本文選題：超聲造影 + 甲狀腺微小乳頭狀癌　； 參考：《遵義醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：分析常規(guī)超聲、超聲造影以及聯(lián)合常規(guī)超聲和超聲造影三種方法，，對(duì)鑒別甲狀腺微小良惡性病變的診斷價(jià)值。評(píng)價(jià)超聲造影的定性診斷及定量診斷兩種方法在甲狀腺微小良惡性病變?cè)\斷中的作用。 方法：102例甲狀腺結(jié)節(jié)納入標(biāo)準(zhǔn)：①甲狀腺內(nèi)孤立性低弱回聲結(jié)節(jié)，②甲狀腺背景為實(shí)質(zhì)回聲均勻的正常甲狀腺組織，③結(jié)節(jié)最大直徑≤10mm，④TI-RADS分類(lèi)為3類(lèi)和4類(lèi)；排除標(biāo)準(zhǔn)：①結(jié)節(jié)直徑＞10mm的低弱回聲結(jié)節(jié)，②高回聲或等回聲結(jié)節(jié)，③伴有多發(fā)結(jié)節(jié)，④結(jié)節(jié)內(nèi)粗大鈣化致使不能顯示結(jié)節(jié)實(shí)性成份的結(jié)節(jié)，⑤FNA診斷分型中取材不滿(mǎn)意不能診斷的結(jié)節(jié)。儀器采用意大利百勝公司的Mylab90超聲診斷儀。造影劑選用意大利Bracco公司生產(chǎn)的聲諾維（SonoVue），經(jīng)肘正中靜脈團(tuán)注造影劑1.0ml。采用目測(cè)法觀(guān)察甲狀腺內(nèi)微小結(jié)節(jié)的增強(qiáng)特點(diǎn)，并應(yīng)用Qontrast4.0分析軟件進(jìn)行時(shí)間-強(qiáng)度曲線(xiàn)（TIC）定量參數(shù)分析，并與手術(shù)病理為金標(biāo)準(zhǔn)進(jìn)行對(duì)照。超聲造影操作人員要求由三個(gè)固定的具有造影經(jīng)驗(yàn)3年以上的醫(yī)師操作，以達(dá)到標(biāo)準(zhǔn)統(tǒng)一。統(tǒng)計(jì)學(xué)數(shù)據(jù)應(yīng)用Binary Logistic回歸分析以及診斷性試驗(yàn)方法中ROC曲線(xiàn)，得出ROC曲線(xiàn)下面積，進(jìn)行比較分析。 結(jié)果：1、單因素分析，患者一般情況中甲狀腺微小乳頭狀癌患者的平均年齡（40.69±10.67）歲低于良性組患者的平均年齡（49.52±13.21）歲、惡性組患病年齡多在30-50歲之間，年齡在良惡性組間差異性比較中有統(tǒng)計(jì)學(xué)意義（P㩳0.05），性別在良惡性組間比較中無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；常規(guī)超聲檢查中，甲狀腺微小乳頭狀癌的結(jié)節(jié)多顯示為不規(guī)則形態(tài)、邊界不清晰、縱橫比（A/T）≥1、結(jié)節(jié)內(nèi)微鈣化以及頸部查見(jiàn)可疑異常腫大淋巴結(jié)在良惡性組間差異性比較中有統(tǒng)計(jì)學(xué)意義（P㩳0.05）；超聲造影定性指標(biāo)中，甲狀腺微小乳頭狀癌的超聲造影特征多表現(xiàn)為慢進(jìn)、向心性增強(qiáng)、不均勻性增強(qiáng)、達(dá)峰時(shí)呈等增強(qiáng)或低增強(qiáng)、增強(qiáng)后結(jié)節(jié)徑線(xiàn)改變、邊界不清晰、結(jié)節(jié)周邊無(wú)環(huán)狀增強(qiáng)，以上指標(biāo)中除不均勻性增強(qiáng)外良惡性組間差異性比較有統(tǒng)計(jì)學(xué)意義（P㩳0.05）；超聲造影時(shí)間-強(qiáng)度曲線(xiàn)（TIC）定量參數(shù)中，峰值強(qiáng)度（PEAK）、局部血流量（RBF）、最大灌注強(qiáng)度（SImax）、平均灌注強(qiáng)度（SImean）、相對(duì)峰值強(qiáng)度、相對(duì)峰值時(shí)間、相對(duì)局部血流量、相對(duì)局部血容量、相對(duì)平均灌注強(qiáng)度、相對(duì)最大灌注強(qiáng)度在良惡性組間差異性比較中有統(tǒng)計(jì)學(xué)意義（P㩳0.05）； 2、多因素分析，常規(guī)超聲及患者一般情況多因素分析中：①縱橫比A/T，②形態(tài)是否規(guī)則，③結(jié)節(jié)內(nèi)微鈣化，④頸部有無(wú)可疑異常淋巴結(jié)進(jìn)入Logistic多因素回歸方程，預(yù)測(cè)甲狀腺微小乳頭狀癌的準(zhǔn)確性、敏感性及特異性分別為82.4%、80.0%、84.6%；超聲造影定性指標(biāo)多因素分析中：①造影增強(qiáng)時(shí)間，②有無(wú)環(huán)狀增強(qiáng)進(jìn)入多因素回歸方程，運(yùn)用Logistic回歸方程預(yù)測(cè)甲狀腺微小乳頭狀癌的準(zhǔn)確性、敏感性及特異性分別為87.3%、86.0%、88.5%；超聲造影定量指標(biāo)中僅有相對(duì)最大灌注強(qiáng)度（相對(duì)SImax）一項(xiàng)參數(shù)進(jìn)入Logistic回歸方程，其預(yù)測(cè)甲狀腺微小乳頭狀癌的準(zhǔn)確性、敏感性及特異性分別為66.7%、60.0%、73.1%；聯(lián)合常規(guī)超聲以及超聲造影定性定量的多因素分析中：①縱橫比A/T，②微鈣化，③頸部有無(wú)可疑異常淋巴結(jié)，④造影灌注方式，⑤有無(wú)環(huán)狀增強(qiáng)及⑥SImax進(jìn)入Logistic回歸方程，其預(yù)測(cè)甲狀腺微小乳頭狀癌的準(zhǔn)確性、敏感性及特異性分別為93.1%、92.0%、94.2%。 3.ROC曲線(xiàn)分析，常規(guī)超聲診斷方法、超聲造影定性診斷和定量診斷方法以及聯(lián)合常規(guī)超聲和超聲造影定性定量診斷方法產(chǎn)生的ROC曲線(xiàn)下面積分別為90.0%、90.7%、99.0%。由此可見(jiàn)，聯(lián)合應(yīng)用常規(guī)超聲和超聲造影定性定量?jī)煞N診斷方法，其診斷能力明顯優(yōu)于單獨(dú)應(yīng)用前兩者；分別由超聲造影的定性診斷方法和定量診斷方法獲得的ROC曲線(xiàn)，其曲線(xiàn)下面積分別為90.7%、69.7%。由此可見(jiàn)，超聲造影的定性診斷能力明顯優(yōu)于超聲造影定量診斷方法的診斷能力。 結(jié)論：對(duì)甲狀腺微小乳頭狀癌的診斷能力而言，超聲造影定性診斷方法的準(zhǔn)確性、敏感性和特異性均高于超聲造影的定量診斷方法。聯(lián)合應(yīng)用常規(guī)超聲以及超聲造影定性及定量各項(xiàng)指標(biāo)和參數(shù)對(duì)甲狀腺微小良惡性結(jié)節(jié)的鑒別診斷能力明顯優(yōu)于單獨(dú)運(yùn)用前兩者，值得在臨床上推廣應(yīng)用。
