超声在甲状腺良恶性结节诊断中的应用

Application of ultrasonography in diagnosis of benign and malignant thyroid nodules

目的探讨超声对甲状腺良恶性结节的诊断价值。方法对146例甲状腺结节患者行超声检查,观察分析结节的二维图像、内部及周边血流特征以及血流动力学特点,结果与病理对照。结果恶性结节中纵/横比(A/T)≥1的发生率明显高于良性结节,差异有统计学意义(P<0.001),且在结节边界、形态、周边晕环、内部及后方回声、钙化等方面与良性结节差异有统计学意义(P<0.05);彩色多普勒血流显像(CDFI)良性结节中38.6%(98/254)的结节血流为Alder2级或3级,恶性结节中69.6%(71/102)血流为Alder2级或3级,二者差异有统计学意义(P<0.001)。恶性结节内血流的平均PSV和RI均高于良性结节,差异有统计学意义(P<0.05),且频谱形态有差别。结论超声对甲状腺结节性病变有较高的诊断价值,综合分析二维及彩色多普勒超声图像特点可提高鉴别诊断的准确率。

Objective To investigate the value of ultrasonography （US） in diagnosis of thyroid nodules. Methods 146 patients with thyroid nodules were examined before thyroidectomy by US. The two-dimensional US and the blood flow inside or beside the nodules were observed, the hemodynamics parameters were measured and the diagnosis of US were compared with the pathology. Results It showed that the anteroposterior/transverse diameter ratio （A/T）≥1 in malignant patients was higher than that in the benign ones and there was statistical significance between them （P〈0.001）. And there was also obvious differences in the border, configuration, hypoechoic ring, echo inside and behind the nodules and calcify （P〈0.05）. It showed that 38.6%（98/254） of the flow in the benign nodules was Alder 2 or 3 and 69.6 % （71/102） of the folw in the malignant nodules was Alder 2 or 3 and there was significant difference between them （P〈0.001）. The peak systolic velocity （PSV） and the resistance index （RI） of the malignant nodules were higher than those of benign ones, there was significant difference between them （P〈0.05）, and there was difference in the shape of the frequency spectrum too. Conclusion There was clinical value in the diagnosis of thyroid nodules by ultrasonography, the combination of conventional US characteristic and CDFI in thyroid nodules could improve the accuracy of differential diagnosis.