实时超声弹性成像诊断甲状腺良恶性结节的可行性及实效性探究

目的:对实时超声弹性成像在甲状腺良恶性结节的诊疗中的可行性和实效性进行探究。方法:选取我院2011-03~2013-05期间104例(共132个结节)患者作为研究对象。术前对所有患者分别利用实时超声弹性成像和常规超声成像进行结节检查并记录结果,然后对所有患者进行手术治疗并依据病理结果确定结节良恶性状态,对各个结果进行比较分析。结果:根据病理结果,132个结节包含94个良性结节和38个恶性结节。超声弹性成像检查结果根据弹性硬度分类得到0~Ⅱ的结节84个,Ⅲ~Ⅳ级48个,敏感度为79.32%(29/38),特异度为78.72%(74/94),准确度为78.03%(103/132);而常规超声检查对应结果敏感度为71.05%(27/38),特异度79.79%(75/94),准确度77.27%(102/132);两者联合检查结果则敏感度为86.84%(33/38),特异度为93.62%(88/94),准确度为91.67%(121/132)。超声弹性成像诊断和常规超声诊断之间无显著差异(P>0.05),而联合诊断的敏感度、特异度和准确度均显著高于前两者(P<0.05)。结论:实时超声成像诊断和常规超声诊断联合使用可以大大提高甲状腺结节诊断准确率。     

乳腺疾病患者超声弹性成像与常规超声的临床诊断分析

目的探讨超声弹性成像与常规超声在诊断乳腺疾病上的临床价值。方法将我院筛查出的88例乳腺疾病患者作为研究对象,分别对其进行常规超声和超声弹性成像检查,根据最终的病理学检查结果对比常规超声、超声弹性成像与联合检查在诊断乳腺肿块良恶性上的准确性。结果在诊断良、恶性乳腺肿块上,常规超声的准确度、敏感度、特异度分别为72.73%、66.66%和72.94%,超声弹性成像的准确度、敏感度、特异度分别为84.09%、100.00%和83.53%。超声弹性成像联合常规超声的准确度、敏感度、特异度分别为94.32%、100.00%和95.29%,其准确度和敏感度均明显高于单一常规超声和超声弹性成像(P0.05)。结论常规超声与超声弹性成像在鉴别乳腺疾病良恶性上均有一定价值,超声弹性成像的的诊断敏感性和诊断效能高于常规超声,但二者联合应用效果更为显著,在乳腺疾病筛查过程中建议二者联合应用。     

声脉冲辐射力弹性成像对甲状腺结节良恶性鉴别诊断价值

目的 分析声脉冲辐射力（ARFI）弹性成像对甲状腺结节良恶性鉴别诊断价值。方法 选取2020年6月至2022年11月医院收治的甲状腺结节患者72例（85个结节）为研究对象,均接受常规超声及ARFI弹性成像检查,以组织病理结果为“金标准”,分析ARFI弹性成像鉴别诊断甲状腺结节良性恶。结果 本研究中85结节,经病理明确诊断良性病灶57个,恶性病灶28个;常规超声诊断在85个结节中共检出61个良性病灶,24个恶性病灶,诊断灵敏度60.7%(17/28)、特异度87.8%(50/57)、准确度为78.7%(67/85);恶性组声触诊组织成像（VTI）面积比、剪切波速度（SWV）、SWV比值均高于良性组,差异有统计学意义（P<0.05）;ARFI弹性成像参数绘制受试者工作特征（ROC）曲线结果显示,VTI面积比、SWV、SWV比值及联合诊断甲状腺结节良恶性的曲线下面积（AUC）均>0.7,具有一定诊断价值,且联合诊断价值最高。结论 ARFI弹性成像诊断甲状腺良恶性灵敏度、特异度较高,具有较高诊断价值。     