[Abstract]:Objective: to analyze the diagnostic value of three methods of conventional ultrasound, ultrasound contrast and conventional ultrasound and ultrasound contrast in the differential diagnosis of benign and malignant thyroid lesions. To evaluate the role of two methods of qualitative diagnosis and quantitative diagnosis of contrast ultrasound in the diagnosis of thyroid microbenign and malignant lesions.
Methods: 102 cases of thyroid nodules were included: (1) isolated hypoechoic nodules in the thyroid gland, (2) thyroid background as parenchyma and homogeneous normal thyroid tissue, (3) the maximum diameter of the nodules were less than 10mm, and (4) TI-RADS classified as 3 and 4 categories; the exclusion criteria: (1) the low and weak echo nodules with the diameter of the nodule > 10mm, and the hyperechoic or equal echo Nodules, (3) with multiple nodules, (4) nodular calcification that can not show nodular solid components, (5) FNA diagnostic typing that is dissatisfied with undiagnosed nodules. The instrument adopts the Mylab90 ultrasonic diagnostic instrument of Italy Baisheng company. The contrast agent is selected from the SonoVue of the Bracco male division in Italy and the median vein of the elbow. The contrast agent 1.0ml. was observed by visual method to observe the enhancement of small nodules in the thyroid gland. The quantitative parameters of time intensity curve (TIC) were analyzed with Qontrast4.0 analysis software and compared with the gold standard of surgical pathology. The operators of ultrasound contrast operators were required to be operated by three fixed doctors with more than 3 years of angiography. In order to achieve standard unification, statistical data is used in the Binary Logistic regression analysis and the diagnostic test method of ROC curve to obtain the area under the ROC curve, and to make a comparative analysis.
Results: 1, single factor analysis, the average age of the patients with thyroid small papillary carcinoma (40.69 + 10.67) was lower than that of the benign group (49.52 + 13.21). The age of the malignant group was 30-50 years old, and the age was statistically significant between the benign and malignant groups (P? 0.05), and the sex was in the benign and malignant group. There was no statistical significance in the comparison (P > 0.05); in the routine ultrasound examination, the nodules of the thyroid micropapillary carcinoma showed irregular shape, the boundary was not clear, the longitudinal and transverse ratio (A/T) was more than 1, the microcalcification in the nodules and the suspicious abnormal lymph nodes in the neck were statistically significant (P? 0.05) in the benign and malignant groups; The contrast-enhanced ultrasound features of thyroid micropapillary carcinoma were characterized by slow progress, centripetal enhancement, inhomogeneity enhancement, enhanced or low enhancement in the peak, enhanced posterior nodular diameter, unclear boundary, non circular enhancement in the periphery of nodules, and the differences among the above groups in addition to non uniformity and non uniformity. Statistical significance (P? 0.05); in the quantitative parameters of the time intensity curve (TIC), the peak intensity (PEAK), the local blood flow (RBF), the maximum perfusion intensity (SImax), the average perfusion intensity (SImean), the relative peak intensity, the relative peak time, relative local blood flow, relative local blood volume, relative mean perfusion intensity, relative maximum perfusion intensity, and relative maximum perfusion were observed. There was a significant difference in the intensity between the benign and malignant groups (P? 0.05).
