【摘要】：目的：探討采用聲脈沖輻射力彈性成像技術(shù)用于評價并鑒別周圍型肺部腫瘤及腫瘤樣病變的良、惡性的應(yīng)用價值，盡早為臨床醫(yī)生制定合理的治療方案提供方便可靠地依據(jù)。 方法：收集河南科技大學第一附屬醫(yī)院2011年10月至2012年10月期間經(jīng)X線胸片或CT診斷發(fā)現(xiàn)并住院的周圍型肺部腫塊患者74例（74個病灶，一般選取將要進行超聲介入手術(shù)穿刺的部位），術(shù)前經(jīng)彩色超聲常規(guī)檢查，，患者采取能充分暴露病變部位的合適體位，對腫塊部位進行反復(fù)掃查，選擇一個恰當?shù)呐d趣區(qū)，首先進行常規(guī)超聲檢查，觀察測量腫塊部位、大小、形態(tài)、邊界、內(nèi)部回聲、后方回聲有無衰減、縱橫比。用彩色能量多普勒觀察腫塊周邊及內(nèi)部血供多少，了解腫塊供血情況。最后主要利用其中的聲脈沖輻射力彈性成像功能定量測得腫塊的剪切波速度，取樣過程中囑患者屏氣，保持探頭與掃查部位垂直固定，不同深度及部位重復(fù)測量5次，取其平均值，若瘤體內(nèi)有液化壞死者，感興趣區(qū)置于瘤體實性部分，余均置于瘤體回聲相對均一的位置。統(tǒng)計分析不同病理類型肺部腫瘤之間彈性成像特征及剪切波速度的差異，同時采用ROC曲線評價剪切波速度值對周圍型肺部腫塊良惡性的鑒別診斷價值，并確定其截斷點。 結(jié)果：74例肺部腫塊病人的病理檢查結(jié)果：惡性病灶共44個，良性病灶30個，其中鱗癌20例，腺癌17例，小細胞肺癌6例，原始神經(jīng)外胚層腫瘤1例，孤立性纖維性腫瘤1例,炎性29例。良性病灶的剪切波速度值（0.91±0.32）m/s明顯低于惡性病灶的剪切波速度值（1.54±0.44）m/s，經(jīng)SPASS19.0統(tǒng)計軟件分析，P=0.000＜0.05,差異有統(tǒng)計學意義。惡性組中肺腺癌和肺鱗癌剪切波速度值比較[（1.38±0.43）m/s VS（1.40±0.41）m/s],經(jīng)SPASS19.0統(tǒng)計軟件分析，P=0.92＞0.05，差異無統(tǒng)計學意義。將腫塊分成良性組和惡性組進行比較，建立ROC曲線，獲得良惡性病變的截斷值，以1.2m/s作為鑒別良惡性病變截斷點，提示惡性腫瘤的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值分別為77.3%、80%、84.3%、52.6%。 結(jié)論：聲脈沖輻射力彈性成像技術(shù)對于評估周圍型肺部腫瘤和腫瘤樣病變的良惡性具有可行性，結(jié)合常規(guī)的二維超聲及彩色多普勒血流成像對于早期診斷并鑒別腫塊的良、惡性顯示了良好的應(yīng)用價值。
[Abstract]:Objective: to evaluate and differentiate benign and malignant lung tumors and tumor-like lesions by using acoustic pulse radiation-force elastic imaging, and to provide a convenient and reliable basis for clinicians to formulate a reasonable treatment plan as soon as possible. Methods: from October 2011 to October 2012, 74 patients (74 lesions) with peripheral pulmonary masses diagnosed and hospitalized by chest X-ray or CT were collected from the first affiliated Hospital of Henan University of Science and Technology. General selection of the site to be performed ultrasound interventional operation puncture), preoperative color ultrasound routine examination, patients can be fully exposed to the appropriate position of the diseased area, repeated scanning of the mass site, select a suitable area of interest, First, conventional ultrasound was performed to observe the location, size, shape, boundary, internal echo, attenuation of the posterior echo and aspect ratio of the tumor. The blood supply around and inside the tumor was observed by color energy Doppler. Finally, the shear wave velocity of the mass was measured quantitatively by using the acoustic pulse radiation force elastic imaging function. During the sampling process, the patient was told to hold breath, to keep the probe perpendicular to the scanning site, and to repeat the measurements at different depths and parts for 5 times. If there is liquefaction and necrosis in the tumor, the region of interest is placed in the solid part of the tumor, and the rest is placed in the position where the echo of the tumor is relatively uniform. The characteristics of elastic imaging and shear wave velocities of lung tumors of different pathological types were statistically analyzed. At the same time, the ROC curve was used to evaluate the value of shear wave velocities in the differential diagnosis of benign and malignant peripheral lung masses, and the truncation point was determined. Results: there were 44 malignant lesions and 30 benign lesions, including squamous cell carcinoma in 20 cases, adenocarcinoma in 17 cases, small cell lung cancer in 6 cases, primitive neuroectodermal tumor in 1 case and solitary fibrous tumor in 1 case. Inflammatory 29 cases. The shear wave velocities of benign lesions (0.91 鹵0.32) m / s were significantly lower than those of malignant lesions (1.54 鹵0.44) m / s. The results of SPASS19.0 software showed that the shear wave velocities of benign lesions were (0.000 鹵0.32) m / s lower than those of malignant lesions (P < 0.05). The shear wave velocities of lung adenocarcinoma and squamous cell carcinoma in malignant group were compared [(1.38 鹵0.43) m / s VS (1.40 鹵0.41) m / s]. The results of SPASS19.0 statistical software showed that the velocity of shear wave was 0.92 > 0.05, there was no significant difference. The tumor was divided into benign group and malignant group. The ROC curve was established, and the truncation value of benign and malignant lesions was obtained by using 1.2m/s as the cutoff point for differentiating benign and malignant lesions, indicating the sensitivity, specificity and positive predictive value of malignant tumor. The negative predictive values were 77.3 and 84.3, respectively. Conclusion: it is feasible to evaluate benign and malignant peripheral lung tumors and tumor-like lesions by using acoustic pulse power elastic imaging, combined with conventional two-dimensional ultrasound and color Doppler flow imaging, for early diagnosis and differential diagnosis of benign tumors. Malignancy shows good application value.
【學位授予單位】：河南科技大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R445.1;R563

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