胃肠超声造影联合声脉冲辐射力成像技术对胃壁良恶性疾病的诊断价值
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摘要
目的:探讨胃肠超声造影联合声辐射力脉冲成像(ARFI)技术在胃壁常见良恶性病变中的诊断价值。方法:回顾性选取在医院接受超声造影检查中发现胃壁局限或弥漫性增厚的52例住院及门诊患者,根据手术后病理、胃镜下活检及临床诊断的明确结果将其分为胃壁恶性病变组(32例)和胃壁良性病变组(20例)。采用ARFI技术对其胃壁进行声触诊组织量化(VTQ)技术检测和分析,得出平均剪切波速度(SWV)值,评价良恶性病变增厚胃壁SWV值的区别,并绘制构建受试者工作特征(ROC)曲线,预测两组患者胃壁恶性病变SWV的临界值。结果:胃壁恶性病变组SWV值明显高于胃壁良性病变组SWV值,其差异有统计学意义(t=5.44,P<0.05)。由ROC曲线可知,当SWV截值为1.71 m/s(曲线下最大面积=0.885时),其预测胃壁恶性病变的灵敏度和特异度分别为81.8%和92.3%,此时灵敏度和特异度之和为最高,以胃壁SWV值>1.71 m/s作为胃壁恶性病变的判断标准,具有较高诊断价值。结论:VTQ技术测量增厚病变胃壁的SWV值可以间接评估胃壁的良恶性病变,是一项可用于初步诊断胃壁良恶性病变的新指标。
Objective: To investigate the diagnostic value of the combination of gastrointestinal contrast ultrasonography and acoustic radiation force impulse imaging(ARFI) technique for benign or malignant disease of gastric wall. Methods: 52 patients with local or diffuse thickening of gastric wall who underwent contrast ultrasonography were retrospectively selected in this research. According to postoperative pathological examination, biopsy under gastroscope and the definite results of clinical diagnosis, these patients were divided into malignant lesion group(32 cases) and benign lesion group(20 cases). Adopted ARFI technique to implement detection and analysis with virtual touch tissue quantification(VTQ) for their gastric wall, and to obtain average shear wave velocity(SWV) value, and to evaluate the difference of SWV values of the thickening of gastric wall between benign lesion and malignant lesion, and to draw and construct receiver operating characteristic(ROC) curve, and to predict the cut-off value of malignant lesion SWV of gastric wall of two groups. Results: The SWV value of malignant lesion group was significantly higher than that of benign lesion group(t=5.44, P<0.05). When the sectional value of SWV was 1.71 m/s(maximum area under curve was 0.885), the sensitivity and specificity of SWV in predicting malignant lesion of gastric wall were 81.8% and 92.3%, respectively. At this time, the sum of sensitivity and specificity was highest. Conclusion: Used VTQ technique to measure SWV value of gastric wall of thickening lesions can indirectly assess the benign or malignant lesion of gastric wall, and it is a new indicator that can be used to obtain primary diagnosis for benign or malignant lesion of gastric wall.
Objective: To investigate the diagnostic value of the combination of gastrointestinal contrast ultrasonography and acoustic radiation force impulse imaging(ARFI) technique for benign or malignant disease of gastric wall. Methods: 52 patients with local or diffuse thickening of gastric wall who underwent contrast ultrasonography were retrospectively selected in this research. According to postoperative pathological examination, biopsy under gastroscope and the definite results of clinical diagnosis, these patients were divided into malignant lesion group(32 cases) and benign lesion group(20 cases). Adopted ARFI technique to implement detection and analysis with virtual touch tissue quantification(VTQ) for their gastric wall, and to obtain average shear wave velocity(SWV) value, and to evaluate the difference of SWV values of the thickening of gastric wall between benign lesion and malignant lesion, and to draw and construct receiver operating characteristic(ROC) curve, and to predict the cut-off value of malignant lesion SWV of gastric wall of two groups. Results: The SWV value of malignant lesion group was significantly higher than that of benign lesion group(t=5.44, P<0.05). When the sectional value of SWV was 1.71 m/s(maximum area under curve was 0.885), the sensitivity and specificity of SWV in predicting malignant lesion of gastric wall were 81.8% and 92.3%, respectively. At this time, the sum of sensitivity and specificity was highest. Conclusion: Used VTQ technique to measure SWV value of gastric wall of thickening lesions can indirectly assess the benign or malignant lesion of gastric wall, and it is a new indicator that can be used to obtain primary diagnosis for benign or malignant lesion of gastric wall.
引文
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[12]Stock KF,Klein BS,VoCong MT,et al.ARFI-based tissue elasticity quantification in comparison to histology for the diagnosis of renal transplant fibrosis[J].Clin Hemorheol Micro,2010,46(2):139-148
[13]Zhang YF,Xu HX,He Y,et al.Virtual touch tissue quantification of acoustic radiation force impulse:a new ultrasound elastic imaging in the diagnosis of thyroid nodules[J].PLOSONE,2012,7(11):e49094.
