多模态超声成像对睾丸良恶性病变的鉴别诊断价值  

Value of multiparametric ultrasonography in the differential diagnosis of benign and malignant testicular lesions

作　　者：李振东 聂芳[1] 刘婷[1] 董甜甜[1] 王国娟[1] 贾英英[1] 万晓辉[1] Li Zhendong;Nie Fang;Liu Ting;Dong Tiantian;Wang Guojuan;Jia Yingying;Wan Xiaohui(Department of Ultrasound,Lanzhou University Second Hospital Gansu Province Clinical Research Center for Ultrasonography Gansu Province Intelligent Ultrasound Medicine Engineering Research Center,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院超声医学中心、甘肃省超声影像临床医学研究中心、甘肃省智能超声医学工程研究中心,兰州730030

出　　处：《中华超声影像学杂志》2023年第5期406-411,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨由二维超声(US)、彩色多普勒血流成像(CDFI)、超声造影(CEUS)及应变式弹性成像(RTE)构成的多模态超声成像在睾丸良恶性病变鉴别诊断中的价值。方法回顾性选取2020年6月至2022年6月兰州大学第二医院超声医学中心经US检查发现的睾丸病变患者40例(40个病灶),进一步行CDFI、CEUS及RTE检查。采用CDFI及CEUS确定病灶内是否存在血供,将无血供的病灶定义为良性病灶,富血供的病灶定义为恶性病灶。进行RTE检查评估病灶组织硬度大小,病变组织的硬度被编码为红色(软)、绿色(中等)、蓝色(硬),将硬度大的病灶定义为恶性病灶,硬度小的病灶定义为良性病灶。对病灶进行手术切除或穿刺后行病理组织学检查作为诊断标准。绘制ROC曲线分析多模态超声成像对睾丸良恶性病变诊断的正确分类率、敏感性、特异性、似然比及曲线下面积。结果40个睾丸病灶中良性病灶24个(60.0%),恶性病灶16个(40.0%)。CDFI、CEUS、RTE诊断睾丸病变的敏感性分别为0.875、1.000、1.000,特异性分别为0.833、0.750、0.708,正确分类率分别为85.0%、85.0%、82.5%,阳性似然比分别为5.24、4.00、4.42,ROC曲线下面积分别为0.781、0.802、0.771。RTE联合CDFI诊断睾丸病变的敏感性1.000,特异性0.875,正确分类率92.8%,阳性似然比8.00,曲线下面积0.915(P<0.001);RTE联合CEUS诊断睾丸病变的敏感性1.000,特异性0.917,正确分类率95.0%,阳性似然比12.0,曲线下面积0.958(P<0.001)。结论多模态超声成像对鉴别睾丸占位性病变的良恶性具有重要价值。Objective To explore the value of multiparametric ultrasonography consisting of gray-scale ultrasound(US),color Doppler flow imaging(CDFI),real-time strain elastography(RTE),and contrast-enhanced ultrasound(CEUS)in the differential diagnosis of testicular lesions.Methods Forty patients(40 lesions)detected by ultrasonography examination at the Ultrasound Medical Center of Lanzhou University Second Hospital from June 2020 to June 2022 were retrospectively analyzed,and further the CDFI,CEUS and RTE were performed.The presence of vascularization in the lesion was determined by CDFI and CEUS,avascular lesions were defined as benign,vascularization lesions were defined as malignant.The lesion tissue elasticity was assessed by real-time strain elastography,tissue stiffness was encoded as red(soft),green(intermediate),and blue(hard),and the hard lesions were defined as malignant,soft lesions were defined as benign.All lesions were subjected to pathological histologic examination after surgical resection or puncture biopsy as a reference standard.The correct classification rate,sensitivity,specificity and likelihood ratio of the multiparametric ultrasonography imaging for the diagnosis of benign and malignant testicular lesions were analyzed by ROC.Results Of 40 testicular lesions,24(60.0%)were benign and 16(40.0%)were malignant.The sensitivity of CDFI,CEUS and RTE in the diagnosis of testicular lesions was 0.875,1.000 and 1.000,and the specificity was 0.833,0.750 and 0.708,respectively.The correct classification rate was 85.0%,85.0%and 82.5%,and the positive likelihood ratio was 5.24,4.00 and 4.42,respectively.AUC was 0.781,0.802,0.771,respectively.By combining RTE and CDFI,a sensitivity of 1.000 and specificity of 0.875 and correct classification rate of 92.8%and positive likelihood ratio of 8.00 and AUC of 0.915(P<0.001)were achieved in differentiating testicular lesions.And combining RTE and CEUS,achieved sensitivity of 1.000 and specificity of 0.917 and correct classification rate of 95.0%and positive likelihood rati

关 键 词：多模态超声 睾丸病变 彩色多普勒血流成像 超声造影 应变式弹性成像 鉴别诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.21[医药卫生—诊断学]