超声弹性成像技术对宫颈占位病变的诊断价值探讨
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摘要
研究背景与目的
超声弹性成像(Ultrasonic Elastography,UE)是近年来发展的一种新的超声诊断技术。能够测量组织的弹性(组织对施加与其表面的外界激励产生的应变)这一力学特性,癌症组织的硬度与其病理状态紧密相关,该技术有望对癌症等组织病变提供新的诊断信息,弥补了X线计算机体层成像(computed tomography,CT)、磁共振成像(magnetic resonance imaging, MRI)等影像学的不足。从1991年该技术问世后相关组织弹性研究便逐步开展。学者们在乳腺、甲状腺等浅表器官的良恶性鉴别诊断取得了很好的效果,在肝脏、前列腺、肾脏等方面也已进行了一系列研究,但在宫颈方面的研究较少。宫颈部位缺乏神经分布,故发生病变时常无自觉症状,或症状不典型,仅表现为阴道少量出血,既往多以妇科检查、宫颈脱落细胞学检查、阴道镜碘不着色区域取活组织病理检查等方法来诊断,但这些方法不易发现宫颈管内及宫颈肌层的病变。宫颈恶变时组织硬度增加,常规超声不能提供相关信息,妇科检查仅凭触觉,评价主观性比较强。利用经阴道超声检查联合实时超声弹性成像技术,腔内探头对宫颈施加一定的压力,不同组织的弹性系数不同,受到压力时发生的位移不同,根据弹性图像特征来判断组织的软硬度,从而鉴别病变的性质。
本研究的主要目的是总结正常宫颈及不同病变宫颈的弹性图像特征并探讨超声弹性成像技术对宫颈占位良恶性鉴别诊断价值。
对象与方法
1.正常宫颈组20例,平均年龄(31士2.3)岁。宫颈慢性炎症组20例,平均年龄(35±1.6)岁。其中宫颈囊肿11例,宫颈肥大9例。宫颈占位组71例(共73个病灶),平均年龄(39±3.1)岁,包含良性病灶33个,恶性病灶40个。正常组、慢性炎症组均有妇科检查及宫颈液基细胞学检查(TCT)结果,宫颈占位组均在我院接受手术治疗并送病理检查。
2.采用日立HV-900超声诊断仪,腔内探头频率4～8MHZ,该仪器配置有实时超声弹性成像功能及相关后处理软件。每个研究对象均行经阴道超声检查,进行常规纵、横切面扫查,发现病灶后观察病灶的位置、形态、大小、边界、内部回声、血流情况,初步判断病灶的性质。获取理想二维图像后进入弹性成像模式,观察正常宫颈及病变宫颈的弹性图像特征,对宫颈占位病灶进行应变率比值测定及弹性评分,采用5分超声弹性成像评分标准。
结果
1、超声弹性评分法诊断宫颈占位良恶性病变敏感度、特异度、准确度分别为；67.5%、72.7%、69.9%；经阴道超声分别为：55%、78.8%、65.8%；二者联合成像分别为：82.5%、87.9%、84.9%。超声弹性评分法、经阴道超声分别与二者联合成像相比较,有明显统计学差异,统计结果分别为(X2.287,P<0.05；X2=1.625,P<0.05)。
2、应变率比值测量宫颈良恶性病变最佳截断值为3.01,超声弹性应变率比值法与弹性评分法诊断宫颈占位病灶的受试者工作特征曲线(receiver oprating characteristic cueve,ROC)下面积(Az)分别为：0.816和0.736,两者无明显统计学差异(X2=4.178,P>0.05)
3、正常宫颈及不同宫颈病变的弹性图像特征
正常宫颈：呈现较为均匀一致以绿色为主的图像,宫颈管内呈红色及绿色长条状。
宫颈肥大：与正常宫颈类似,呈现以绿色为主蓝绿相间的图像。
宫颈囊肿：呈现为红、蓝、绿分层现象,较小的囊肿呈较均匀的绿色,较大的囊肿常仅部分可见红、绿色,部分区域色彩缺损。
宫颈肌瘤：多以绿色为主,呈现蓝绿相间的图像,还可见以蓝色、红色为主的图像。
宫颈管息肉：以绿色为主伴少量红色和(或)蓝色。
宫颈癌：以蓝色为主,其内或周边可见少量的绿色,或整个病灶区全部为蓝色所覆盖。
4、血流丰富型宫颈癌17例,5分7例,4分6例,≤3分2例；血流不丰富型宫颈癌13例,5分1例,4分8例,≤3分4例；无血流型宫颈癌10例,5分1例,4分2例,≤3分7例。
结论
1、超声弹性成像是经阴道超声检查的一种有益补充,超声弹性成像在宫颈占位病变诊断中具有良好应用前景。
2、超声弹性评分法、应变率比值法对宫颈良恶性病灶诊断均有一定价值,应变率比值法准确度略高于弹性评分法,但二者差异无统计学意义。
3、宫颈癌血流是否丰富对弹性分级影响不大。
Background and Objective
Ultrasound elastography as an easier, novel and accurate diagnosis technology. It is a technique for imaging mechanical properties of a material by measuring and imaging induced strain within tissue following the application of an externally applied displacement to the surface of that tissue. Ultrasound tissue elasticity imaging is expected as means for providing novel diagnostic information for tissue disease such as cancer since the tissue hardness is closely related to its pathological state. Therefore, many investigations on imaging tissue elasticity by ultrasound have been carried out from the1991s.The value of replacing invasive methods of evaluation witha non-invasive tool is apparent. It make up for the deficiency of CT, MRI and other imaging.