肿块深度对乳腺超声弹性成像检查结果的影响分析

目的探究超声弹性成像(UE)中肿瘤深度对于判断乳腺肿物的良、恶性影响。方法选取本院2017年1月~2018年10月间收治的178例因乳腺肿块行手术切除患者为观察对象,纳入病灶200个。依据肿瘤深度不同分4组。对所有的患者在术前均予以常规超声检查以及超声弹性成像检查,对比不同深度肿瘤的UE成像情况、分析诊断效能(准确度、特异度、灵敏度以及阴、阳性预测值),对比良恶性乳腺肿瘤UE成像检查的阳性率。结果诊断良性病灶114个、恶性病灶86个;D组成像效果与A、B、C组相比的UE成像效果更差(P<0.05);A组特异度与B、C、D组的对比差异有统计学意义(P<0.05);A组准确度显著高于D组,差异有统计学意义(P<0.05),UE成像技术对恶性病灶的诊断阳性率显著更高(P<0.05)。结论在乳腺超声弹性成像检查中,对于乳腺肿物的良、恶性成像质量,诊断的特异度与准确度均受到肿瘤深度的影响。     

超声弹性成像应变率比值法在乳腺良恶性结节鉴别诊断中的应用

目的:探讨超声弹性应变率比值法在乳腺良恶性结节鉴别诊断中的应用。方法:74例共82个病灶均行常规超声检查,测量病灶的应变率比值,并以病理结果作为对照。结果:82个病灶中,良性57个,恶性25个,良、恶性乳腺肿块弹性应变率比值分别为1.71±0.53和3.93±0.85,二者差异有统计学意义(P0.001)。应变率比值法对乳腺良恶性结节的敏感度、特异度、准确度分别为93.1%、94.9%、89.1%。结论:超声弹性应变率比值法有助于乳腺良恶性结节的鉴别,具有一定的临床应用价值。     

超声弹性成像在浅表软组织局灶性病变诊断中的应用

目的 探讨超声弹性成像技术在浅表软组织局灶性病变诊断中的临床应用价值.方法 收集在我院就诊并手术的浅表软组织局灶性病变65例,并对其行实时超声弹性成像检查,根据病灶软硬度不同进行评分,并与术后病理进行分析.结果 良性病灶超声弹性图中良性囊肿病变以红绿蓝相间为多,良性实质性病变以1～3分多见,而恶性病变以4～5分多见.两组病变的弹性评分情况比较差异具有统计学意义（P＜0.01）.以≥4分作为判断恶性病变的标准,其敏感度为84％,特异度为90％,准确率为88％.结论 超声弹性成像对浅表软组织局灶性病变良恶性病变的鉴别诊断提供有价值的信息.     

高频超声及弹性成像对甲状腺微小结节病变中的诊断价值

目的对比分析甲状腺微小癌和甲状腺微结节病变的高频超声及弹性成像的声像图特征,探讨高频超声及弹性成像对微小良恶性甲状腺结节鉴别诊断中的应用价值。方法选取在我院接受甲状腺切除术的99例患者(116个甲状腺结节)。常规高频超声采用半定量评分法判断结节性质,超声弹性成像采用5级评分法判断结节性质。以病理检查为金标准,计算灵敏度、特异度、准确度。结果经病理检查证实,116个甲状腺结节中,良性结节86个,恶性结节30个。常规高频超声诊断甲状腺良恶性结节的灵敏度为60.0%,特异度为69.8%,准确度67.2%;超声弹性成像诊断甲状腺结节的灵敏度为93.3%,特异度为91.9%,准确度为92.2%。灵敏度、特异度、准确度在两种检查方式之间,差异具有统计学意义(P<0.05)。结论超声弹性成像的诊断准确率明显优于常规高频超声检查,值得进一步推广临床使用。     

超声弹性成像及灰阶超声在肝纤维化诊断中的对比研究

目的:比较超声弹性成像(ultrasound elastosonography UE)及灰阶超声在肝纤维化诊断中的应用价值。方法:对120例慢性乙型肝炎患者的肝脏在进行超声引导下穿刺活检前进行超声弹性成像和灰阶超声检查,以病理结果为诊断金标准,分析超声弹性成像和灰阶超声评价肝纤维化的准确度。结果:超声弹性成像诊断肝纤维化的敏感度、特异度、准确度分别为92.5%、85.0%、90.0%。灰阶超声诊断肝纤维化的敏感度、特异度、准确度分别为42.5%、97.5%、60.8%。超声弹性成像联合灰阶超声诊断肝纤维化的敏感度、特异度、准确度分别为:93.7%、95.0%、94.2%。UE诊断准确度高于灰阶超声2=32.59(P<0.05)。UE诊断肝纤维化的受试者特征(ROC)曲线下面积为0.874(95%CI,0.798～0.950)。结论:超声弹性成像在评价肝纤维化较灰阶超声更有价值。     

