本文選題：周圍型肺病變　切入點(diǎn)：實(shí)時(shí)　出處：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:1.探討超聲造影(CEUS)時(shí)間-強(qiáng)度曲線(TIC)定量參數(shù)鑒別診斷周圍型肺良、惡性病變的應(yīng)用價(jià)值。2.采用CEUS實(shí)時(shí)對(duì)比觀察法評(píng)價(jià)造影劑到達(dá)周圍型肺病變及鄰近肺組織內(nèi)的時(shí)間差異對(duì)周圍型肺病變的診斷價(jià)值。3.對(duì)比研究CEUS實(shí)時(shí)對(duì)比觀察法新診斷標(biāo)準(zhǔn)及傳統(tǒng)CEUS始增時(shí)間診斷標(biāo)準(zhǔn)鑒別診斷周圍型肺病變的臨床應(yīng)用價(jià)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(jiàn)的95例周圍型肺病變患者行CEUS檢查,實(shí)時(shí)對(duì)比觀察病灶及周邊肺組織灌注情況,采集動(dòng)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(dǎo)下經(jīng)皮肺穿刺活檢獲得組織標(biāo)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(qiáng)強(qiáng)度最強(qiáng)區(qū)域?yàn)楦信d趣區(qū)(ROI),應(yīng)用儀器內(nèi)置繪圖、分析軟件繪制時(shí)間-強(qiáng)度曲線(TIC),獲得CEUS灌注參數(shù)造影劑到達(dá)時(shí)間(AT)、達(dá)峰時(shí)間(TTP)、上升時(shí)間(RT)、峰值強(qiáng)度(PI)等。2.采用CEUS實(shí)時(shí)對(duì)比觀察法,分別觀察并記錄造影劑最初到達(dá)病灶及其鄰近肺組織內(nèi)的時(shí)間及兩者間的時(shí)間差,繪制受試者工作特征曲線(ROC),計(jì)算曲線下面積及最佳截點(diǎn)值。3.根據(jù)傳統(tǒng)CEUS始增時(shí)間診斷標(biāo)準(zhǔn),即注入造影劑后良性病灶開(kāi)始增強(qiáng)時(shí)間10 s,惡性病灶開(kāi)始增強(qiáng)時(shí)間≥10 s,計(jì)算該診斷標(biāo)準(zhǔn)鑒別診斷周圍型肺病變的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及診斷準(zhǔn)確率。4.比較CEUS實(shí)時(shí)對(duì)比觀察法新診斷標(biāo)準(zhǔn)及傳統(tǒng)CEUS始增時(shí)間診斷標(biāo)準(zhǔn)診斷周圍型肺病變的敏感度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及診斷準(zhǔn)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(zhǎng)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(dǎo)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(xì)胞肺癌11例,大細(xì)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(cuò)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(wú)明顯統(tǒng)計(jì)學(xué)意義(p均0.05)。3.采用CEUS實(shí)時(shí)對(duì)比觀察法顯示造影劑最初到達(dá)周圍型惡性肺病變時(shí)間及病灶-肺組織時(shí)間差均明顯大于肺良性病變組,統(tǒng)計(jì)學(xué)有明顯差異(p均0.05)。造影劑最初到達(dá)鄰近肺組織的時(shí)間在惡性組和良性組之間無(wú)顯著統(tǒng)計(jì)學(xué)差異(p0.05)。繪制ROC曲線,造影劑到達(dá)病灶-肺組織時(shí)間差較造影劑到達(dá)肺病灶時(shí)間診斷價(jià)值高,曲線下面積分別為0.961,0.861。計(jì)算造影劑到達(dá)病灶-肺組織時(shí)間差的最佳截止點(diǎn)為2.5 s,以此界值為標(biāo)準(zhǔn),CEUS實(shí)時(shí)對(duì)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(yáng)性預(yù)測(cè)值為98.1%、陰性預(yù)測(cè)值為95.1%、診斷準(zhǔn)確率為96.8%。4.與病理結(jié)果對(duì)照,采用傳統(tǒng)CEUS始增時(shí)間診斷標(biāo)準(zhǔn)鑒別診斷周圍型肺病變的敏感度為72.7%、特異度為82.5%、陽(yáng)性預(yù)測(cè)值為85.1%、陰性預(yù)測(cè)值為68.7%、診斷準(zhǔn)確率為76.8%。5.CEUS實(shí)時(shí)對(duì)比觀察法新診斷標(biāo)準(zhǔn)與傳統(tǒng)CEUS始增時(shí)間診斷標(biāo)準(zhǔn)診斷在鑒別周圍型肺良惡性病灶的診斷準(zhǔn)確率對(duì)比,具有明顯統(tǒng)計(jì)學(xué)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(yīng)用價(jià)值。2.采用CEUS實(shí)時(shí)對(duì)比觀察法鑒別診斷周圍型肺病變新標(biāo)準(zhǔn)為:造影最初到達(dá)病灶與鄰近肺組織的時(shí)間差異≥2.5 s,病變多為惡性;如果該時(shí)間差2.5 s,則病變趨于良性。3.CEUS實(shí)時(shí)對(duì)比觀察法新診斷標(biāo)準(zhǔn)的診斷效能高于傳統(tǒng)CEUS始增時(shí)間診斷標(biāo)準(zhǔn)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(qiáng)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(hào)：1685805