Clinical applications of ultrasound elastography include its use to assist in detection of breast carcinoma, thyroid carcinomas and also to differentiate tumour from a high-intensity focused ultrasound-ablated lesion in the prostate. Investigators have also carried out a series of research in the liver, prostate, kidney, etc. but few studies in the cervix. Cervix lack of nerve, when the lesions occur patients often no self-conscious symptoms, Or just for a small amount of vaginal bleeding,formerly we often depend on gynecological examination, cervical cytology, colposcopy method to diagnose. However, It is difficult to find the cervical canal and cervical muscle lesions by these methods. Because ultrasound can observe lesion features such as size, shape, blood flow, etc. It has became the irreplaceable tool of the department of gynaecology.Malignant cervical tissue hardness increase, Conventional ultrasound can not provide relevant information. Gynecological examination rely on the tactile evaluation softness,subjective is stronger. Transvaginal ultrasound combined with ultrasound elastography using intracavity probes impose certain pressure on the cervix. Different tissue elasticity coefficient is different, when they under the same pressure produce different displacement. According to the elastic tissue hardness information provided by the image characteristics, we identify the nature of the lesions.
The main purpose of this study was summary of ultrasound image characteristics of normal cervix and cervical diseases such as cervical cancer, to investigate ultrasound elastography differential diagnosis of benign and malignant cervical placeholder.
Objects and Methods
1.Based on the diagnosis of20cases of normal cervix, the mean age was31±2.3.20cases of cervical chronic inflammation, the mean age was35±1.6,among the patients,there were11cases with cervical cysts,9cases with cervical hypertrophy.71cases (73lesions) with cervical placeholder,the mean age39±3.1,33benign lesions,40malignant lesions. Normal group and the chronic inflammation group has gynecological examination and Thinprep cytologic test(TCT) results, Cervical placeholder group underwent surgery in our hospital and pathologic examination.
2.Hitachi HV-900Ultrasonic imaging apparatus with4.0-8.0MHz frequency was used, The instruments is equipped with real-time elastography function and post-processing software. All of them underwant the vaginal ultrasound scanning, including longitudinal and transverse sesection. After the lesion was found, Observed the location of the lesion, shape, size, border, internal echo, blood flow, preliminary to determine the nature of the lesion. After to obtain ideal two-dimensional image into the elastic mode.We observed the elastic image of normal cervix and cervical lesions.All cerval lesions were evaluated by elasticity score(which were classified into5) and by strain ratio.
