發(fā)布時間：2018-09-09 12:15

【摘要】：目的 聲觸診組織定量(VTQ)技術是聲輻射力脈沖成像技術(ARFI)新的測量組織硬度的一種定量技術，探究它對甲狀腺良惡性結節(jié)鑒別診斷的價值并把它與二維超聲成像相比較。 資料與方法 本研究包括128例患者136個結節(jié)，均經(jīng)病理證實，且所有結節(jié)都首先行常規(guī)超聲檢查，然后行ARFI的VTQ技術檢查。記錄每一個結節(jié)二維超聲特征，再將VTQ技術檢查的組織硬度以剪切波速度(SWV)和剪切波速度比值(SWR)記錄下來。受試者操作特性曲線(ROC)分析用來評價二維超聲及SWV和SWR在良惡性結節(jié)之間的鑒別診斷。二維超聲和VTQ技術ROC曲線下的面積被計算，它們之間的面積比較用Z檢驗，p0.05為差異有統(tǒng)計學意義。 結果 1.102個良性結節(jié)中，14(13.7%)個病灶周邊有聲暈；41(40%)個病灶有微鈣化；97(95.1%)個病灶呈低回聲；7(6.8%)個病灶縱橫比1；37(36.2%)個病灶內(nèi)部有血流信號。32個惡性結節(jié)中，3(8.8%)個病灶周邊有聲暈；12(35.4%)個病灶有微鈣化；33(97.9%)個病灶呈低回聲；19(55.8%)個病灶縱橫比1；21(61.7%)個病灶內(nèi)部有血流信號。 根據(jù)超聲各評分診斷點作為檢驗變量，以病理診斷為狀態(tài)變量，作ROC曲線，診斷甲狀腺良、惡性結節(jié)的曲線下的面積為0.725，診斷臨界點≥4分，二維超聲診斷良惡性結節(jié)的ROC曲線下面積最大(0.716)，約登指數(shù)為：0.441，其敏感性、特異性分別為62.8%、81.3%。 2.甲狀腺良、惡性結節(jié)的SWV分別為：(2.37±0.38)m/s、(3.93±1.96) m/s(t=4.907，p值=0.000)；甲狀腺良、惡性病灶SWR分別為：1.15±0.28、1.77±0.69(t=4.512，p值=0.000)；SWV大于2.75m/s作為診斷甲狀腺結節(jié)敏感性81.4%，特異性82.1%，準確性80.8%，，陽性預測值58.6%,陰性預測值92.2%；SWR大于1.32診斷甲狀腺結節(jié)的敏感性69.8%，特異性89.3%，準確性83.8%，陽性預測值67.6%,陰性預測值89.2%，SWV的ROC曲線下的面積0.868(95%CI:0.762,0.941)(p=0.000)和SWR的ROC曲線下的面積0.813(95%CI:0.687,0.901)(p=0.000)之間無統(tǒng)計學差異(p0.20)。 3.把各個SWV作為檢驗變量，以病理診斷為狀態(tài)變量制作ROC曲線，ROC曲線下的面積為0.868，p值0.000，標準誤0.040；把超聲各評分診斷點作為檢驗變量，以病理診斷為狀態(tài)變量制作ROC曲線，ROC曲線下的面積為:0.725，p值0.001，標準誤0.045；兩者經(jīng)Z檢驗，Z=2.897，p0.004，兩者比較差異有統(tǒng)計學意義。 結論 ARFI的VTQ成像對組織的硬度提供一種量化和可重復的信息，在鑒別甲狀腺良惡性結節(jié)方面是一種有用的技術，VTQ的診斷準確性高于二維超聲，被認為是常規(guī)超聲成像的一個有益補充。
[Abstract]:Objective the technique of acoustic palpation tissue quantitative (VTQ) (VTQ) is a new quantitative technique for measuring tissue hardness by acoustic radiation pulse imaging (ARFI). To explore its value in differential diagnosis of benign and malignant thyroid nodules and compare it with two-dimensional ultrasound imaging. Materials and methods this study included 136 nodules in 128 patients, all of which were confirmed by pathology, and all nodules were examined by conventional ultrasound first, then by VTQ technique of ARFI. The two-dimensional ultrasonic characteristics of each node were recorded and the tissue hardness measured by VTQ technique was recorded with shear wave velocity (SWV) and shear wave velocity ratio (SWR). (ROC) analysis was used to evaluate the differential diagnosis between benign and malignant nodules by two dimensional ultrasound, SWV and SWR. The area under the ROC curve of two-dimensional ultrasound and VTQ technique was calculated and the difference between them was statistically significant by Z test. Results 1.14 (13.7%) of 102 benign nodules had microcalcification around 41 (40%) lesions, 97 (95.1%) had hypoechoic lesions and 7 (6.8%) had a aspect ratio of 1. In 37 (36.2%) lesions, there was blood flow signal in 37 (36.2%) lesions, and in 3 (8.8%) of 32 malignant nodules, 12 (35.4%) lesions had microcalcification. 33 (97.9%) lesions showed hypoechoic lesions. The aspect ratio of 19 (55.8%) lesions to 121 (61.7%) lesions had blood flow signals. According to the diagnostic points of ultrasound scores as test variables and pathological diagnosis as state variables, the ROC curve was used to diagnose benign and malignant thyroid nodules. The area under the curve was 0.725, and the critical point of diagnosis was 鈮

本文編號：2232339