实时剪切波弹性成像与声辐射力脉冲成像在女性膀胱颈梗阻诊断中的价值。

Value of Real-Time Shear Wave Elastography Versus Acoustic Radiation Force Impulse Imaging in the Diagnosis of Female Bladder Neck Obstruction.

机构信息

Ultrasound Department, People's Hospital of Liaoning Province, Liaoning, China.

Department of Anesthesiology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Liaoning, China.

出版信息

J Ultrasound Med. 2019 Sep;38(9):2427-2435. doi: 10.1002/jum.14941. Epub 2019 Jan 25.

DOI:10.1002/jum.14941

PMID:30680774

Abstract

OBJECTIVE

To investigate the application value of shear wave elastography (SWE) and acoustic radiation force impulse imaging (ARFI) in the diagnosis of female bladder neck obstruction (FBNO), we compared the advantages of these 2 methods to provide a more accurate reference for clinical work.

METHODS

From April 2016 to February 2018, 27 patients who were diagnosed with FBNO by cystoscopy and/or urine dynamics testing were selected for the study, together with 24 healthy adults in a case-control study at Liaoning Province People's Hospital. We collected general information from 27 patients with FBNO, and using transperineal 2-dimensional ultrasound detection, shear wave elastography (SWE) and ARFI were used, respectively, to detect the Young's modulus and shear wave velocity (SWV) of the bladder necks. Cystoscopy results were considered to be the gold standard, and receiver operating characteristic (ROC) curves were drawn for ARFI, SWE, and the combined diagnosis of the two. The efficacy of the diagnosis was determined by comparing the areas under the ROC curves and calculating the sensitivity, specificity, and accuracy.

RESULTS

The areas under the ROC curve for the Q-box mean and max value detected by SWE for FBNO patients were 88.4% and 89.9%, respectively, and the sensitivity, specificity, and accuracy were 81.5%, 79.2%, and 80.4%, respectively. The area under the ROC curve detected by ARFI for FBNO patients was 93.7%, and the sensitivity, specificity, and accuracy were 88.9%, 79.2%, and 84.3%, respectively. The sensitivity, specificity, and accuracy of the combined detection of ARFI and SWE were 92.5%, 87.5%, and 90.2%, respectively. The best diagnostic cutoff point of the SWV or the Q-box mean and max value of SWE in FBNO obtained with the ROC curve was SWV = 2.38 m/s (sensitivity, 71.4%; specificity, 82.5%), Q-box mean = 20.2 kPa, Q-box max = 39.8 kPa (sensitivity, 67.5%; specificity, 76.2%). The average shear wave velocity of ARFI, Q-box mean, and Q-box max value of SWE in the control group were 1.89 ± 0.35 m/s, 15.3 ± 3.6 kPa, and 29.2 ± 8.7 kPa, respectively. In the FBNO group, these values were 2.81 ± 0.63) m/s, 27.2 ± 8.6 kPa, and 51.2 ± 12.3 kPa, respectively. The differences were statistically significant (P < .05).

CONCLUSION

The value of the ARFI in the diagnosis of FBNO is a little greater than that of SWE in terms of sensitivity and accuracy, and the combined detection of ARFI and SWE performs better than ARFI or SWE employed separately.

摘要

目的

探讨剪切波弹性成像（SWE）和声辐射力脉冲成像（ARFI）在女性膀胱颈梗阻（FBNO）诊断中的应用价值，比较两种方法的优势，为临床工作提供更准确的参考。

方法

选取 2016 年 4 月至 2018 年 2 月在辽宁省人民医院经膀胱镜和/或尿动力学检查诊断为 FBNO 的 27 例患者进行病例对照研究，另选取 24 例健康成年人作为对照组。收集 27 例 FBNO 患者的一般资料，采用经会阴二维超声分别检测膀胱颈杨氏模量和剪切波速度（SWV）。以膀胱镜结果为金标准，绘制 ARFI、SWE 的受试者工作特征（ROC）曲线，并比较 ROC 曲线下面积，计算敏感度、特异度和准确率。

结果

SWE 检测 Q-box 均值和最大值诊断 FBNO 患者的 ROC 曲线下面积分别为 88.4%和 89.9%，敏感度、特异度和准确率分别为 81.5%、79.2%和 80.4%。ARFI 检测 FBNO 患者的 ROC 曲线下面积为 93.7%，敏感度、特异度和准确率分别为 88.9%、79.2%和 84.3%。ARFI 和 SWE 联合检测的敏感度、特异度和准确率分别为 92.5%、87.5%和 90.2%。ROC 曲线得到的 FBNO 患者 SWV 或 SWE 的 Q-box 均值和最大值的最佳诊断截断点为 SWV=2.38 m/s（敏感度，71.4%；特异性，82.5%），Q-box 均值=20.2 kPa，Q-box 最大值=39.8 kPa（敏感度，67.5%；特异性，76.2%）。ARFI、SWE 的 Q-box 均值和最大值的平均剪切波速度在对照组分别为 1.89±0.35 m/s、15.3±3.6 kPa 和 29.2±8.7 kPa，在 FBNO 组分别为 2.81±0.63）m/s、27.2±8.6 kPa 和 51.2±12.3 kPa，差异有统计学意义（P<.05）。