聲觸診組織定量技術(shù)在鑒別診斷甲狀腺結(jié)節(jié)良惡性中的應(yīng)用
發(fā)布時(shí)間：2019-01-04 07:54
【摘要】：目的探討聲脈沖輻射力成像(ARFI)聲觸診組織定量(VTQ)技術(shù)在鑒別診斷甲狀腺良、惡性結(jié)節(jié)中的應(yīng)用價(jià)值及其影響因素。 方法測量165例共180枚甲狀腺結(jié)節(jié)的二維、彩色多普勒及VTQ彈性成像,分別進(jìn)行橫切面和縱切面掃查,記錄檢查切面,結(jié)節(jié)最大徑,血流,鈣化及距離皮膚的深度,測量結(jié)節(jié)及周邊甲狀腺組織的橫向剪切波速度(SWV),并計(jì)算縱切面下結(jié)節(jié)與周邊正常甲狀腺組織的差值。采用ROC曲線方法評價(jià)VTQ技術(shù)鑒別甲狀腺良惡性結(jié)節(jié)的診斷價(jià)值并確定診斷界值,采用Z檢驗(yàn)比較不同方法的診斷效能差異。采用多元線性回歸方法分析結(jié)節(jié)的最大徑、鈣化、內(nèi)部血流、深度、探頭掃查方向及病理類型對SWV值的影響,評估各因子對SWV值的貢獻(xiàn)。 結(jié)果①180枚甲狀腺結(jié)節(jié)包括良性65枚(54枚結(jié)節(jié)性甲狀腺腫,11枚濾泡性腺瘤),惡性115枚(114枚乳頭狀癌,1枚濾泡狀癌)。橫、縱切面良性結(jié)節(jié)及周邊甲狀腺組織的SWV值平均為(2.15±0.78)m/s、(1.93±0.47)m/s和(2.2±0.71)m/s、(2.06±0.41m/s,115枚惡性結(jié)節(jié)及周邊甲狀腺組織的SWV平均值分別為(2.97±1.12) m/s、(1.90±0.48) m/s和(3.09±1.08) m/s、(1.97±0.44)m/s。②惡性組的SWV值明顯高于良性組,兩者比較有明顯統(tǒng)計(jì)學(xué)差異(P0.0001)；惡性結(jié)節(jié)與其周邊甲狀腺組織比較,差異有統(tǒng)計(jì)學(xué)意義(P0.0001)；而良性結(jié)節(jié)與其周邊甲狀腺組織無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。③橫、縱切面ROC曲線下面積(AUC)分別為0.772、0.799,以2.47m/s診斷界值點(diǎn)時(shí),對應(yīng)的敏感度、特異度分別為敏感度為64.3%、71.9%和74.8%、73.4%�？v切面下甲狀腺結(jié)節(jié)與周邊組織的差值ROC曲線下面積為0.831,以差值0.34作為最佳截?cái)帱c(diǎn),敏感度為87.0%,特異度為67.2%。④三種方法間AUC比較差異無明顯統(tǒng)計(jì)學(xué)意義(P0.05)。⑤多元線性逐步回歸分析顯示,微鈣化、結(jié)節(jié)的深度、探頭掃查方向?qū)WV值的影響差異沒有統(tǒng)計(jì)學(xué)意義(P0.05),而結(jié)節(jié)的最大徑、病理類型及內(nèi)部血流對SWV值的影響有統(tǒng)計(jì)學(xué)意義(P0.05)。建立回歸方程為：Y=1.163-0.054X1-0.054X3-0.228X6,其中病理類型對SWV值的影響最大(標(biāo)準(zhǔn)化回歸系數(shù)為-0.312)。 結(jié)論①VTQ技術(shù)可以定量評價(jià)不同甲狀腺組織的硬度,在鑒別甲狀腺良惡性結(jié)節(jié)方面具有較高的臨床應(yīng)用價(jià)值。②甲狀腺結(jié)節(jié)的病理類型、內(nèi)部血流及結(jié)節(jié)的最大徑是影響SWV值的因素,而結(jié)節(jié)距離皮膚的深度、探頭掃查方向及微鈣化與SWV值無關(guān)。
[Abstract]:Objective to investigate the value and influencing factors of quantitative (VTQ) technique of acoustic pulse radiography (ARFI) in the differential diagnosis of benign and malignant thyroid nodules. Methods two dimensional color Doppler imaging and VTQ elastic imaging were performed in 165 patients with 180 thyroid nodules. Transverse and longitudinal scanning were performed to record the section, the maximum diameter of the node, blood flow, calcification and depth from the skin. The transverse shear wave velocities (SWV),) of the nodule and the surrounding thyroid tissue were measured and the difference between the sublongitudinal nodule and the peripheral normal thyroid tissue was calculated. The ROC curve method was used to evaluate the diagnostic value of VTQ technique in differentiating benign and malignant thyroid nodules and the diagnostic bounds were determined. The diagnostic efficacy of different methods was compared by Z test. The effects of the maximum diameter, calcification, internal blood flow, depth, probe scan direction and pathological type on the SWV value were analyzed by multivariate linear regression method, and the contribution of each factor to the SWV value was evaluated. Results 1180 thyroid nodules included 65 benign thyroid nodules (54 nodular goiter, 11 follicular adenomas) and 115 malignant thyroid nodules (114 papillary carcinomas and 1 follicular carcinoma). The mean SWV values of benign nodules and peripheral thyroid tissues were (2.15 鹵0.78) m / s, (1.93 鹵0.47) m / s and (2.2 鹵0.71) m / s, (2.06 鹵0.41) m / s, respectively. The mean SWV values of 115 malignant nodules and peripheral thyroid tissues were (2.97 鹵1.12) m / s, (1.90 鹵0.48) m / s and (3.09 鹵1.08) m / s, respectively. The SWV value of (1.97 鹵0.44) m/s.2 malignant group was significantly higher than that of benign group (P0.0001). There was significant difference between malignant nodules and their peripheral thyroid tissues (P0.0001). However, there was no significant difference between benign nodules and their peripheral thyroid tissues (P0.05). The area (AUC) under the longitudinal ROC curve was 0.7720.799, respectively. The sensitivity was 71.9% and 74.8%, respectively. The area under the ROC curve of the difference between the sublongitudinal thyroid nodule and the surrounding tissue was 0.831. The sensitivity was 87.0 with the difference of 0.34 as the best cut-off point. There was no significant difference in AUC between the three methods with specificity of 67.2.4 (P0.05). 