皮肤剪切波弹性成像诊断下肢淋巴水肿的探讨  

Ultrasound shear wave elastography of skin in diagnosis of lymphedema of lower extremity:a preliminary study

作　　者：李家平[1] 罗佳[1] 李蔓英[1] 戚剑[2] 周翔[2] 李秋霜 陈少贞[3] 谢晓燕[1] 郑艳玲[1] LI Jiaping;LUO Jia;LI Manying;QI Jian;ZHOU Xiang;LI Qiushuang;CHEN Shaozhen;XIE Xiaoyan;ZHENG Yanling(Department of Medical Ultrasonics,Institute of Diagnostic and Interventional Ultrasound,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China;Department of Microsurgery,Orthopaedic Trauma and Hand Surgery,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China;Department of Rehabilitation Medicine,the First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院超声医学科,广州510080 [2]中山大学附属第一医院显微创伤手外科,广州510080 [3]中山大学附属第一医院康复科,广州510080

出　　处：《中华显微外科杂志》2024年第4期382-387,共6页Chinese Journal of Microsurgery

基　　金：国家自然科学基金重点项目(92059201);中国博士后科学基金(2022M723619)。

摘　　要：目的探索淋巴水肿肢体皮肤剪切波弹性成像(SWE)测量的更佳测量模式,并检测其对淋巴水肿的诊断效能。方法2023年8月1日-10日,中山大学附属第一医院超声医学科招募22例健康志愿者,使用导声垫以及厚层耦合剂分别测量肢体皮肤杨氏模量(E-value)(分别设为GP组和CG组);2023年8月15日-9月28日,连续纳入中山大学附属第一医院显微创伤手外科11例下肢淋巴水肿患者检测13侧水肿肢体皮肤E-value。构建受试者工作特征曲线(ROC)并计算灵敏度、特异度、阳性预测值、阴性预测值以及准确度评估诊断效能。使用SPSS 26.0、R studio以及GraphPad Prism 8软件进行统计分析,采用配对样本非参数检验(Wilcoxon符号秩检验)对比两组间E-value差异,P<0.01为差异有统计学意义;采用Spearman相关性检验分别分析GP组以及CG组的E-value值相关性。结果远端肢体皮肤的E-value测值均高于相应近端皮肤测值,且以下肢为著。各部位GP组测得E-value值均高于CG组,差异有统计学意义(P<0.01),在可重复性分析中,组内相关系数(ICC)提示可重复性较好。共使用CG检测11例下肢淋巴水肿患者13侧水肿肢体,其大腿水肿处皮肤E-value与健康者人群相比较,差异无统计学意义(P>0.01),小腿水肿处皮肤E-value显著增高,差异有统计学意义(P<0.01)。根据约登指数计算小腿水肿皮肤E-value为27.6 kPa,皮肤厚度增厚截断值为2.3 mm,构建联合诊断模型诊断小腿淋巴水肿的灵敏度、特异度、阳性预测值、阴性预测值以及准确度分别为92.3%、100%、100%、95.7%、97.1%。ROC曲线下面积(AUC)为0.962。GP组与CG组臂、前臂、大腿和小腿皮肤处的E-value的相关系数(R)分别为0.665、0.882、0.850和0.815,均为显著相关。结论使用厚层耦合剂进行皮肤SWE检测的可行性高,联合皮肤SWE以及皮肤厚度两者诊断下肢淋巴水肿的诊断效能较高,可为淋巴水肿早期监测及诊断、显微手术治�ObjectiveTo explore a better measurement mode of shear wave elastography(SWE)in the skin of lymphedema limbs,and to test its diagnostic efficacy in lymphedema.MethodsBetween 1st and 10th August,2023,22 healthy volunteers were recruited in the Department of Medical Ultrasonics,Institute of Diagnostic and Interventional Ulrasound,the First Afiliaed Hospital of Sun Yat-Sen University to measure the Young's modulus(E-value)of limb skin by SWE using a gel pad(GP group)and the thick-layer coupling gel(CG group)respectively.Then between 15th August and 28th September,2023,11 patients with 13 lower limb lymphedema,who were treated in the Department of Microsurgery,Orhopaedic Trauma and Hand Surgery,the First Affiliaed Hospital of Sun Yat-Sen University,were consecutively enrolled to find out the E-value of skin in oedematous limbs.The receiver operating characteristic curve(ROC)was constructed and the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were calculated to evaluate the diagnostic efficiency.SPSS 26.0,R studio and GraphPad Prism 8 software were used for statistical analysis.Paired sample non-parametric test(Wilcoxon signed rank test)was used to compare the difference in E-value between the 2 groups.P<0.01 was considered statistically significant.Spearman correlation test was used to analyse the correlation of E-value values between the GP group and CG group.ResultsOverall,it was found from the healthy volunteers that E-value of skin in distal limbs were higher than that in proximal limbs,especially in lower extremities.E-value of all scanned location in GP group were found higher than those of CG group with statistically significant difference(P<0.01),and the values of interclass correlation coefficient(ICC)showed a good repeatability.The 11 patients with lymphedema in 13 lower extremities were examined with the thick-layer coupling gel.The skin E-value in calf of patients with lymphedema were significantly higher than that of the healthy volunteers(P<0.01),except the sk

关 键 词：淋巴水肿 超声 剪切波弹性成像 肢体皮肤 导声垫 

分 类 号：R445.1[医药卫生—影像医学与核医学] R658.2[医药卫生—诊断学]