[J];World Journal of Gastroenterology;2012年31期

10 邱濤;王文斌;;鋇餐造影在胃癌中的臨床診斷價值[J];臨床合理用藥雜志;2012年19期

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