本文關(guān)鍵詞： 聲觸診組織成像和定量 阻力指數(shù) 乳腺導(dǎo)管內(nèi)癌 診斷　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過觀察病灶常規(guī)二維聲像圖特征和病灶內(nèi)部及周邊血流阻力指數(shù)的大小,同時(shí)使用聲觸診組織成像和定量剪切波彈性成像技術(shù)對(duì)乳腺病灶進(jìn)行評(píng)估,探討乳腺病灶血流阻力指數(shù)增高及VTIQ剪切波彈性成像技術(shù)對(duì)乳腺導(dǎo)管內(nèi)癌的診斷價(jià)值。方法本研究共收集2015年6月～2016年11月在在我院行超聲檢查并手術(shù)切除病理證實(shí)的患者106個(gè)乳腺結(jié)節(jié)。病灶選取時(shí)滿足以下任何一項(xiàng)者均納入;1.病灶縱橫比大于1;2.病灶邊界模糊不清;3.病灶周邊可見血流信號(hào);4,病灶形態(tài)不規(guī)則;5.病灶大小適中。使用VTIQ技術(shù)進(jìn)行測(cè)量時(shí),選取病灶的最大切面,使用VTIQ技術(shù)對(duì)病灶內(nèi)部剪切波速度(SWV)進(jìn)行測(cè)量。在VTIQ速度模式下,多次對(duì)有效區(qū)域的SWV進(jìn)行測(cè)量(5～7組),取均值,單位為m/s。R0I取樣時(shí),根據(jù)VTIQ二維剪切波彈性圖像中不同色彩,將ROI分別置于病灶內(nèi)部SWV最高區(qū)域、最低區(qū)域及周邊和中央?yún)^(qū)域。重點(diǎn)觀察病灶血供的類型及血流的豐富程度,并對(duì)病灶內(nèi)部血流阻力指數(shù)進(jìn)行測(cè)量,當(dāng)病灶內(nèi)多條血流信號(hào)者,取其阻力指數(shù)最高的進(jìn)行測(cè)量,并記錄其峰值流速。所有的常規(guī)超聲圖像及VTIQ圖像均存貯于機(jī)器硬盤內(nèi),以備更進(jìn)一步分析。以病理結(jié)果為金標(biāo)準(zhǔn),比較乳腺導(dǎo)管內(nèi)癌組與良性組SWV及血流阻力指數(shù)的差異,分析VTIQ技術(shù)及病灶血流阻力指數(shù)對(duì)于乳腺導(dǎo)管內(nèi)癌的診斷價(jià)值。結(jié)果:據(jù)病理所示,106例乳腺病灶中37例為乳腺導(dǎo)管內(nèi)癌,32例為導(dǎo)管內(nèi)乳頭狀瘤,31例為乳腺增生伴腺瘤形成,6例為良性分葉狀腫瘤。106例乳腺病灶中,有82例病灶有血流信號(hào),其中血供類型為邊緣型的有63例,穿支型的有19例。邊緣型中有31例為導(dǎo)管內(nèi)癌,32例為良性病變。穿支型中有4例為導(dǎo)管內(nèi)癌,15例為良性病變。邊緣型乳腺導(dǎo)管內(nèi)癌的血流阻力指數(shù)為(0.704±0.05),邊緣型乳腺良性病變血流阻力指數(shù)為(0.616±0.056),t值為-5.08,P值小于0.01,差異具有統(tǒng)計(jì)學(xué)意義。穿支型因病例數(shù)過少,缺乏統(tǒng)計(jì)學(xué)意義。乳腺導(dǎo)管內(nèi)癌組的平均SWV值為(4.58±1.27),乳腺良性病變組的平均SWV值為(2.80±0.92),t值為10.33,P0.01,差異具有統(tǒng)計(jì)學(xué)意義,繪制ROC曲線,ROC曲線顯示:VTIQ技術(shù)測(cè)得的SWV鑒別診斷乳腺腫塊導(dǎo)管內(nèi)癌與良性病變的閾值為4.09m/s,曲線下面積為0.827(95%CI:0.771～0.882,P0.001)。ROC曲線顯示,VTIQ技術(shù)鑒別診斷乳腺腫塊良惡性的敏感度、特異度、準(zhǔn)確性、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值、Youden指數(shù)分別為87.9%、83%、75.0%、78.5%、86.7%、0.61。結(jié)論病灶邊緣區(qū)血流阻力指數(shù)對(duì)于鑒別乳腺導(dǎo)管內(nèi)癌及良性病變來說有一定的指導(dǎo)價(jià)值。對(duì)于乳腺導(dǎo)管內(nèi)癌的診斷來說,VTIQ剪切波技術(shù)具有一定的參考價(jià)值使用,對(duì)于乳腺導(dǎo)管內(nèi)癌的檢出可以提供幫助。因而,當(dāng)二維超聲無法鑒別腫塊的良惡性時(shí),使用VTIQ技術(shù)及測(cè)量病灶邊緣區(qū)血流阻力指數(shù)可以為診斷提供參考價(jià)值。
[Abstract]:Objective to evaluate the lesions of breast by observing the characteristics of conventional two-dimensional sonography and the size of the internal and peripheral blood flow resistance index, and using acoustic palpation tissue imaging and quantitative shear wave elastography. To investigate the diagnostic value of high blood flow resistance index of breast lesions and VTIQ shear wave elastography in breast ductal carcinoma. Methods this study was performed in our hospital from June 2015 to November 2016. 106 breast nodules were examined by ultrasonography and surgically resected pathologically. 1. The aspect ratio of the lesion was greater than 1; 2.The boundary of lesion was blurred; 3. Blood flow signal was seen around the lesion. 