软组织肿瘤的MR灌注成像与MR波谱成像的比较研究

目的 通过分析软组织肿瘤同一病例相同感兴趣区的MR灌注加权成像(MR-PWI)及MR氢质子波谱(1H-MRS)的功能影像信息,比较两者用于软组织肿瘤的定性诊断价值.方法 研究同时行MR-PWI、1H-MRS的全身各部位软组织肿瘤共40例.比较MR-PWI及1H-MRS各参数在良、恶性肿瘤中的差异,进而对2种诊断方法进行评价.所获数据采用t检验或配对四格表确切概率法分析.结果 MR-PWI良、恶性软组织肿瘤的血流量(BF)值差异有统计学意义(t=2.531,P<0.05),血容量(BV)及平均通过时间(MTT)值差异均无统计学意义(t值分别为1.587和1.732,P值均>0.05);以BF值=4.35 ml·100 mg-1·min-1为阈值,MR-PWI诊断恶性肿瘤的敏感度为81.8%(18/22),特异度为72.2%(13/18).良、恶性软组织肿瘤的时间信号曲线(TIC)类型比较:Ⅰ a型在良性肿瘤中占3/18,在恶性肿瘤中占17/22;Ⅰ b型在良性肿瘤中占12/18,在恶性肿瘤中占3/22;Ⅰ c型在恶性肿瘤中占2/22.Ⅱ型在良性肿瘤中占3/18.良、恶性软组织肿瘤的胆碱(Cho)、肌酸复合物(Cr)、脂质(Lip)值差异均无统计学意义(t值分别为1.332、1.637、1.986,P值均>0.05),而Cho/Cr比值的差异有统计学意义(t=2.927,P<0.05);以Cho/Cr比值=3.22为阈值,1H-MRS诊断恶性肿瘤的敏感度为86.4%(19/22),特异度为88.9%(16/18).1H-MRS谱线比较:18例良性及17例恶性软组织肿瘤在2.0～2.1ppm(×10-6)处均未出现异常峰,而2例恶性神经鞘瘤和3例恶性纤维组织细胞瘤均在2.0～2.1ppm处出现异常峰.MR-DWI与1H-MRS用于恶性肿瘤诊断准确度的差异无统计学意义(X2=0.125,P>0.05).结论 软组织肿瘤的MR-PWI的BF值、1H-MRS的Cho/Cr比值有利于软组织肿瘤良、恶性的鉴别;软组织肿瘤的TIC形态有助于肿瘤良、恶性的鉴别.MR-PWI和1H-MRS两者用于诊断恶性软组织肿瘤的准确度无明显差异,1H-MRS诊断恶性软组织肿瘤的敏感度和特异度较高.     

软组织肿瘤MR扩散成像与灌注成像的比较研究

目的 通过分析一组软组织肿瘤同一病例相同ROI的MR DWI及PWI的影像信息,比较这2种MR功能成像技术用于软组织肿瘤的定性诊断价值.方法 对50例软组织肿瘤(良性24例,恶性26例)同时行DWI及PWI.通过扩散及灌注软件分析DWI及PWI参数在良、恶性肿瘤中的表现,进行差异的t检验,对所获两法的诊断符合率进行x2检验.采用受试者操作特征曲线(ROC曲线)分析曲线下面积(AUC),确定诊断阈值并对2种诊断方法进行评价.结果 良、恶性软组织肿瘤的ADC值[(良、恶性分别为(2.03±0.36)和(1.52±0.39)×10-3mm2/s]、首过灌注(FP)期信号强度丢失率[良、恶性分别为(13.54±3.37)%和(47.57±5.21)%]的差异均有统计学意义(t值分别为2.515和2.938,P值均<0.05),时间-信号强度曲线(TIC)最大线性斜率[良、恶性分别为(5.51±2.54)%和(7.94±3.33)%]的差异无统计学意义(t值为1.272,P>0.05);以ADC值1.866×10-3mm2/s为阈值,DWI诊断恶性肿瘤的敏感度为84.6%(22/26),特异度为83.3%(20/24);以FP期最大信号丢失率40.33%为阈值,PWI诊断恶性肿瘤的敏感度为88.5%(23/26),特异度为75.0%(18/24);TIC类型的Ⅰa型在良性肿瘤中占3/24,在恶性肿瘤中占20/26;Ⅰb型在良性肿瘤中占14/24,在恶性肿瘤中占3/26;Ⅰc型在恶性肿瘤中占3/26.Ⅱ型TIC在良性肿瘤中占7/24.在DWI上用ADC值、PWI上用FP期最大信号强度丢失率作诊断,诊断符合率分别为84.0%(42/50)和82.0%(41/50),两者的差异无统计学意义(x2=0.8,P>0.05);AUC测得的准确度分别为81.7%和83.6%,PWI诊断恶性软组织肿瘤的敏感度高.结论 以DWI和PWI的ADC值、FP期信号强度丢失率分别为1.866×10-3mm2/s和40.33%为阈值时,均有利于软组织肿瘤良、恶性的鉴别;TIC最大线性斜率对于软组织肿瘤良、恶性的鉴别意义不大;软组织肿瘤的TIC形态有助于肿瘤良、恶性的鉴别.DWI和PWI用于诊断恶性软组织肿瘤的准确性均为中等,在DWI与PWI用于诊断恶性软组织肿瘤的准确性相近时,应选择诊断敏感度较高的PWI.     

