超声造影灌注模式结合定量分析指导甲状腺癌治疗的研究

Guiding role of perfusion mode of contrast-enhanced ultrasound combined with quantitative analysis in the treatment of thyroid cancer

目的:探讨超声造影灌注模式结合定量分析对甲状腺癌治疗的指导作用。方法:选取医院收治的89例(共192个癌结节)甲状腺癌患者的临床资料,所有患者均行超声造影灌注模式检查和定量分析,并根据超声检查结果指导根治术中淋巴结清扫。对比超声造影灌注模式特征和定量参数;绘制受试者工作特征(ROC)曲线,分析超声指标对淋巴结转移的评估效能;统计患者术后6个月、1年复发率及病死率。结果:在89例患者中淋巴结转移38例(占42.70%),无淋巴结转移51例(占57.30%)。淋巴结转移患者和无淋巴结转移患者的癌结节长径分别为(18.59±3.51)mm和(13.20±2.15)mm,两者比较差异有统计学意义(t=10.109,P<0.05),而癌结节灌注强度、灌注缺损、灌注均匀和灌注模式两者比较均无差异;淋巴结转移患者的癌结节边缘区峰值强度(PI)、边缘区ROC曲线下面积(AUC)均高于无淋巴结转移患者,差异有统计学意义(t=33.639,t=17.417;P<0.05),且两者边缘区和中央区上升时间(RT)、平均渡越时间(MTT)、上升斜率(WIS)、峰值降半时间(TPH)、达峰时间(TTP)以及中央区PI和AUC比较差异均无统计学意义。所有患者术后6个月无复发、无死亡;术后1年复发率为11.24%(10/89),病死率为4.49%(4/89)。结论:甲状腺癌采用超声造影灌注模式结合定量分析可准确评估是否有淋巴结转移,据此指导临床治疗可获得良好的预后。

Objective:To explore the guiding role of perfusion mode of contrast-enhanced ultrasound combined with quantitative analysis in the treatment of thyroid cancer.Methods:The clinical data of 89 patients with thyroid cancer(192 cancer nodules)who admitted to hospital were enrolled.All of the patients underwent examination and quantitative analysis of perfusion mode of contrast-enhanced ultrasound,and the lymph node dissection of radical operation was guided according to the results of ultrasound examination.And the characteristics and quantitative parameters of perfusion mode of contrast-enhanced ultrasound were compared.And then,receiver operating characteristics(ROC)curve was drawn to analyze the assessment efficiency of ultrasonic indexes for lymph node metastasis.The recurrence rates and mortality rates of the patients at 6 months and 1 year after operation were further statistically analyzed.Results:38 cases of 89 patients occurred lymph node metastasis(accounting for 42.70%),and 51 cases had not occurred lymph node metastasis(accounting for 57.30%).The long diameter of cancer nodule of patients with lymph node metastasis(18.59±3.51)was significantly higher than those of patients without lymph node metastasis(13.20±2.15)(t=10.109,P<0.05).And there were no statistically significant differences in the perfusion intensity,perfusion defect,perfusion even and perfusion pattern of cancer nodules between the two kinds of patients.The peak intensity(PI)and the area under curve(AUC),which were significantly higher than those of patients without lymph node metastasis(t=33.639,t=17.417,P<0.05).And there were no statistically significant differences in the rise time(RT),mean transit time(MTT),wash in slope(WIS),time from peak to half(TPH),time to peak(TTP)in marginal and central regions,and PI and AUC of central regions between the two kinds of patients.All of patients had no recurrence and death at 6 months after operation,and the recurrence rate and the case fatality rate at 1 year after operation were 11.24%and 4.49%,respectively.Conclusion:For thyroid cancer,perfusion mode of contrast-enhanced ultrasound combined with quantitative analysis can accurately assessed whether there is lymph node metastasis,so as to obtain favorable prognosis by guiding clinical treatment.