Značaj elastografije u dijagnostici diferentovanih karcinoma štitaste žlezde

Abstract

Uvod. Tiroidni nodusi predstavljaju čest medicinski problem. Ultrazvuk štitaste žlezde je najčešće primenjivana metoda za početnu procenu i izbor nodusa za iglenu biopsiju (FNAB). Ultrazvučna elastografija je neinvazivna metoda u kojoj se meri otpor mekih tkiva u cilju otkrivanja sumnjivih promena i određivanja prirode tumora. Slika sumnjive promene i okolnog tkiva prikazana je različitim bojama, što označavamo kao kvalitativno testiranje otpora tkiva a izražava se elastografskim skorom (1-4). Otpori mogu meriti i kvantitativno, kako unutar same sumnjive promene, tako i u okolnim tkivima,a procenjuju se na osnovu ndeksa otora (engl. strain ratio-SR) . Pregled je potpuno bezbolan i jednostavan. Zasnovan je na činjenicama da su svi tumori, posebno maligni (u našem slučaju tiroidni karcinomi), čvršće strukture, zbog izražene proliferacije ćelija, povećane gustine tkiva, ponekad i pojačane vaskularizacije i samim tim pružaju veći otpor u odnosu na okolna tkiva. Na pritisak sondom ultrazvučnog aparata, boje normalnog tkiva menjaju se od crvene, preko žute, do zelene, dok su u tumorski izmenjenim tkivima plavih ili sivo-crnih nijansi. Kvantitativnim merenjem, odnosno poređenjem otpora sumnjivih promena sa okolnim tkivima registruje se pet, pa i više od dvadeset puta veći otpor tumorskog tkiva, u odnosu na normalne okolne strukture. Za primenu elastografije potreban je ultrazvučni aparat posebnih karakteristika, koji ima ultrazvučne sonde za registrovanje otpora ali i odgovarajući softver ultrazvučnog aparata. Cilj. Cilj studije je da se sagleda značaj ultrazvučne elastografije u dijagnostici diferentovanih karcinoma štitaste žlezde i korelacija sa drugim dijagnostičkim procedurama Metod: Istraživanje predstavlja retrospektivnu, kliničku, neinterventnu studiju preseka u cilju analize dijagnostičkog testa – ultrazvučne elastografije. Istraživanje će biti obavljeno na pacijentima koji su inicijalno upućeni u Kliniku za endokrinologiju, Vojnomedicinske akdemije u cilju evaluacije nodoznih struma, a kod kojih je nakon dijagnostičkog postupka sprovedeno operativno lečenje. Očekivani rezultati: Elastografski skor 3-4 ima visoku prediktivnu vrednost za detekciju tiroidnih karcinoma Očekivani zaključak: Ultrazvučna elastografija predstavlja novu neinvazivnu metodu koja ima visoku prediktivnu vrednost za detekciju tiroidnih karcinoma,naročito u korelaciji sa drugim dijagnostičkim procedurama

Introduction and aim: Thyroid nodules are a common medical problem. Ultrasound of the thyroid gland is the most commonly used method for initial assessment and selection of a biopsy nose (FNAB). Ultrasound elastography is a non-invasive method in which the resistance of soft tissues is measured in the tissues of detecting suspected changes and the determination of sodium tumors. The picture of a suspected change and surrounding tissue is shown in a different color, which means qualitative testing of the resistant tissue and is produced by elastographic scores (1-4). Resistance can be measured both quantitatively, unwieldy by the changes themselves, and in the surrounding tissues, and evaluate the basics of the Strain ratio (SR). The review is complete painless and one-handed. It is based on the factors that all tumors, especially malignant (in our case, thyroid carcinoma), solid structure, mild cell enlargement, increased tissue dysfunction, and sometimes strengthening of vascularisations, and, in turn, provide greater resistance against surrounding tissues. At the pressure of the ultrasonic probe, the colors of the normal tissue change from redness, too yellow to green, and in tumor-modified tissues of blue or gray-black shades. Quantitative measurement, ie disturbed, resistant, suspicious change with the surrounding tissue of the registry, is five, and more than twenty times more resistance to tumor tissue compared to the normal environment of the structure. For the application of elastography an ultrasonic device with special characteristics is required, which has ultrasonic probes for the registration of resistance and the corresponding ultrasound device software. Aim:The goal of the study is to see the significance of ultrasound elastography in the diagnosis of differentiated thyroid carcinoma and correlation with other diagnostic procedures Method: Research of retrospective presentation, clinical, noninteractive interruption study in order to analyze the diagnostic test - ultrasound elastography. The research will be compulsory for patients initially admitted to the Clinic for Endocrinology, Military Medical Academy in order to evaluate nose patients, and in which the diagnostic procedure is operative treatment. Expected results: The elastographic score 3-4 has a high predictive value for the detection of thyroid carcinoma Expected conclusion: Ultrasound elastography presents a new non-invasive method that has a high predictive value for the detection of thyroid carcinoma, in a ninja correlation with other diagnostic procedures