高频彩色多普勒超声检查浅表软组织肿块的应用价值

目的：探讨高频超声及彩色多普勒血流显像（CDFI）对浅表软组织肿块的诊断价值。方法：对217例经病理证实的浅表软组织肿块的二维声像图及彩色多普勒血流显像进行分析。结果：217例中良性病变179例,恶性病变38例。超声对病变的检出率为100%,准确率为94.0%（204/217）。良恶性肿物的血流动力学参数Vmax、RI有显著性差异。结论：高频超声及彩色多普勒血流显像对浅表软组织肿块的诊断及鉴别诊断具有一定的临床价值。     

The application of Virtual Touch tissue quantification (VTQ) in diagnosis of thyroid lesions: A preliminary study

Objectives

Virtual Touch tissue quantification (VTQ) is a quantified ultrasound (US) acoustic radiation force impulse (ARFI) imaging method that provides numerical measurements (wave-velocity values) of tissue stiffness. The purpose of this study was to detect whether VTQ could be applied to differentiate between benign and malignant thyroid lesions.

Methods

Healthy subjects’ thyroid tissue and thyroid lesions were examined by VTQ to analyze their elasticity after conventional ultrasound. All the thyroid lesions were analyzed pathologically after surgery and correlated the VTQ values with the pathological results.

Results

The VTQ value of healthy thyroid tissue, the benign lesions, and the malignant lesions were 1.69 ± 0.41 m/s, 2.03 ± 0.42 m/s, and 3.10 ± 1.08 m/s, respectively. The VTQ value of the malignant lesions was higher than that of the healthy thyroid tissue and the benign lesions (both p < 0.001). The VTQ value of the benign lesions was higher than that of the healthy thyroid tissue (p < 0.001). With a cutoff value of 2.42 m/s, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for differentiating between the benign and the malignancy lesions were 80.00%, 89.23%, 87.05%, 69.56%, and 93.54%, respectively.

Conclusions

VTQ could provide quantitative elasticity measurements, which might play an important role in differentiating between benign and malignant thyroid lesions.     

The value of virtual touch tissue image (VTI) and virtual touch tissue quantification (VTQ) in the differential diagnosis of thyroid nodules

Objectives

To explore the value of virtual touch tissue image (VTI) and virtual touch tissue quantification (VTQ) in the differential diagnosis of thyroid nodules.

Methods

One-hundred and seven patients with 113 thyroid nodules were performed conventional ultrasound and acoustic radiation force impulse (ARFI) elastography. The stiffness of the nodules on virtual touch tissue image (VTI) was graded, and the area ratios (AR) of nodules on VTI images versus on B-mode images were calculated. Shear wave velocity (SWV) within the thyroid nodules were measured using virtual touch tissue quantification (VTQ) technique. The pathological diagnosis as the gold standard draws the receiver-operating characteristic curve (ROC) to find the cut-off point of VTI grades, AR and SWV to predict thyroid cancer.

Results

The difference in VTI grades of malignant and benign nodules was statistically significant (P < 0.05), as well as in AR and SWV. There was no significant difference in the AR of nodules or the SWV of nodules in benign group or in malignant group. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of VTI grades, AR, and SWV in the differential diagnosis of thyroid nodules were calculated. There was no significant difference in diagnostic accuracy among the three methods.

