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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (04) : 302 -307. doi: 10.3877/cma.j.issn.1672-6448.2016.04.014

所属专题： 文献；

浅表器官超声影像学

声辐射力脉冲弹性成像技术诊断早期干燥综合征涎腺病变的价值
陈绍琦1,†(), 王育凯2, 伍秋林3, 何结仪1   
  1. 1. 515041　汕头大学医学院第一附属医院超声科
    2. 515041　汕头市中心医院风湿科
    3. 515041　汕头，广东省医学分子影像重点实验室
  • 收稿日期:2015-07-11 出版日期:2016-04-01
  • 通信作者: 陈绍琦
  • 基金资助:
    广东省普通高校青年创新人才项目(2015KQNCX048); 广东省医学科研基金项目(A2015566，B2015128)

Initial experience of virtual touch tissue quantification in diagnosis of salivary glands in early stage of Sjögren′s syndrome

Shaoqi Chen1,†(), Yukai Wang2, Qiulin Wu3, Jieyi He1   

  1. 1. Department of Ultrasound, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
    2. Department of Rheumatism, the Central Hospital of Shantou, Shantou 515041, China
    3. Guangdong Key Laboratory of Molecular Imaging, Shantou 515041, China
  • Received:2015-07-11 Published:2016-04-01
  • Corresponding author: Shaoqi Chen
  • About author:
    Corresponding author: Chen Shaoqi, Email:
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陈绍琦, 王育凯, 伍秋林, 何结仪. 声辐射力脉冲弹性成像技术诊断早期干燥综合征涎腺病变的价值[J]. 中华医学超声杂志（电子版）, 2016, 13(04): 302-307.

Shaoqi Chen, Yukai Wang, Qiulin Wu, Jieyi He. Initial experience of virtual touch tissue quantification in diagnosis of salivary glands in early stage of Sjögren′s syndrome[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(04): 302-307.

目的

探讨声辐射力脉冲弹性成像（ARFI）声触诊组织定量（VTQ）技术诊断早期干燥综合征（SS）涎腺病变的应用价值。

方法

2013年1月至2015年4月汕头大学医学院第一附属医院和汕头市中心医院收治的经唇腺活检证实的SS患者44例（SS组），其中早期SS患者21例，中晚期SS患者23例。另选取同期汕头大学医学院第一附属医院收治的健康志愿者45名（健康对照组）。应用VTQ技术定量检测SS组患者和健康对照组受检者腮腺及颌下腺组织剪切波速度（SWV）。采用独立样本t检验比较SS组患者与健康对照组受检者涎腺SWV值的差异。绘制VTQ技术诊断早期SS、中晚期SS患者腮腺、颌下腺病变的操作者工作特征（ROC）曲线。

结果

SS组患者颌下腺、腮腺的SWV值分别为（2.44±0.48）、（2.77±0.70）m/s；健康对照组受检者颌下腺、腮腺的SWV值分别为（1.74±0.24）、（1.77±0.28）m/s；SS组患者颌下腺、腮腺SWV值均高于健康对照组受检者，且差异均有统计学意义（t值分别为22.67、19.92，P均<0.01）。早期SS组患者颌下腺、腮腺的SWV值分别为（2.42±0.37）、（2.76±0.57） m/s；中晚期SS组患者颌下腺、腮腺的SWV值分别为（2.47±0.34）、（2.80±0.37）m/s；早期SS患者与中晚期SS患者颌下腺、腮腺SWV值差异均无统计学意义。ROC曲线显示，VTQ技术诊断早期SS颌下腺病变最佳阈值为SWV值=2.28 m/s，敏感度为100%，特异度为90.41%，曲线下面积为0.997；VTQ技术诊断早期SS腮腺病变最佳阈值为SWV值=2.27 m/s，敏感度为100%，特异度为95.89%，曲线下面积为1.00；VTQ技术诊断中晚期SS颌下腺病变最佳阈值为SWV=2.30 m/s，敏感度为73.76 %，特异度为92.59%，曲线下面积为0.845；VTQ技术诊断中晚期SS腮腺病变最佳阈值为SWV=2.41 m/s，敏感度为72.66%，特异度为93.10%，曲线下面积为0.836。

结论

VTQ技术能诊断早期SS患者涎腺病变，弥补常规超声检查无法早期诊断SS涎腺病变的不足；但VTQ技术诊断中晚期SS患者涎腺病变的价值与常规超声检查相当。

关键词: 干燥综合征, 涎腺, 声辐射力脉冲弹性成像技术, 声触诊组织定量技术, 弹性成像技术
Objective

To investigate the usefulness of virtual touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) elastography in the diagnosis of the early stage of Sj?gren′s syndrome (SS) disease.

