本文關(guān)鍵詞： 彈性成像技術(shù) TI-RADS分類 甲狀腺結(jié)節(jié) 鑒別診斷　出處：《廣州中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討超聲彈性成像(ultrasonic elastography, U E)彈性評分及應(yīng)變率比值(strain ratio, SR)結(jié)合TI-RADS分類對甲狀腺結(jié)節(jié)良惡性的鑒別診斷價值,早期發(fā)現(xiàn)癌,早期治療,為臨床提供可靠的參考價值。方法：選取了254例甲狀腺結(jié)節(jié)患者,共309個結(jié)節(jié)(其中良性結(jié)節(jié)205個,惡性結(jié)節(jié)104個),以結(jié)節(jié)的最大直徑10mm為界分為兩組,行常規(guī)超聲及超聲彈性成像UE檢查。并且所有的結(jié)節(jié)均按照TI-RADS分類標(biāo)準(zhǔn)進(jìn)行分類。所有的病例均經(jīng)手術(shù)病理證實,以病理檢查結(jié)果為金標(biāo)準(zhǔn),建立受試者的工作特征的曲線(即ROC曲線),比較TI-RADS分類與彈性成像技術(shù)(UE)的彈性評分及應(yīng)變率比值SR對甲狀腺良惡性結(jié)節(jié)的鑒別診斷價值。結(jié)果：甲狀腺惡性結(jié)節(jié)組別的彈性應(yīng)變率比值SR明顯高于甲狀腺良性結(jié)節(jié)組別,二者的比較差異具有統(tǒng)計學(xué)意義(t=7.69,P0.05)。彈性成像UE的彈性評分及應(yīng)變率比值SR對甲狀腺結(jié)節(jié)良惡性診斷的敏感度、特異度及準(zhǔn)確度分別為85.67%、89.85%、86.70%及87.41%、91.21%、90.01%,TI—RADS標(biāo)準(zhǔn)分類的敏感度、特異度及準(zhǔn)確度分別為70.56%、83.49%和80.08%。彈性成像UE對甲狀腺良惡性結(jié)節(jié)鑒別診斷的敏感度、特異度及準(zhǔn)確度是高于TI—RADS分類的,差異有統(tǒng)計學(xué)意義(P0.05)；彈性成像和TI—RADS分類兩種方法結(jié)合后,其敏感度、特異度及準(zhǔn)確度為90.44%、93.21%和92.46%,均高于單一檢查方法。UE的應(yīng)變率比值法與TI-RADS分類法的曲線下面積分別為0.82和0.76,差異有統(tǒng)計學(xué)意義(P0.01)；兩種方法結(jié)合后曲線下面積為0.86,診斷效能高于單一方法(P0.01)。在結(jié)節(jié)直徑≤1Omm組中,UE的應(yīng)變率比值法診斷準(zhǔn)確度高于TI-RADS分類法(P0.05),而在結(jié)節(jié)直徑l0mm組中,TI-RADS分類法的診斷準(zhǔn)確度高于UE應(yīng)變率比值法(P0.05)。甲狀腺良惡性結(jié)節(jié)的形態(tài)、邊界、邊緣、后方回聲、生長方式、微鈣化、血流分布及淋巴結(jié)有無異常等情況的差異具有統(tǒng)計學(xué)意義(P0.01)。結(jié)論：彈性成像UE對甲狀腺良惡性結(jié)節(jié)的診斷準(zhǔn)確率高于TI-RADS分類法,對于不同大小的結(jié)節(jié),兩種方法可以起到相互補充的作用,兩者結(jié)合能夠提高甲狀腺結(jié)節(jié)良惡性的診斷效能。邊緣模糊、邊界不清,形態(tài)不規(guī)則、縱橫比1、后方回聲衰減、結(jié)節(jié)內(nèi)微鈣化、血流紊亂等可作為甲狀腺惡性結(jié)節(jié)的征象。其中,在結(jié)節(jié)最大徑≤10mm的結(jié)節(jié)中,縱橫比可作為預(yù)測惡性腫瘤的主要指標(biāo)；在結(jié)節(jié)最大徑10mm的結(jié)節(jié)中,形態(tài)不規(guī)則、邊界不清、邊緣模糊、結(jié)節(jié)內(nèi)微鈣化、后方回聲衰減、血流紊亂、伴淋巴結(jié)形態(tài)不良等可作為預(yù)測惡性腫瘤的主要指標(biāo)。
[Abstract]:Objective: to evaluate the value of ultrasound elastography (U E) score and strain rate ratio strain ratio (SRS) combined with TI-RADS classification in the differential diagnosis of benign and malignant thyroid nodules, early detection and early treatment of thyroid nodules. Methods: a total of 309 thyroid nodules (205 benign and 104 malignant) were selected from 254 patients with thyroid nodules. All nodules were classified according to TI-RADS classification criteria. All cases were confirmed by surgery and pathology, and the results of pathological examination were taken as gold standard. The value of elastic score and strain rate ratio SR in differential diagnosis of benign and malignant thyroid nodules by comparing TI-RADS classification with elastic imaging technique was compared with that of ROC curve (i.e. ROC curve). Results: thyroid nodule. The elastic strain rate ratio SR in nodal group was significantly higher than that in benign thyroid nodule group. The difference was statistically significant (P 0.05). The sensitivity, specificity and accuracy of elastography UE and strain rate ratio SR in the diagnosis of benign and malignant thyroid nodules were 85.67 ~ 89.85% and 87.41% respectively, and the sensitivity of TI-RADS standard classification was 91.21%. The specificity and accuracy of UE were 70.56% and 80.08%, respectively. The sensitivity, specificity and accuracy of UE in differential diagnosis of benign and malignant thyroid nodules were higher than those of TI-RADS classification (P 0.05). Its sensitivity, The specificity and accuracy were 90.444.93.21% and 92.46% respectively, which were higher than those of single test method. UE strain rate ratio method and TI-RADS classification method were 0.82 and 0.76, respectively, the difference was statistically significant (P 0.01), the area under the curve was 0.86 after the combination of the two methods. The diagnostic accuracy of the strain rate ratio method in the group with nodule diameter 鈮，

本文編號：1520142