Conclusion

VTI grades, AR of nodules on VTI images versus on B-mode images and SWV within the nodules can help the differential diagnosis of thyroid nodules.     

Ultrasound evaluation of soft tissue tumors.

Because of its availability, ultrasound should be the preferred initial modality for the evaluation of palpable superficial masses. Most ultrasound units are equipped with high frequency probes that allow superficial focalization. The differential diagnosis of soft tissue masses and the sonographic features of some benign and malignant soft tissue lesions are reviewed in this article. After an initial ultrasound evaluation confirming the presence of a tumor, the need for and the role of other imaging modalities can be determined. In selected cases ultrasound may obviate the need for further imaging. MRI and CT should be reserved for cases in which sonography fails to establish a specific diagnosis or to demonstrate the limits of the soft tissue mass.     

Imaging of benign and malignant soft tissue masses of the foot

The foot is a relatively uncommon site of neoplastic and non-neoplastic soft tissue tumors. Although it contains a relatively small amount of somatic soft tissue elements, the foot is considerably rich in tendons, fasciae, retinaculae, and synovium. Corresponding to this distribution of soft tissue elements, some soft tissue lesions, such as giant cell tumor of tendon sheath, fibromatosis, and synovial sarcoma, are commonly seen in this location. Vascular tumors represent common soft tissue masses of the foot as well. Magnetic resonance imaging is the modality of choice in the assessment of soft tissue tumors. The presence of a suspected lesion can be confirmed and tumor margins can be defined accurately. In general, MRI does not provide histologic specificity, but considering some MR features may often help in correctly distinguishing benign from malignant lesions. In addition, characteristic features of the most common benign tumors (i.e., fibromatosis, cavernous hemangioma) and reactive processes of the foot (ganglion cyst, Morton's neuroma) often suggest a specific diagnosis. Electronic Publication     

The value of acoustic radiation force impulse (ARFI) in the differential diagnosis of thyroid nodules

Objectives

The aim of this study was to investigate the value of shear wave velocity value (SWV) and shear wave velocity ratio (SWR) in differentiating between malignant and benign thyroid nodules using virtual touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) technology.

Methods

The SWV and SWR were analyzed in 155 thyroid nodules in 155 patients (93 benign and 62 malignant) and eighty normal thyroid glands. The diagnostic performance of SWV and SWR were compared.

Results

The mean value of SWV of malignant nodules differed significantly from those of the benign nodules (6.34 ± 2.58 m/s vs. 2.15 ± 0.59 m/s, P < 0.05) and the normal thyroid (1.96 ± 0.31 m/s, P < 0.05). There was no statistically significant difference between the mean value of SWV of benign nodules and normal thyroid (P > 0.05). The mean value of SWR of malignant nodules differed significantly from those of the benign nodules (2.99 ± 1.45 vs. 1.07 ± 0.34, P < 0.05). The sensitivity, specificity, positive predictive values, negative predictive values and accuracy of SWV in differentiating between malignant and benign nodules were 96.80%, 95.70%, 93.75%, 97.80% and 96.13% respectively based on the cutoff point as 2.84 m/s. Those of SWR were 91.90%, 81.70%, 77.03%, 93.83% and 85.83% based on the cutoff point as 1.32. The diagnostic accuracy rate of SWV was statistically higher than that of SWR (P < 0.05).

Conclusion

VTQ of ARFI technology provides the quantitative information of thyroid tissue elasticity and has high accuracy rate in differentiating between malignant and benign nodules. It is a useful complement for conventional ultrasonography.     

高频超声对体表软组织肿块的诊断价值

目的：分析高频彩超对软组织肿块的超声表现,探讨超声对软组织肿块的诊断价值。方法：回顾分析经病理证实的118例软组织肿块的声像表现,总结其二维及血流分布特点。结果：118例肿块中超声检出率100%,其中良性肿块114例,占96.6%,恶性肿瘤4例,占3.4%,误诊11例占9.3%,超声诊断符合率为90.7%。结论：高频彩色多普勒超声检查有助于确定浅表软组织内肿物的形态、大小及深度,区分肿物的囊实性,显示血流特征,具有一定的临床诊断意义和应用价值。