Methods

From January 2013 to April 2015, a total number of 44 SS patients who were confirmed by labial gland biopsy were enrolled in the study. All of them were referred by the First Affiliated Hospital of Medical College of Shantou University and the Central Hospital of Shantou. SS patients were further divided into two subgroups: 21 patients belonged to early group and 21 patients belonged to advanced group. Totally 45 healthy volunteers were enrolled by the First Affiliated Hospital of Medical College of Shantou University in this study. The parotid glands and submandibular glands of the SS patients and healthy volunteers were identified and VTQ measurements of shear wave velocity (SWV) were obtained. The difference of the SS patients and healthy volunteers salivary glands SWV value were measured using independent samples t-tests. Draw the VTQ technology in the diagnosis of early and advanced stage SS patients with parotid and submandibular glands of the receiver operating characteristic (ROC) curves.

Results

The mean SWVs of the SS submandibular and parotid glands were (2.44±0.48) m/s and (2.77±0.70) m/s; The mean SWVs of the healthy volunteers submandibular and parotid glands were (1.74±0.24) m/s and (1.77±0.28) m/s. The SWV in both submandibular and parotid glands are significantly higher in SS patients than in healthy volunteers, There was significant difference between these two groups (t values were 22.67, 19.92 respectively, both P<0.01). The mean SWVs of the early stages of SS submandibular and parotid glands were (2.42±0.37) m/s and (2.76±0.57) m/s; The mean SWVs of the advanced stages of SS submandibular and parotid glands were (2.47±0.34) m/s and (2.80±0.37) m/s. There was no significant difference between these two groups. In the use of VTQ technique to diagnose the submandibular glands of early stage SS patients, area under ROC was 0.997, with a cutoff value of 2.28 m/s, the sensitivity and specificity were 100% and 90.41%. To diagnose the parotid glands of early stage SS patients, area under ROC was 1.0, with a cutoff value of 2.27 m/s, the sensitivity and specificity were 100% and 95.89%. To diagnose the submandibular glands of advanced stage SS patients, area under ROC was 0.845, with a cutoff value of 2.30 m/s, the sensitivity and specificity were 73.76% and 92.59%. To diagnose the parotid glands of advanced stage SS patients, area under ROC was 0.836, with a cutoff value of 2.41 m/s, the sensitivity and specificity were 72.66% and 93.1%.

Conclusions

VTQ has higher accuracy in the assessment of early stage SS disease than conventional ultrasonography. But there was no significant difference between VTQ and conventional Ultrasonography in the evaluation of the advanced stage SS disease.

Key words: Sj?gren′s syndrome, salivary gland, acoustic radiation force impulse, virtual touch tissue quantification, Elastography
表1 SS组患者与健康对照组受检者涎腺SWV值比较
组别 例数 性别构成（例，男性/女性） 年龄（岁，±s）
SS组 44 2/42 45.16±1.68
健康对照组 45 3/42 43.73±1.72
检验值 ? χ2=0.022 t=0.594
P值 ? >0.05 >0.05
表2 SS组患者与健康对照组受检者涎腺SWV值比较（m/s，±s）
组别 例数 颌下腺 腮腺
SS组 44 2.44±0.48 2.77±0.70
健康对照组 45 1.74±0.24 1.77±0.28
t值 ? 22.67 19.92
P值 ? <0.01 <0.01
表3 SS组患者双侧涎腺SWV值比较（m/s，±s）
侧别 例数 颌下腺 腮腺
左侧 44 2.46±0.47 2.75±0.77
右侧 44 2.43±0.50 2.80±0.62
t值 ? 0.377 0.424
P值 ? >0.05 >0.05
表4 健康对照组受检者双侧涎腺SWV值比较（m/s，±s）
侧别 例数 颌下腺 腮腺
左侧 45 1.76±0.24 1.74±0.28
右侧 45 1.74±0.23 1.70±0.27
t值 ? 0.640 1.806
P值 ? >0.05 >0.05
表5 早期SS组与中晚期SS组患者涎腺SWV值比较（m/s，±s）
组别 例数 颌下腺 腮腺
早期SS组 21 2.42±0.37 2.76±0.57
中晚期SS组 23 2.47±0.34 2.80±0.37
t值 - 0.553 0.320
P值 - 0.585 0.751
图6 中晚期干燥综合征唇腺病理表现（Masson染色×100）。示淋巴细胞破坏腺泡小叶，腺体导管扩张，囊肿形成，腺体纤维化
图10 声触诊组织定量技术诊断中晚期干燥综合征患者腮腺病变操作者工作特征曲线。声触诊组织定量技术诊断中晚期干燥综合征患者腮腺病变最佳阈值为剪切波速度值=2.41 m/s，敏感度为72.66%，特异度为93.1%，曲线下面积为0.836
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