2, multifactor analysis, conventional ultrasound and patient general analysis of multifactor analysis: (1) the accuracy of the thyroid micropapillary carcinoma is 82.4%, 80%, and 84.6%, respectively, whether the longitudinal and transverse A/T, the second shape is regular, the third is the microcalcification in the nodules, and the suspicious abnormal lymph nodes in the neck are entered into the multiple regression equation of the multiple factors of the thyroid papillary carcinoma. The multiple factor analysis of ultrasound contrast qualitative indexes: (1) contrast enhancement time, or ring enhancement into multiple regression equation, using Logistic regression equation to predict the accuracy of thyroid small papillary carcinoma, the sensitivity and specificity were 87.3%, 86%, 88.5%, respectively, and only the relative maximum perfusion intensity in the hyper contrast quantitative index. Relative SImax) a parameter entered the Logistic regression equation, and its accuracy was 66.7%, 60%, and 73.1% for the prediction of thyroid small papillary carcinoma, respectively, and the qualitative and quantitative analysis of combined conventional ultrasound and ultrasound contrast: (1) the longitudinal and transverse ratio A/T, the second microcalcification, and the neck without suspicious abnormal lymph nodes; (4) angiography The accuracy of the thyroid micropapillary carcinoma was predicted with 93.1%, 92%, 94.2%., respectively, with no annular enhancement and 6 SImax into the Logistic regression equation.
3.ROC curve analysis, conventional ultrasonic diagnosis, qualitative diagnosis and quantitative diagnosis of contrast-enhanced ultrasound and qualitative and quantitative diagnosis of combined conventional ultrasound and ultrasound contrast ROC curves are 90%, 90.7%, 99.0%., respectively. The combined use of conventional ultrasound and ultrasound contrast qualitative and quantitative diagnosis of two methods, the diagnosis The ability of the ROC curve obtained by qualitative diagnosis and quantitative diagnosis of ultrasound contrast, respectively, is 90.7% and 69.7%., respectively. The qualitative diagnosis ability of ultrasound contrast is better than that of the quantitative diagnostic method of ultrasound contrast.
Conclusion: for the diagnosis of thyroid small papillary carcinoma, the accuracy, sensitivity and specificity of the qualitative diagnosis are higher than the quantitative diagnostic methods of contrast-enhanced ultrasound. The differential diagnosis of thyroid small benign and malignant nodules by combined use of conventional ultrasound and ultrasound contrast medium and quantitative parameters and parameters The force is obviously better than the former two. It is worth popularizing in clinic.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R736.1;R445.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王勇;郝玉芝;金美花;羅德紅;鄒霜梅;宋穎;李琳;周純武;;超聲檢查在診斷甲狀腺微小病變中的價(jià)值[J];當(dāng)代醫(yī)學(xué);2009年20期