4the shape of the lesion was irregular; 5. The size of the lesion was moderate. When VTIQ technique was used to measure the lesion, the largest section of the lesion was selected. The internal shear wave velocities of lesions were measured by VTIQ technique. In the VTIQ mode, the SWV in the effective region was measured several times, and the mean value was taken. According to the different colors of VTIQ two-dimensional shear wave elastic image, the ROI was placed in the highest area of SWV in the lesion. The lowest region and peripheral and central regions. The types of blood supply and the abundance of blood flow were observed, and the blood flow resistance index was measured when there were multiple blood flow signals in the lesions. The highest resistance index was measured and the peak velocity was recorded. All conventional ultrasound images and VTIQ images were stored in the machine hard disk for further analysis. The pathological results were taken as the gold standard. To compare the difference of SWV and blood flow resistance index between breast intraductal carcinoma group and benign group, and analyze the diagnostic value of VTIQ technique and focus blood flow resistance index in breast intraductal carcinoma. Of 106 breast lesions, 37 were intraductal carcinoma, 32 were intraductal papilloma, 31 were hyperplasia of mammary gland with adenoma, 6 were benign lobular tumor. There were 82 lesions with blood flow signal, including 63 cases with marginal type of blood supply, 19 cases with perforating branch type and 31 cases with intraductal carcinoma. 32 cases were benign lesions, 4 cases were intraductal carcinoma and 15 cases were benign lesions. The blood flow resistance index of marginal breast ductal carcinoma was 0.704 鹵0.05). The blood flow resistance index of marginal breast benign lesions was 0.616 鹵0.056 t = -5.08% P < 0.01, the difference was statistically significant, and the number of perforating type cases was too small. The average SWV value of breast intraductal carcinoma group was 4.58 鹵1.27 and that of benign breast lesion group was 2.80 鹵0.92). T value was 10.33% (P 0.01), the difference was statistically significant, and the ROC curve was drawn. The ROC curve showed that the threshold value of SWV for differential diagnosis of intraductal carcinoma and benign lesions in breast masses was 4.09 m / s. The area under the curve was 0.827 / 95. The sensitivity of VTIQ in differential diagnosis of benign and malignant breast masses was demonstrated by the curve of ROC. Specificity, accuracy, positive predictive value, negative predictive value and Youden index were 87.9% and 83.3%, respectively. Conclusion the blood flow resistance index in the marginal region of breast lesions is valuable in differentiating breast intraductal carcinoma from benign lesions, and is useful for the diagnosis of breast intraductal carcinoma. VTIQ shear wave technique has a certain reference value for the detection of breast intraductal carcinoma. Therefore, when two-dimensional ultrasound can not distinguish benign and malignant tumors. The use of VTIQ technique and the measurement of the blood flow resistance index in the marginal region of the lesion can provide a reference value for the diagnosis.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R445.1;R737.9

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