Results
1. Ultrasound elastography score diagnosis of cervical placeholder,the sensitivity, specificity, and accuracy of the elastosonography in differentiating benign and malignant cervical nodules were67.5%,72.7%,69.9%, respectively, Transvaginal ultrasound were:55%,78.8%,65.8%,respectively; The combination imaging were:82.5%,87.9%,84.9%,respectively.The ultrasound elastography score, transvaginal ultrasound, with the combination of the two imaging compared, respectively, has significant differences,statistical results were (X2=2.287, P<0.05;X2=1.625, p<0.05).
2. the cutoff point of strain ratio was determinded as3.01.The area under the ROC curve(Az)of strain ratio and5-scoring system were0.816and0.736, significant difference were not found between strain ratio method and5-scoring system (X2=4.178,P>0.05)
3. Normal cervix and cervical lesions elastic image features.
Normal cervix:rendering more uniform green image, Cervical canal was a long strip of red and green.
Cervical hypertrophy:Similar to the normal cervical image features. Cervical mainly green, blue, green and white images.
Cervical cysts:Rendered as red, blue, green, Smaller cysts was more uniform green, Large cysts often only partially visible red, green, some regional color defect.
Cervical myoma:dominated by green,blue and green image,is visible in blue and red as the main image.
Cervical canal polypus:dominated by green with a small amount of red and (or) blue.
Cervical cancer:Mainly in blue, or visible around small amounts of green, Or entire lesion area is covered by blue.
4.17cases of blood flow-rich type of cervical carcinoma,7cases of5points,6cases of4points,2cases≤3minutes;13of cases Blood flow is not rich type of cervical cancer,1cases of5points,8cases of4points,4cases≤3minutes,4cases;10cases of no blood flow type of cervical Cancer,1cases of5points,2cases of4points,7cases≤3minutes.
Conclusions:
1.Ultrasonic elastography(UE) is a useful complement transvaginal ultrasound, UE is a promising technology in diagnosis of cervical placeholder.
2. Ultrasonic elastic scoring and the strain ratio methods in the diagnosis of cervical benign and malignant lesions have a certain value, the accuracy of the strain ratio method is slightly higher than the elasticity score, but the difference was not statistically significant.
3.The blood flow signal of cervical cancer has little effect on the elasticity score.
超声弹性成像(Ultrasonic Elastography,UE)是近年来发展的一种新的超声诊断技术。能够测量组织的弹性(组织对施加与其表面的外界激励产生的应变)这一力学特性,癌症组织的硬度与其病理状态紧密相关,该技术有望对癌症等组织病变提供新的诊断信息,弥补了X线计算机体层成像(computed tomography,CT)、磁共振成像(magnetic resonance imaging, MRI)等影像学的不足。从1991年该技术问世后相关组织弹性研究便逐步开展。学者们在乳腺、甲状腺等浅表器官的良恶性鉴别诊断取得了很好的效果,在肝脏、前列腺、肾脏等方面也已进行了一系列研究,但在宫颈方面的研究较少。宫颈部位缺乏神经分布,故发生病变时常无自觉症状,或症状不典型,仅表现为阴道少量出血,既往多以妇科检查、宫颈脱落细胞学检查、阴道镜碘不着色区域取活组织病理检查等方法来诊断,但这些方法不易发现宫颈管内及宫颈肌层的病变。宫颈恶变时组织硬度增加,常规超声不能提供相关信息,妇科检查仅凭触觉,评价主观性比较强。利用经阴道超声检查联合实时超声弹性成像技术,腔内探头对宫颈施加一定的压力,不同组织的弹性系数不同,受到压力时发生的位移不同,根据弹性图像特征来判断组织的软硬度,从而鉴别病变的性质。
本研究的主要目的是总结正常宫颈及不同病变宫颈的弹性图像特征并探讨超声弹性成像技术对宫颈占位良恶性鉴别诊断价值。
对象与方法
1.正常宫颈组20例,平均年龄(31士2.3)岁。宫颈慢性炎症组20例,平均年龄(35±1.6)岁。其中宫颈囊肿11例,宫颈肥大9例。宫颈占位组71例(共73个病灶),平均年龄(39±3.1)岁,包含良性病灶33个,恶性病灶40个。正常组、慢性炎症组均有妇科检查及宫颈液基细胞学检查(TCT)结果,宫颈占位组均在我院接受手术治疗并送病理检查。