[14]Bai M,Du L,Gu J,et al.Virtual touch tissue quantification using acoustic radiation force impulse technology:initial clinical experience with solid breast masses[J].J Ultrasound Med,2012,31(2):289-294.
[15]Guo LH,Liu BJ,Xu HX,et al.Acoustic radiation force impulse elastography in differentiating renal solid masses:a preliminary experience[J].Int J Clin Exp Pathol,2014,7(11):7469-7476.
[16]陈杰.病理学[M].北京:人民卫生出版社,2005:261-262.
[17]关维,纪小龙,徐薪,等.对正常胃、胃溃疡及胃癌组织中弹力纤维分布规律的观察[J].世界华人消化杂志,2005,13(3):308-311.
[18]孙德胜,孟繁坤,王金锐,等.慢性肝病肝剪切波速与纤维化分级的相关性研究[J].中国医学影像学杂志,2009,17(4):241-245.
[19]Mueller MM,Fusenig NE.Friends or foesbipolar effects of the tumour stroma in cancer[J].Nat Rev Cancer,2004,4(11):839-849.
[20]Schedin P,O'Brien J,Rudolph M,et al.Microenvironment of the involuting mammary gland mediates mammary cancer progression[J].JMammary Gland Biol Neoplasia,2007,12(1):71-82.
[21]Goertz RS,Amann K,Heide R,et al.An abdominal and thyroid status with Acoustic Radiation Force Impulse Elastometry-Afeasibility study Acoustic Radiation Force Impulse Elastometry of human organs[J].Eur J Radiol,2011,80(3):226-230.
[2]郭心璋,张武,口服胃肠超声造影的临床应用[J].中华医学超声杂志(电子版),2010,7(3):334-365.
[3]陆文明.临床胃肠疾病超声诊断学[M].西安:第四军医大学出版社,2004:76
[4]Choi WJ,Park JS,Kim KG,et al.Computerized analysis of calcification of thyroid nodules as visualized by ultrasonography[J].Eur JRadiol,2015,84(10):1949-1953.
[5]McCarville MB.Contrast-enhanced sonography in pediatrics[J].Pediatr Radiol,2011,41(Suppl 1):S238-242.
[6]邱伟,李明星.超声双重造影诊断胃癌的研究进展[J].临床合理用药杂志,2015,8(5):179-181.
[7]李建国.胃肠肿瘤超声检查[J].中国超声医学杂志,2000,16(3):213-217.
[8]陈仁彬.实用超声诊断学[M].北京:中国医药科技出版社,1997:309-313.
[9]Ricci P,Maggini E,Mancuso E,et al.Clinical application of breast elastography:State of the art[J].Eur J Radiol,2014,83(3):429-437.
[10]Rifai K,Cornberg J,Mederacke I,et al.Clinical feasibility of liver elastography by acoustic radiation force impulse imaging(ARFI)[J].Digest Liver Dis,2011,43(6):491-497.
[11]Friedrich-Rust M,Wunder K,Kriener S,et al.Liver fibrosis in viral hepatitis:noninvasive assessment with acoustic radiation force impulse imaging versus transient elastography[J].Radiology,2009,252(2):595-604.
[12]Stock KF,Klein BS,VoCong MT,et al.ARFI-based tissue elasticity quantification in comparison to histology for the diagnosis of renal transplant fibrosis[J].Clin Hemorheol Micro,2010,46(2):139-148
[13]Zhang YF,Xu HX,He Y,et al.Virtual touch tissue quantification of acoustic radiation force impulse:a new ultrasound elastic imaging in the diagnosis of thyroid nodules[J].PLOSONE,2012,7(11):e49094.
[14]Bai M,Du L,Gu J,et al.Virtual touch tissue quantification using acoustic radiation force impulse technology:initial clinical experience with solid breast masses[J].J Ultrasound Med,2012,31(2):289-294.
[15]Guo LH,Liu BJ,Xu HX,et al.Acoustic radiation force impulse elastography in differentiating renal solid masses:a preliminary experience[J].Int J Clin Exp Pathol,2014,7(11):7469-7476.
[16]陈杰.病理学[M].北京:人民卫生出版社,2005:261-262.
[17]关维,纪小龙,徐薪,等.对正常胃、胃溃疡及胃癌组织中弹力纤维分布规律的观察[J].世界华人消化杂志,2005,13(3):308-311.
[18]孙德胜,孟繁坤,王金锐,等.慢性肝病肝剪切波速与纤维化分级的相关性研究[J].中国医学影像学杂志,2009,17(4):241-245.
[19]Mueller MM,Fusenig NE.Friends or foesbipolar effects of the tumour stroma in cancer[J].Nat Rev Cancer,2004,4(11):839-849.
[20]Schedin P,O'Brien J,Rudolph M,et al.Microenvironment of the involuting mammary gland mediates mammary cancer progression[J].JMammary Gland Biol Neoplasia,2007,12(1):71-82.
[21]Goertz RS,Amann K,Heide R,et al.An abdominal and thyroid status with Acoustic Radiation Force Impulse Elastometry-Afeasibility study Acoustic Radiation Force Impulse Elastometry of human organs[J].Eur J Radiol,2011,80(3):226-230.