Značaj elastografije u dijagnostici diferentovanih karcinoma štitaste žlezde
The importance of ultrasound elastography in the diagnosis of differentiated thyroid carcinoma
Докторанд
Kiković, SašaМентор
Hajduković, ZoranЧланови комисије
Marković, IvanĐukić, Aleksandar
Mitrović, Slobodanka
Dragović, Tamara
Метаподаци
Приказ свих података о дисертацијиСажетак
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 ult...razvučnog 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 va...scularisations, 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