5 multiple linear stepwise regression analysis showed that the microcalcification, the depth of nodules, The influence of probe scan direction on SWV value was not statistically significant (P0.05), while the maximum diameter of nodules, pathological type and internal blood flow had significant effects on SWV value (P0.05). The regression equation was established as follows: YT 1.163-0.054X1-0.054X3-0.228X6, in which pathological type had the greatest influence on SWV value (normalized regression coefficient was -0.312). Conclusion 1VTQ technique can quantitatively evaluate the hardness of different thyroid tissues and has a high clinical value in differentiating benign and malignant thyroid nodules. 2 the pathological types of thyroid nodules. The internal blood flow and the maximum diameter of the nodules were the factors affecting the SWV value, while the depth of the nodules from the skin, the direction of the probe scanning and the microcalcification were not related to the SWV value.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R736.1
本文編號：2400002
[Abstract]:Objective to investigate the value and influencing factors of quantitative (VTQ) technique of acoustic pulse radiography (ARFI) in the differential diagnosis of benign and malignant thyroid nodules. Methods two dimensional color Doppler imaging and VTQ elastic imaging were performed in 165 patients with 180 thyroid nodules. Transverse and longitudinal scanning were performed to record the section, the maximum diameter of the node, blood flow, calcification and depth from the skin. The transverse shear wave velocities (SWV),) of the nodule and the surrounding thyroid tissue were measured and the difference between the sublongitudinal nodule and the peripheral normal thyroid tissue was calculated. The ROC curve method was used to evaluate the diagnostic value of VTQ technique in differentiating benign and malignant thyroid nodules and the diagnostic bounds were determined. The diagnostic efficacy of different methods was compared by Z test. The effects of the maximum diameter, calcification, internal blood flow, depth, probe scan direction and pathological type on the SWV value were analyzed by multivariate linear regression method, and the contribution of each factor to the SWV value was evaluated. Results 1180 thyroid nodules included 65 benign thyroid nodules (54 nodular goiter, 11 follicular adenomas) and 115 malignant thyroid nodules (114 papillary carcinomas and 1 follicular carcinoma). The mean SWV values of benign nodules and peripheral thyroid tissues were (2.15 鹵0.78) m / s, (1.93 鹵0.47) m / s and (2.2 鹵0.71) m / s, (2.06 鹵0.41) m / s, respectively. The mean SWV values of 115 malignant nodules and peripheral thyroid tissues were (2.97 鹵1.12) m / s, (1.90 鹵0.48) m / s and (3.09 鹵1.08) m / s, respectively. The SWV value of (1.97 鹵0.44) m/s.2 malignant group was significantly higher than that of benign group (P0.0001). There was significant difference between malignant nodules and their peripheral thyroid tissues (P0.0001). However, there was no significant difference between benign nodules and their peripheral thyroid tissues (P0.05). The area (AUC) under the longitudinal ROC curve was 0.7720.799, respectively. The sensitivity was 71.9% and 74.8%, respectively. The area under the ROC curve of the difference between the sublongitudinal thyroid nodule and the surrounding tissue was 0.831. The sensitivity was 87.0 with the difference of 0.34 as the best cut-off point. There was no significant difference in AUC between the three methods with specificity of 67.2.4 (P0.05). 5 multiple linear stepwise regression analysis showed that the microcalcification, the depth of nodules, The influence of probe scan direction on SWV value was not statistically significant (P0.05), while the maximum diameter of nodules, pathological type and internal blood flow had significant effects on SWV value (P0.05). The regression equation was established as follows: YT 1.163-0.054X1-0.054X3-0.228X6, in which pathological type had the greatest influence on SWV value (normalized regression coefficient was -0.312). Conclusion 1VTQ technique can quantitatively evaluate the hardness of different thyroid tissues and has a high clinical value in differentiating benign and malignant thyroid nodules. 2 the pathological types of thyroid nodules. The internal blood flow and the maximum diameter of the nodules were the factors affecting the SWV value, while the depth of the nodules from the skin, the direction of the probe scanning and the microcalcification were not related to the SWV value.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R736.1
【引證文獻(xiàn)】
相關(guān)期刊論文 前1條
1 張英;張蕾;王歡;;超聲成像聯(lián)合聲觸診定性彈性成像在鑒別甲狀腺良惡性結(jié)節(jié)中應(yīng)用研究[J];湖南師范大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2017年01期
，本文編號：2400002
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