2.采用日立HV-900超声诊断仪,腔内探头频率4～8MHZ,该仪器配置有实时超声弹性成像功能及相关后处理软件。每个研究对象均行经阴道超声检查,进行常规纵、横切面扫查,发现病灶后观察病灶的位置、形态、大小、边界、内部回声、血流情况,初步判断病灶的性质。获取理想二维图像后进入弹性成像模式,观察正常宫颈及病变宫颈的弹性图像特征,对宫颈占位病灶进行应变率比值测定及弹性评分,采用5分超声弹性成像评分标准。
结果
1、超声弹性评分法诊断宫颈占位良恶性病变敏感度、特异度、准确度分别为；67.5%、72.7%、69.9%；经阴道超声分别为：55%、78.8%、65.8%；二者联合成像分别为：82.5%、87.9%、84.9%。超声弹性评分法、经阴道超声分别与二者联合成像相比较,有明显统计学差异,统计结果分别为(X2.287,P<0.05；X2=1.625,P<0.05)。
2、应变率比值测量宫颈良恶性病变最佳截断值为3.01,超声弹性应变率比值法与弹性评分法诊断宫颈占位病灶的受试者工作特征曲线(receiver oprating characteristic cueve,ROC)下面积(Az)分别为：0.816和0.736,两者无明显统计学差异(X2=4.178,P>0.05)
3、正常宫颈及不同宫颈病变的弹性图像特征
正常宫颈：呈现较为均匀一致以绿色为主的图像,宫颈管内呈红色及绿色长条状。
宫颈肥大：与正常宫颈类似,呈现以绿色为主蓝绿相间的图像。
宫颈囊肿：呈现为红、蓝、绿分层现象,较小的囊肿呈较均匀的绿色,较大的囊肿常仅部分可见红、绿色,部分区域色彩缺损。
宫颈肌瘤：多以绿色为主,呈现蓝绿相间的图像,还可见以蓝色、红色为主的图像。
宫颈管息肉：以绿色为主伴少量红色和(或)蓝色。
宫颈癌：以蓝色为主,其内或周边可见少量的绿色,或整个病灶区全部为蓝色所覆盖。
4、血流丰富型宫颈癌17例,5分7例,4分6例,≤3分2例；血流不丰富型宫颈癌13例,5分1例,4分8例,≤3分4例；无血流型宫颈癌10例,5分1例,4分2例,≤3分7例。
结论
1、超声弹性成像是经阴道超声检查的一种有益补充,超声弹性成像在宫颈占位病变诊断中具有良好应用前景。
2、超声弹性评分法、应变率比值法对宫颈良恶性病灶诊断均有一定价值,应变率比值法准确度略高于弹性评分法,但二者差异无统计学意义。
3、宫颈癌血流是否丰富对弹性分级影响不大。
Background and Objective
Ultrasound elastography as an easier, novel and accurate diagnosis technology. It is a technique for imaging mechanical properties of a material by measuring and imaging induced strain within tissue following the application of an externally applied displacement to the surface of that tissue. Ultrasound tissue elasticity imaging is expected as means for providing novel diagnostic information for tissue disease such as cancer since the tissue hardness is closely related to its pathological state. Therefore, many investigations on imaging tissue elasticity by ultrasound have been carried out from the1991s.The value of replacing invasive methods of evaluation witha non-invasive tool is apparent. It make up for the deficiency of CT, MRI and other imaging.
Clinical applications of ultrasound elastography include its use to assist in detection of breast carcinoma, thyroid carcinomas and also to differentiate tumour from a high-intensity focused ultrasound-ablated lesion in the prostate. Investigators have also carried out a series of research in the liver, prostate, kidney, etc. but few studies in the cervix. Cervix lack of nerve, when the lesions occur patients often no self-conscious symptoms, Or just for a small amount of vaginal bleeding,formerly we often depend on gynecological examination, cervical cytology, colposcopy method to diagnose. However, It is difficult to find the cervical canal and cervical muscle lesions by these methods. Because ultrasound can observe lesion features such as size, shape, blood flow, etc. It has became the irreplaceable tool of the department of gynaecology.Malignant cervical tissue hardness increase, Conventional ultrasound can not provide relevant information. Gynecological examination rely on the tactile evaluation softness,subjective is stronger. Transvaginal ultrasound combined with ultrasound elastography using intracavity probes impose certain pressure on the cervix. Different tissue elasticity coefficient is different, when they under the same pressure produce different displacement. According to the elastic tissue hardness information provided by the image characteristics, we identify the nature of the lesions.
