【作者】 张路平；

【导师】 杨漪；

【作者基本信息】 河北医科大学 ， 影像医学与核医学（专业学位）， 2016， 硕士

【摘要】 目的:通过测量、分析子宫肌瘤、腺肌瘤、正常宫壁的Elast PQ值,初步研究点定量弹性成像在诊断及鉴别诊断子宫肌瘤与腺肌瘤中的可行性及价值。找到区分此两种疾病的量化标准。方法:选取2015年1月至2016年1月河北医科大学第四医院,66例子宫肌瘤患者、55例腺肌瘤患者、98例正常体检女性。所有选取研究对象宫内均未放置节育器,未合并其他盆腔病变。所有研究对象先行常规超声检查,观察病灶图像特征,再利用点定量弹性成像测出其Elast PQ值。应用SPSS13.0统计学软件,按照各组数据特征而选用相应的统计方法。以P<0.05认为差异有统计学意义。分析正常组不同部位肌壁、年龄、月经周期之间Elast PQ值差异是否具有统计学意义。结合术后病理结果回顾性地分析子宫肌瘤、腺肌瘤Elast PQ值之间关系。根据病理结果绘制子宫肌瘤、腺肌瘤Elast PQ值的受试者工作曲线(ROC),求得点定量弹性成像鉴别二者的最佳截断值。对点定量弹性成像和常规超声在鉴别子宫肌瘤、腺肌瘤方面的价值做比较。结果:不同年龄、宫体不同部位、处于不同月经周期的正常子宫,测得其肌壁的Elast PQ值之间差异没有统计学意义。追踪病理结果得出,66例子宫肌瘤Elast PQ均值为26.16±11.55kpa,98例正常宫体肌壁Elast PQ均值为10.76±3.36kpa,55例腺肌瘤Elast PQ值中位数为7.65kpa,肌瘤组、腺肌瘤组、正常组Elast PQ值之间比较,P<0.05差异有统计学意义。肌瘤、腺肌瘤组Elast PQ值比较,P<0.05差别有统计学意义,绘制ROC曲线得出AUC为0.874,点定量弹性成像鉴别子宫肌瘤、腺肌瘤最佳截断值为14.03kpa。此时灵敏度是86.4%,特异度是90.9%,阳性预测值是91.9%,阴性预测值是84.7%,约登指数是69.4%,准确率是88.4%。常规超声鉴别子宫肌瘤、腺肌瘤,灵敏度是89.4%,特异度是83.0%,阳性预测值是84.3%。阴性预测值是86.3%,约登指数是69.4%,准确率是85.1%。对点定量成像技术与常规超声鉴别子宫肌瘤和腺肌瘤的准确率做比较,P>0.05,认为差异没有统计学意义。结论:不同肌壁部位、月经周期及年龄对子宫肌壁的硬度或弹性没有明显影响。点定量弹性成像可以从弹性或硬度上对子宫肌瘤、腺肌瘤鉴别提供量化标准,有助于二者的鉴别。更多还原

【Abstract】 Objective: To assess the feasibility and value of quantitative parameters of elasticity point quantification(ElastPQ) in the differential diagnosis of hysteromyoma and adenomyoma by measuring the elasticity point quantification value of hysteromyoma, adenomyoma and some healthy people. Find out the quantitative criteria for the differential diagnosis of hysteromyoma and adenomyoma.Methods: 66 paitients with hysteromyoma, 55 paitients with adenomyoma in uterus and 98 normal people were collected from January 2015 to January 2016 in Fourth hospital of Hebei Medical University, these people were underwent both conventional ultrasonography and elasticity point quantification technique detection. All parameters were analyzed with SPSS 13.0 statistical software with appropriate statistical methods according to their features. Analyze the influence of age, position and different menstrual cycle on ElastPQ value on normal people. According to pathologic results, ROC curve was drawn to evaluate the best cutoff value in differentiating hysteromyoma and adenomyoma. The results of ElastPQ were compared with conventional ultrasound.Results: There was no significant difference of Elast PQ value among different ages, positions and menstrual cycle in normal uterus(P>0.05). According to the result of pathology, the mean ElastPQ value of 66 hysteromyoma and 98 normal people was26.16±11.55 kPa and 10.76±3.36 kPa, respectively.The median ElastPQ value of adenomyoma was7.65 kPa. The ElastPQ value among hysteromyoma, adenomyoma and normal uterus had significant differnce(P<0.05). On ROC curve, the area under the curve(AUC) of the ElastPQ value was 0.874. Taking 14.03 kPa as the best cutoff value of differentiate hysteromyoma and adenomyoma, the sensitivity, specificity positive predictive value, negative predictive value and Youden’s index was86.4%, 90.9%, 91.9%, 84.7%, 0.694, respectively. At the same time the sensitivity, specificity, positive predictive value,negative predictive value and Youden’s index of the conventional ultrasound was 89.4%, 83.0%, 69.4%, 86.3%, 0.843, respectively. The differential diagnosis accuracy for and adenomyoma of ElastPQ compared with conventional ultrasound had no significant difference(P>0.05).Conclusion: There is no significant difference of ElastPQ value between different ages, positions and menstrual cycle in normal uterus. ElastPQ can help differentiate hysteromyoma from adenomyoma to some extent by offering quantitative criteria for stiffness of tissue.更多还原