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研究生:王安中
研究生(外文):an-chueng wang
論文名稱:甲狀腺彈性超音波檢查技術之探討
論文名稱(外文):The Investigation of Thyroid US-elastosonography
指導教授:陳渙東郭瓊文郭瓊文引用關係
指導教授(外文):Huan-Tong ChenChuen-Wen Kuo
學位類別:碩士
校院名稱:元培科技大學
系所名稱:放射技術研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
畢業學年度:99
語文別:中文
論文頁數:70
中文關鍵詞:甲狀腺彈性超音波檢查灰階超音波彩色都卜勒超音波
外文關鍵詞:thyroid glandUS-elastographyB-mode ultrasoundcolor Doppler ultrasound
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彈性超音波是一項新的檢查技術,又可稱為電子觸診或音波觸診,本研究藉由此項技術可鑑別出甲狀腺結節的軟硬程度,評估彈性超音波對良性與惡性的診斷能力。
本研究收集184位受檢者,所有受檢者在執行介入性細針抽吸 (FNA)檢查前均以灰階 (B-mode)超音波、彩色都卜勒超音波與彈性超音波檢查技術進行檢查。
結果顯示灰階超音波的鈣化、邊界、回音型態與暈影等四項的判讀特徵因素可以輕易的發現結節,但無法辨識結節的良性或惡性,其靈敏度為70.6%與特異性為67.1%。彩色都卜勒可以了解組織與結節血流表現但無法分辨結節的良惡性,其靈敏度與特異性分別為82.4%與24%。彈性超音波無論彩色或黑白影像,對甲狀腺結節的惡性診斷有良好的偵測性94.1%。若將三者相結合同時使用,可以減少良性結節接受介入性檢查或手術 44.6% (82/184)與42.4% (78/184)另外在多個甲狀腺結節時,彈性超音波可針對結節最硬或最有可能為惡性結節者建議執行介入性細針抽吸 (FNA)檢查,如此將可提升該項檢查的診斷率。

US-elastography is a new developed technique also known as electronic palpation device. The aim of this study was to evaluate the ability of discrimination between benign and malignant thyroid nodules by using US-elastography.
One hundred and eighty-four patients were collected in this study. All patients were examined gray-scale ultrasound (B-mode), color Doppler ultrasound and US-elastography prior to fine-needle aspiration (FNA).
The results indicated that B-mode could find easily the presence of nodules, but could not identify nodules of benign or malignant. The diagnostic sensitivity and specificity by using B mode were 70.6% and 67.1% respectively. Color Doppler ultrasound could observe the blood flow performance of nodules but could not distinguish nodules of benign and malignant with the sensitivity and specificity of 82.4% and 24% respectively. Regardless of color or black and white image of US-elastography, the diagnosis of malignant thyroid nodules had a good detection of 94.1%. Moreover, it could reduce the rate of patients receiving fine needle aspiration or surgery 44.6% (82/184) or 42.4% (78/184) while all three techniques were combined simultaneously. Furthermore, US-elastography could evaluate the hardness or possible the malignant of thyroid nodule in multiple thyroid nodules cases. This novel technique could provide the appropriate timing to performed fine-needle aspiration and improve the diagnosis rate of malignant nodules.

中文摘要 I
Abstract II
致謝詞 III
目錄 V
表目錄 VII
圖目錄 VIII
第1章序言 1
1.1 前言 1
1.2 研究背景及目的 1
第2章文獻回顧 3
2.1 甲狀腺的構造 3
2.2 甲狀腺的生理功能 4
2.3 甲狀腺疾病的分類 5
2.4 甲狀腺檢查方式 6
2.4.1理學檢查 6
2.4.2血液檢查 …………..……………………………………6
2.4.3影像醫學檢查 7
2.5 彈性超音波檢查 12
2.6 彈性超音波於甲狀腺之應用 13
第3章檢查儀器與設備 14
3.1 彈性超音波理論基礎 14
3.2 儀器介紹 16
3.3 統計方法 17
第4章研究方法與步驟 18
4.1 研究架構 18
4.2 受檢者基本資料建檔 19
4.3 檢查前準備作業 19
4.4 檢查方法及步驟 20
4.4.1傳統超音波檢查與資料收集. 20
4.4.2彈性超音波檢查與資料收集. 22
4.4.3病理檢查結果 23
4.4.4良性、惡性結節分類與辨識方法 24
4.5 資料彙整與統計 27
第5章結果 28
5.1 超音波七項判讀特徵因素之統計結果 28
5.2 診斷結果與超音波檢查七項判讀特徵因素之統計 34
5.3 超音波檢查七項判讀特徵因素與診斷結果之分析 36
5.4 良性、惡性結節與超音波七項判讀特徵因素統計結果 42
5.5 良性與惡性結節對超音波七項判讀特徵因素積分之階 層迴歸分析統計結果 48
第6章討論 51
6.1 超音波七項判讀特徵因素與判讀結果之討論 51
6.2 超音波七項判讀特徵因素與診斷結果之討論 56
6.3 超音波七項特徵因素積分與良性、惡性結節統計結果之討論 59
6.4良性與惡性結節對超音波七項判讀特徵因素積分之線 性迴歸統計分析討論 62
第7章結論 63
參考文獻 64
附件 69


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