The main purpose of this study was summary of ultrasound image characteristics of normal cervix and cervical diseases such as cervical cancer, to investigate ultrasound elastography differential diagnosis of benign and malignant cervical placeholder.
Objects and Methods
1.Based on the diagnosis of20cases of normal cervix, the mean age was31±2.3.20cases of cervical chronic inflammation, the mean age was35±1.6,among the patients,there were11cases with cervical cysts,9cases with cervical hypertrophy.71cases (73lesions) with cervical placeholder,the mean age39±3.1,33benign lesions,40malignant lesions. Normal group and the chronic inflammation group has gynecological examination and Thinprep cytologic test(TCT) results, Cervical placeholder group underwent surgery in our hospital and pathologic examination.
2.Hitachi HV-900Ultrasonic imaging apparatus with4.0-8.0MHz frequency was used, The instruments is equipped with real-time elastography function and post-processing software. All of them underwant the vaginal ultrasound scanning, including longitudinal and transverse sesection. After the lesion was found, Observed the location of the lesion, shape, size, border, internal echo, blood flow, preliminary to determine the nature of the lesion. After to obtain ideal two-dimensional image into the elastic mode.We observed the elastic image of normal cervix and cervical lesions.All cerval lesions were evaluated by elasticity score(which were classified into5) and by strain ratio.
Results
1. Ultrasound elastography score diagnosis of cervical placeholder,the sensitivity, specificity, and accuracy of the elastosonography in differentiating benign and malignant cervical nodules were67.5%,72.7%,69.9%, respectively, Transvaginal ultrasound were:55%,78.8%,65.8%,respectively; The combination imaging were:82.5%,87.9%,84.9%,respectively.The ultrasound elastography score, transvaginal ultrasound, with the combination of the two imaging compared, respectively, has significant differences,statistical results were (X2=2.287, P<0.05;X2=1.625, p<0.05).
2. the cutoff point of strain ratio was determinded as3.01.The area under the ROC curve(Az)of strain ratio and5-scoring system were0.816and0.736, significant difference were not found between strain ratio method and5-scoring system (X2=4.178,P>0.05)
3. Normal cervix and cervical lesions elastic image features.
Normal cervix:rendering more uniform green image, Cervical canal was a long strip of red and green.
Cervical hypertrophy:Similar to the normal cervical image features. Cervical mainly green, blue, green and white images.
Cervical cysts:Rendered as red, blue, green, Smaller cysts was more uniform green, Large cysts often only partially visible red, green, some regional color defect.
Cervical myoma:dominated by green,blue and green image,is visible in blue and red as the main image.
Cervical canal polypus:dominated by green with a small amount of red and (or) blue.
Cervical cancer:Mainly in blue, or visible around small amounts of green, Or entire lesion area is covered by blue.
4.17cases of blood flow-rich type of cervical carcinoma,7cases of5points,6cases of4points,2cases≤3minutes;13of cases Blood flow is not rich type of cervical cancer,1cases of5points,8cases of4points,4cases≤3minutes,4cases;10cases of no blood flow type of cervical Cancer,1cases of5points,2cases of4points,7cases≤3minutes.
Conclusions:
1.Ultrasonic elastography(UE) is a useful complement transvaginal ultrasound, UE is a promising technology in diagnosis of cervical placeholder.
2. Ultrasonic elastic scoring and the strain ratio methods in the diagnosis of cervical benign and malignant lesions have a certain value, the accuracy of the strain ratio method is slightly higher than the elasticity score, but the difference was not statistically significant.
3.The blood flow signal of cervical cancer has little effect on the elasticity score.
引文
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