2 張淵;江泉;陳劍;顧曉鳴;章建全;;甲狀腺單發(fā)結(jié)節(jié)三維超聲定性診斷及其ROC曲線(xiàn)分析[J];中國(guó)臨床醫(yī)學(xué)影像雜志;2010年01期

3 卜麗娜;許嵐;吳鵬西;;良惡性甲狀腺結(jié)節(jié)超聲造影定量分析[J];南京醫(yī)科大學(xué)學(xué)報(bào)(自然科學(xué)版);2010年11期

4 張一清;超聲對(duì)甲狀腺腺瘤的診斷及鑒別診斷[J];山西醫(yī)藥雜志;2005年02期

5 張立;范廣民;於麗華;;甲狀腺乳頭狀微小癌中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移的多因素Logistic回歸分析[J];實(shí)用腫瘤雜志;2009年06期

6 劉廣健;呂明德;徐輝雄;謝曉燕;徐作峰;鄭艷玲;梁瑾瑜;;超聲造影與對(duì)比增強(qiáng)CT診斷肝細(xì)胞癌的比較研究[J];中國(guó)超聲醫(yī)學(xué)雜志;2005年12期

7 張惠灝;陳祥錦;;甲狀腺乳頭狀微小癌108例診治分析[J];中國(guó)社區(qū)醫(yī)師(醫(yī)學(xué)專(zhuān)業(yè)半月刊);2009年24期

8 詹維偉;;甲狀腺結(jié)節(jié)的超聲診斷進(jìn)展[J];中華醫(yī)學(xué)超聲雜志(電子版);2011年06期

9 王深明,常光其,鄭小新,葉有強(qiáng),黃雪玲;甲狀腺微小癌110例臨床漏診原因及對(duì)策[J];中華普通外科雜志;2002年07期

10 史曉龍;鄭笑娟;郭新海;李春生;彭敏霞;周?chē)?guó)平;蔣勇;顏樹(shù)宏;余穎萌;;甲狀腺腫塊的超聲造影與病理對(duì)照分析[J];浙江實(shí)用醫(yī)學(xué);2007年02期

本文編號(hào)：2033918