本文選題：聲觸診組織定量 + 聲觸診組織成像��； 參考：《復(fù)旦大學(xué)》2014年碩士論文

【摘要】：腎臟良惡性占位及腎細(xì)胞癌亞型的診斷及鑒別診斷是醫(yī)學(xué)影像學(xué)的重點(diǎn)。治療前明確腎腫瘤的類型有助于臨床判斷預(yù)后和決定治療方法,為患者提供更安全有效的處理。目前彩色多普勒超聲、超聲造影、增強(qiáng)CT/MRI等為診斷腎腫瘤的主要影像手段,通過(guò)觀察腫瘤形態(tài),組成成分及血供情況判斷腎腫瘤類型,而聲脈沖輻射力成像技術(shù)(acoustic radiation force impulse, ARFI)能夠反映腫瘤的硬度信息,并可進(jìn)行定量分析,為腎腫瘤的診斷與鑒別診斷提供了一種新的方法。聲脈沖輻射力成像是一種超聲彈性成像技術(shù),通過(guò)聲脈沖輻射使組織產(chǎn)生縱向壓縮及橫向振動(dòng)。以縱向位移為基礎(chǔ)進(jìn)行成像可直觀反映組織彈性,以黑白表示組織相對(duì)硬度,稱為聲觸診組織成像技術(shù)(virtual touch tissue imaging, VTI)。橫向振動(dòng)以剪切波方式向周邊傳播,利用剪切波相鄰波峰時(shí)間差及波長(zhǎng)計(jì)算剪切波速度可間接反映組織彈性,對(duì)組織硬度進(jìn)行定量評(píng)價(jià),稱為聲觸診組織定量技術(shù)(virtual touch tissue quantification, VTQ)。本研究利用ARFI技術(shù)評(píng)估腎臟腫瘤硬度,探討該技術(shù)在腎臟腫瘤診斷中的應(yīng)用價(jià)值。第一部分聲觸診組織定量技術(shù)在腎臟腫瘤診斷中的應(yīng)用研究目的探討聲觸診組織定量技術(shù)在腎臟腫瘤診斷中的應(yīng)用價(jià)值。方法199例患者共199個(gè)腎腫瘤行VTQ檢查,全部病例均經(jīng)手術(shù)及病理證實(shí)。檢查時(shí)分別將感興趣區(qū)置于腫瘤內(nèi)及腎皮質(zhì)內(nèi),測(cè)量剪切波速度(shear wave velocity, S WV)并記錄,將腫瘤內(nèi)與腎皮質(zhì)內(nèi)各10次測(cè)值取中位數(shù)后作為該例腫瘤與腎皮質(zhì)的SWV值,將上述兩值的比值(腫瘤SWV/腎皮質(zhì)SWV)作為該病例的SWV比值,分析VTQ在腎臟應(yīng)用中的穩(wěn)定性、良惡性腫瘤的SWV差異及VTQ在腎臟腫瘤診斷中的價(jià)值。結(jié)果病理證實(shí)良性腎腫瘤43個(gè)(其中血管平滑肌脂肪瘤40個(gè),中胚層腎瘤2個(gè),嗜酸細(xì)胞型腺瘤1個(gè)),惡性腎腫瘤156個(gè)(其中透明細(xì)胞腎癌129個(gè),乳頭狀腎癌11個(gè),嫌色細(xì)胞腎癌9個(gè),腎尿路上皮癌5個(gè),間葉源性惡性腫瘤及腎母細(xì)胞瘤各1個(gè))。不同深度腎皮質(zhì)VTQ檢測(cè)組內(nèi)相關(guān)系數(shù)均大于0.75,不同深度腎皮質(zhì)SWV值之間的差異有統(tǒng)計(jì)學(xué)意義。比較SWV值及SWV比值,良惡性腫瘤之間、惡性腫瘤各亞型之間的差異均有統(tǒng)計(jì)學(xué)意義。以SWV值2.120m/s為界值,診斷惡性腫瘤的敏感度為59.6%,特異度為65.1%,以SWV比值0.835為界值,診斷惡性腫瘤的敏感度為64.7%,特異度為69.8%。結(jié)論聲觸診組織定量技術(shù)測(cè)量腎臟的穩(wěn)定性較好,深度對(duì)測(cè)量值存在影響。VTQ可以提供腎臟腫瘤的彈性信息,在腎臟腫瘤的診斷中有一定應(yīng)用價(jià)值,SWV比值的診斷意義大于SWV值。第二部分聲觸診組織成像技術(shù)在腎臟腫瘤診斷中的應(yīng)用研究目的探討聲觸診組織成像技術(shù)在腎臟腫瘤診斷中的應(yīng)用價(jià)值。方法腎臟腫瘤患者124例共124個(gè)病灶,全部病例均經(jīng)手術(shù)及病理證實(shí)。利用VTI技術(shù)取得腎臟腫瘤及其周圍腎皮質(zhì)的彈性圖像,由2名醫(yī)師觀察圖像中腫瘤與腎皮質(zhì)的亮度,將亮度分級(jí)進(jìn)行統(tǒng)計(jì)學(xué)分析比較觀察者間差異及良惡性腫瘤間差異,并與同時(shí)測(cè)得的腫瘤SWV比值進(jìn)行相關(guān)性分析。結(jié)果病理結(jié)果證實(shí)良性腫瘤27個(gè),其中血管平滑肌脂肪瘤25個(gè),中胚層腎瘤2個(gè),惡性腫瘤97個(gè),其中透明細(xì)胞癌79個(gè),乳頭狀癌5個(gè),嫌色細(xì)胞癌7個(gè),尿路上皮癌5個(gè),間葉源性惡性腫瘤1個(gè)。統(tǒng)計(jì)結(jié)果顯示：2名觀察者間沒(méi)有顯著性差異,一致性一般(Kappa=0.565)；VTI圖像顯示的腫瘤亮度在良、惡性腫瘤之間的差異沒(méi)有統(tǒng)計(jì)學(xué)意義；VTI圖像顯示的腫瘤亮度與VTQ測(cè)得的SWV比值之間沒(méi)有相關(guān)性。結(jié)論聲觸診組織成像技術(shù)可以提供腎臟腫瘤的彈性信息,觀察者間一致性一般,在腎臟良、惡性腫瘤的鑒別中意義不大。
[Abstract]:The diagnosis and differential diagnosis of the benign and malignant renal space and the subtype of renal cell carcinoma is the focus of medical imaging. The type of renal tumor before treatment can be used to determine the prognosis and determine the treatment and provide more safe and effective treatment for the patients. Current color Doppler ultrasound, ultrasound contrast, enhanced CT/MRI and so on are the main diagnosis of renal tumors. Image means, by observing tumor morphology, composition and blood supply to determine the type of renal tumor, and acoustic radiation force impulse (ARFI) can reflect the hardness information of the tumor, and can be quantified to provide a new method for the diagnosis and differential diagnosis of renal tumor. Force imaging is an ultrasonic elastic imaging technique, which produces longitudinal compression and transverse vibration through acoustic pulse radiation. Imaging based on longitudinal displacement can directly reflect tissue elasticity, in black and white to organize relative hardness, called virtual touch tissue imaging, VTI. Transverse vibration with shear wave. Virtual touch tissue quantification (VTQ) was used to evaluate the tissue hardness by using the shear wave adjacent wave peak time difference and wavelengths to calculate the shear wave velocity indirectly. The quantitative evaluation of tissue hardness was called acoustic palpation tissue quantitative technique (tissue quantification, VTQ). This study used ARFI technology to evaluate the hardness of renal