【摘要】：目的：1.探討超聲彈性成像技術(shù)結(jié)合二維超聲在甲狀腺結(jié)節(jié)診斷中的應(yīng)用價(jià)值,二者聯(lián)合應(yīng)用的優(yōu)勢(shì)及對(duì)于臨床的意義2.分析影響彈性成像技術(shù)在甲狀腺良惡性結(jié)節(jié)鑒別診斷的相關(guān)因素。 方法：選取符合條件在我院外科住院治療的病例65例,其中男性患者20例,女性患者45例,年齡在17-73歲之間,平均年齡(42±2.3)歲,結(jié)節(jié)直徑0.5cm-3.9cm之間。排除單純囊性結(jié)節(jié)及囊性成分大于20%。囑病人采取仰臥位,后仰頭部或墊高肩部,充分暴露檢查區(qū),平靜呼吸,行二維超聲及彩色多普勒超聲,根據(jù)標(biāo)準(zhǔn)鑒別診斷并記錄。而后切換至彈性成像模式,對(duì)結(jié)節(jié)行超聲彈性成像檢查,當(dāng)在彩色超聲彈性成像圖上該結(jié)節(jié)表現(xiàn)為較恒定地顯示出一定的代表顏色后,定幀,存圖。由兩名有經(jīng)驗(yàn)的超聲診斷醫(yī)師對(duì)彈性圖像進(jìn)行評(píng)分分級(jí)并歸類。所有病例均經(jīng)病理證實(shí),良性結(jié)節(jié)65個(gè),惡性結(jié)節(jié)23個(gè)。設(shè)備采用Siemens Acuson Antares5.0帶有超聲彈性成像技術(shù)軟件功能彩色多普勒超聲診斷儀,VF13-5高頻探頭。彈性圖中以彩色編碼代表不同組織的彈性大小,紫、藍(lán)、綠、黃、紅依次代表組織從軟到硬。 結(jié)果： 1.結(jié)節(jié)的形態(tài)不規(guī)則,和周邊組織邊界不清楚；病灶內(nèi)部呈現(xiàn)低回聲；顯示有鈣化點(diǎn)；后方回聲衰減,以二維圖像特征中達(dá)到3項(xiàng)作為惡性診斷標(biāo)準(zhǔn),其診斷結(jié)節(jié)良惡性的敏感性、特異性、準(zhǔn)確性分別為73.9%、87.3%、85.1%。 2.以Alder分級(jí)≥2作為診斷惡性標(biāo)準(zhǔn),其敏感性,特異性,準(zhǔn)確度分別為72.5%,67.6%,69.3%,以RI≥0.7作為診斷惡性標(biāo)準(zhǔn),其敏感性,特異性,準(zhǔn)確性分別為65.2%,75.3%,72.0%,二者聯(lián)合以Alder分級(jí)≥2,且RI≥0.7作為診斷惡性標(biāo)準(zhǔn)時(shí),準(zhǔn)確性有所提高,但敏感性降低。 3.彈性評(píng)分4分及以上為惡性,3分及以下為良性。超聲彈性成像的敏感度、特異度、準(zhǔn)確度為78.3%、87.6%、88.5%,超聲彈性成像面積比診斷惡性結(jié)節(jié)的敏感度、特異度、準(zhǔn)確率分別為61.0%、83.1%、71.8%。二者聯(lián)合診斷,準(zhǔn)確率有所提高,但敏感性降低。 4.彈性成像聯(lián)合二維超聲診斷惡性標(biāo)準(zhǔn)：當(dāng)結(jié)節(jié)均滿足兩者的惡性標(biāo)準(zhǔn)時(shí),則表示為惡性。其診斷甲狀腺良惡性結(jié)節(jié)的敏感度、特異度、準(zhǔn)確度為89.1%、96.9%、95.3%,高于二維超聲。 結(jié)論： 1.二維超聲是診斷基礎(chǔ),CDFI與UE可幫助二維超聲提高惡性病變檢出率,UE診斷價(jià)值優(yōu)于CDFI及PD,UE聯(lián)合二維超聲可以提高診斷率。 2.對(duì)于彈性成像評(píng)分3分的結(jié)節(jié),二維超聲診斷惡性結(jié)節(jié)時(shí)不要制定過高的條件,可避免漏診惡性結(jié)節(jié)。 3.甲狀腺結(jié)節(jié)的出血壞死囊變,或鈣化、或膠原纖維化等會(huì)影響彈性結(jié)果,影響診斷。
[Abstract]:Objective: 1. To explore the value of ultrasound elastic imaging combined with two-dimensional ultrasound in the diagnosis of thyroid nodules, the advantages and clinical significance of the combined use of the two methods. 2. To analyze the factors influencing the differential diagnosis of benign and malignant thyroid nodules by elastic imaging. Methods: a total of 65 cases (20 male and 45 female), aged between 17 and 73 years, with an average age of (42 鹵2.3) years and diameter of 0.5cm-3.9cm, were selected for surgical treatment in our hospital. The exclusion of simple cystic nodules and cystic components was greater than 20. The patient was told to take supine position, supine head or padded shoulder, full exposure of examination area, calm breathing, two dimensional ultrasound and color Doppler ultrasound, according to the standard differential diagnosis and record. Then we switch to the elastic imaging mode and perform the ultrasonic elastic imaging on the node. When the node shows a certain color on the color ultrasonic elastic imaging image, the frame is fixed and the image is stored. Elastic images were graded and classified by two experienced ultrasound diagnostics. All cases were confirmed by pathology, 65 benign nodules and 23 malignant nodules. The equipment uses Siemens Acuson Antares5.0 with ultrasonic elastic imaging technology software, color Doppler ultrasound diagnostic instrument, VF13-5 high frequency probe. The elastic size of different tissues is represented by color coding. Purple, blue, green, yellow and red represent the tissue from soft to hard in turn. Results: 1. The shape of the nodules is irregular, and the boundary of the surrounding tissues is not clear. The sensitivity, specificity and accuracy of the diagnosis of benign and malignant nodules were 73.9%, 87.3% and 85.1%, respectively. 2. The sensitivity, specificity and accuracy of Alder grade 鈮，

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