声辐射力脉冲弹性成像技术对浅表肿大淋巴结良恶性的鉴别诊断  

Value of acoustic radiation force impulse imaging in the differential diagnosis of the superficial lymphadenopathy

作　　者：郑宝群[1] 覃业志[1] 陈晓霞[1] 姚怀齐[1] 

机构地区：[1]汕头大学医学院第一附属医院超声科,515000

出　　处：《中华医学超声杂志（电子版）》2015年第7期568-573,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨声辐射力脉冲弹性成像技术声触诊组织成像(VTI)技术和声触诊组织定量(VTQ)技术在鉴别诊断浅表肿大淋巴结良恶性中的应用价值。方法收集2013年10月至2014年3月于汕头大学医学院第一附属医院就诊的全身浅表淋巴结肿大患者41例,共50个淋巴结。其中非特异性炎症性淋巴结23个,结核性淋巴结2个,淋巴瘤5个,转移性淋巴结20个。所有淋巴结均经活检病理或抗炎治疗后随访证实。所有淋巴结于术前或治疗前均行常规超声、VTI及VTQ检查。绘制常规超声、VTI技术、VTQ技术鉴别诊断浅表肿大淋巴结良恶性的操作者工作特征(ROC)曲线,确定常规超声、VTI技术、VTQ技术鉴别诊断浅表肿大淋巴结良恶性的最佳界值,计算相应的敏感度、特异度、准确性、阳性预测值、阴性预测值。以最终诊断结果作为金标准,计算联合应用常规超声、VTI、VTQ技术鉴别诊断浅表肿大淋巴结良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值。结果 ROC曲线显示,以淋巴结二维灰阶超声结合彩色多普勒评分=9分为最佳界值,常规超声鉴别诊断浅表肿大淋巴结良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为76.0%、84.0%、80.0%、82.6%、77.8%;以VTI分级=3级为最佳界值,VTI技术鉴别诊断浅表肿大淋巴结良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为88.0%、64.0%、76.0%、71.0%、84.2%;以SWV值=2.755 m/s为最佳界值,VTQ技术鉴别诊断浅表肿大淋巴结良恶性的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为80.0%、92.0%、86.0%、90.9%、82.1%。定义常规超声+VTI+VTQ串联法为常规超声、VTI技术、VTQ技术同时诊断为恶性浅表淋巴结才能确诊为恶性,否则为良性;定义常规超声+VTI+VTQ并联法为常规超声、VTI技术、VTQ技术中的一种方法诊断为恶性浅表淋巴结即确诊�Objective To investigate the application value of virtual touch tissue image technology （VTI） and virtual touch tissue quantification technique （VTQ） in the differential diagnosis of benign and malignant superficial lymph nodes. Methods Fifty superficial lymph nodes were obtained, including 23 for nonspecific inflammatory, 2 for tuberculosis, 5 for lymphoma and 20 for metastasis. All lymph nodes were confirmed by biopsy pathology or follow-up after anti-inflammatory treatments and scanned by traditional ultrasound, VTI and VTQ before resections or treatments. Receiver operating characteristic curve of traditional ultrasound, VTI and VTQ was made to determine the optional cut-off point in the differential diagnosis of benign and malignant superficial lymph nodes and calculate the sensitivity, specificity, accuracy, positive predictive value and negative predictive value. Final diagnosis was defined as the golden standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated by the combined application of traditional ultrasound with VTI and VTQ technology. Results Nine （evaluation value） was taken as the critical value which was scanned by both two-dimensional ultrasound and color Doppler. The ROC curve indicated that the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of conventional two-dimensional ultrasound of benign and malignant lymph nodes were 76.0%, 84.0%, 80.0%, 82.6%, and 77.8%. Taking three （critical value） as the cut-off point, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of VTI in the diagnosis of benign and malignant lymph nodes were 88.0%, 64.0%, 76.0%, 71.0%and 84.2%. Taking 2.755 m/s （shear wave velocity） as the cut-off value, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of VTQ in the differentiation of benign and malignant superficial lymph nodes were 80%, 92.0%, 86.0%, 90.9%

关 键 词：弹性成像技术 淋巴结 诊断 鉴别 

分 类 号：R445.1[医药卫生—影像医学与核医学]