tumors and to explore the technique in the kidney. The application value of the acoustic palpation tissue quantitative technique in the diagnosis of renal tumor. Objective to explore the application value of acoustic palpation tissue quantitative technique in the diagnosis of renal tumors. Methods a total of 199 renal tumors in 199 patients were examined by VTQ, all cases were confirmed by operation and pathology. The region of interest was placed within the tumor and in the renal cortex, the shear wave velocity (shear wave velocity, S WV) was measured and the median of the 10 values in the tumor and renal cortex were taken as the SWV value of the tumor and renal cortex. The ratio of the above two values (tumor SWV/ renal cortex SWV) was used as the SWV ratio of the case, and VTQ in the renal application was analyzed. SWV differences in benign and malignant tumors and the value of VTQ in the diagnosis of renal tumors. Results pathology confirmed 43 benign renal tumors (including 40 angiomyolipomas, 2 mesoderm nephroma, 1 eosinophilic adenomas) and 156 malignant renal tumors (including 129 transparent cell renal carcinoma, 11 papillary renal carcinoma, and 9 suspected chromophore kidney cancer). There were 5 renal urothelial carcinoma, mesenchymal malignant tumor and 1 nephroblastoma. The correlation coefficient of VTQ detection group in different depth of renal cortex was more than 0.75, and the difference of SWV values between different depths of renal cortex was statistically significant. The difference of SWV value and SWV ratio, between benign and malignant tumor, and among the different subtypes of malignant tumor were statistically significant. The sensitivity of the SWV value 2.120m/s was 59.6%, the specificity was 65.1%, the SWV ratio 0.835 was the boundary value, the sensitivity of the malignant tumor was 64.7%, the specificity was 69.8%., the sound palpation tissue quantitative technique was used to measure the stability of the kidney, and the depth to the measurement value had the influence of.VTQ to provide renal tumor. The diagnostic value of SWV ratio is more valuable than SWV value. The application of second part acoustic palpation tissue imaging technique in the diagnosis of renal tumor. Objective to discuss the value of acoustic palpation tissue imaging in the diagnosis of renal tumor. Methods 124 cases of renal tumor patients were 124. All cases were confirmed by operation and pathology. VTI technique was used to obtain the elastic images of renal tumor and its surrounding renal cortex. The brightness of the tumor and renal cortex in the image was observed by 2 doctors. The difference of the luminance classification and the difference between the benign and malignant tumor, and the SWV ratio measured at the same time were compared. The results showed that there were 27 benign tumors, including 25 angiomyolipomas, 2 mesoderm tumors and 97 malignant tumors, including 79 transparent cell carcinoma, 5 papillary carcinoma, 7 chromophobe cell carcinoma, 5 urothelial carcinoma and 1 inter leaf malignancy. The statistical results showed that 2 observers had no significant difference. There is no statistically significant difference in the brightness between benign and malignant tumors in the VTI image, and there is no correlation between the tumor brightness of the VTI image and the SWV ratio measured by the VTQ. Conclusion the acoustic palpation tissue imaging technique can provide the elastic information of the renal tumor and the consensus among the observers is consistent. Generally speaking, it is of little significance in differentiating benign and malignant renal tumors.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R445.1;R737.11

【共引文獻(xiàn)】

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相關(guān)碩士學(xué)位論文 前4條

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本文編號(hào)：2010683