發(fā)布時間：2018-03-30 11:55

  本文選題：周圍型肺病變　切入點：實時　出處：《南昌大學》2017年碩士論文

【摘要】：目的:1.探討超聲造影(CEUS)時間-強度曲線(TIC)定量參數(shù)鑒別診斷周圍型肺良、惡性病變的應用價值。2.采用CEUS實時對比觀察法評價造影劑到達周圍型肺病變及鄰近肺組織內(nèi)的時間差異對周圍型肺病變的診斷價值。3.對比研究CEUS實時對比觀察法新診斷標準及傳統(tǒng)CEUS始增時間診斷標準鑒別診斷周圍型肺病變的臨床應用價值。方法:1.選取經(jīng)胸部X線或CT檢查發(fā)現(xiàn)且超聲可見的95例周圍型肺病變患者行CEUS檢查,實時對比觀察病灶及周邊肺組織灌注情況,采集動態(tài)造影數(shù)據(jù)并保存?zhèn)溆�。所有病灶均�?jīng)手術(shù)或超聲引導下經(jīng)皮肺穿刺活檢獲得組織標本,行病理診斷,根據(jù)病理結(jié)果分為肺惡性病變組、肺良性病變組。選取病灶增強強度最強區(qū)域為感興趣區(qū)(ROI),應用儀器內(nèi)置繪圖、分析軟件繪制時間-強度曲線(TIC),獲得CEUS灌注參數(shù)造影劑到達時間(AT)、達峰時間(TTP)、上升時間(RT)、峰值強度(PI)等。2.采用CEUS實時對比觀察法,分別觀察并記錄造影劑最初到達病灶及其鄰近肺組織內(nèi)的時間及兩者間的時間差,繪制受試者工作特征曲線(ROC),計算曲線下面積及最佳截點值。3.根據(jù)傳統(tǒng)CEUS始增時間診斷標準,即注入造影劑后良性病灶開始增強時間10 s,惡性病灶開始增強時間≥10 s,計算該診斷標準鑒別診斷周圍型肺病變的敏感度、特異度、陽性預測值、陰性預測值及診斷準確率。4.比較CEUS實時對比觀察法新診斷標準及傳統(tǒng)CEUS始增時間診斷標準診斷周圍型肺病變的敏感度、特異度、陽性預測值、陰性預測值及診斷準確率。結(jié)果:1.95例周圍型肺病變患者中男性60例,女性35例,平均59.1±12.6歲(24-81歲)。病灶最長的徑線為范圍為3.4-12.4 cm(平均6.4±3.3 cm),左葉42例,右葉53例。64例經(jīng)手術(shù)獲得病理,31例經(jīng)超聲引導下經(jīng)皮肺穿刺取材活檢獲得最終病理診斷。95例周圍型肺病變病理結(jié)果如下:肺惡性腫瘤55例(鱗癌19例,腺癌14例,小細胞肺癌11例,大細胞肺癌3例,腺鱗癌8例),肺良性病變40例(炎癥組織28例,結(jié)核7例,炎性假瘤3例,錯構(gòu)瘤2例)。2.周圍型肺良性病變組CEUS TIC曲線定量參數(shù)AT明顯小于肺惡性病變組(p0.05),TTP、RT、PI在兩組間均無明顯統(tǒng)計學意義(p均0.05)。3.采用CEUS實時對比觀察法顯示造影劑最初到達周圍型惡性肺病變時間及病灶-肺組織時間差均明顯大于肺良性病變組,統(tǒng)計學有明顯差異(p均0.05)。造影劑最初到達鄰近肺組織的時間在惡性組和良性組之間無顯著統(tǒng)計學差異(p0.05)。繪制ROC曲線,造影劑到達病灶-肺組織時間差較造影劑到達肺病灶時間診斷價值高,曲線下面積分別為0.961,0.861。計算造影劑到達病灶-肺組織時間差的最佳截止點為2.5 s,以此界值為標準,CEUS實時對比觀察法鑒別診斷周圍型肺病變的敏感度為96.4%、特異度為97.5%、陽性預測值為98.1%、陰性預測值為95.1%、診斷準確率為96.8%。4.與病理結(jié)果對照,采用傳統(tǒng)CEUS始增時間診斷標準鑒別診斷周圍型肺病變的敏感度為72.7%、特異度為82.5%、陽性預測值為85.1%、陰性預測值為68.7%、診斷準確率為76.8%。5.CEUS實時對比觀察法新診斷標準與傳統(tǒng)CEUS始增時間診斷標準診斷在鑒別周圍型肺良惡性病灶的診斷準確率對比,具有明顯統(tǒng)計學差異(p0.05)。結(jié)論:1.CEUS TIC曲線定量參數(shù)AT在周圍型肺病變的鑒別診斷中有一定的臨床應用價值。2.采用CEUS實時對比觀察法鑒別診斷周圍型肺病變新標準為:造影最初到達病灶與鄰近肺組織的時間差異≥2.5 s,病變多為惡性;如果該時間差2.5 s,則病變趨于良性。3.CEUS實時對比觀察法新診斷標準的診斷效能高于傳統(tǒng)CEUS始增時間診斷標準的診斷效能。
[Abstract]:Objective: 1. to explore contrast-enhanced ultrasound (CEUS) time intensity curve (TIC) in differential diagnosis of quantitative parameters of peripheral pulmonary benign and malignant lesions, the application value of.2. using CEUS real-time observation method to evaluate the clinical value of real-time diagnostic value of.3. CEUS comparative study comparison of peripheral pulmonary lesions were new standard diagnosis method and traditional CEUS by the time the differential diagnosis of peripheral lung lesions diagnosis standard contrast mediareaching peripheral lung lesions and adjacent lung tissue within the time difference. Methods: 1. selected by chest X-ray or CT examination and ultrasound in 95 cases of peripheral lung lesions underwent CEUS examination showed the real-time contrast observed lesions and the peripheral lung tissue perfusion. Collection of dynamic contrast data and save backup. All lesions were confirmed by surgery or ultrasound guided percutaneous lung biopsy to obtain tissue samples for pathological diagnosis, according to the pathological results were divided into malignant lung disease Variable group, benign lung disease group. Select the strongest enhanced lesion regions of interest (ROI), using the instrument built-in drawing, drawing time intensity curve analysis software (TIC), CEUS perfusion parameters of contrast agent arrival time (AT), time to peak (TTP), rise time (RT). The peak intensity (PI) and.2. CEUS by real-time observation method, respectively, to observe and record the initial arrival time of contrast agent and its adjacent lesions in lung tissue and the time difference, the receiver operating characteristic curve (ROC), calculate the area under the curve and the best cutoff value of.3. according to the diagnostic criteria by the time before the traditional CEUS, which injected contrast agent of benign lesions began to increase 10 s, malignant lesions began to increase more than 10 time s, calculate the differential diagnosis of peripheral pulmonary lesions of the diagnostic criteria of sensitivity, specificity, positive predictive value, value and diagnostic accuracy of.4. CEUS real negativepredictive 鏃跺姣旇瀵熸硶鏂拌瘖鏂爣鍑嗗強浼犵粺CEUS濮嬪鏃墮棿璇婃柇鏍囧噯璇婃柇鍛ㄥ洿鍨嬭偤鐥呭彉鐨勬晱鎰熷害,鐗瑰紓搴，

本文編號：1685805