结节性甲状腺肿合并甲状腺癌的超声诊断价值

Significance of ultrasound diagnosis for nodular goiter concurred with thyroid cancer

目的探讨二维及彩色多普勒超声在结节性甲状腺肿合并甲状腺癌诊断中的应用价值。方法应用二维及彩色多普勒超声对137例病理证实为结节性甲状腺肿合并甲状腺癌,其中超声图像上位置明确的67例(恶性结节组,81个恶性结节)患者的超声表现进行回顾性分析。根据彩色血流分布分为0、Ⅰ、Ⅱ、Ⅲ级,并检测肿块收缩期峰值流速(PSV)及阻力指数(RI),与69例结节性甲状腺肿(良性结节组,119个良性结节)患者的检查结果对照分析。结果良性结节组69例119个结节伴钙化18个(15.13%),其中8个(6.72%)微钙化(≤2mm),10个(8.40%)粗钙化(>2mm,包括弧形和环行钙化,合并微钙化4个);检出结节内低回声33个(27.73%),混合回声43个(36.13%),边缘毛刺20个(16.81%)。恶性结节组81个恶性结节的超声图像特征为(1)多数结节(63/81,77.8%)呈低回声,边缘毛刺(54/81,66.67%),不规则(46/81,56.79%);(2)结节内部伴钙化(64/81,79.01%),以≤2mm微钙化为主(50/81,61.73%);恶性结节组结节的低回声、边缘毛刺及微钙化的检出率均高于良性结节组,两组比较差异有统计学意义(P<0.01)。彩色多普勒显示结节内部血流信号分布中等至丰富,以Ⅱ、Ⅲ级血流为主(73/81,90.12%),与良性结节组血流信号分级比较差异有非常显著性(P<0.01),但恶性结节内血流的平均PSV、RI值与良性结节组比较差异无统计学意义(P>0.05)。结论超声检查对鉴别结节性甲状腺肿中的恶性结节具有重要的临床价值,综合分析甲状腺结节的二维及彩色多普勒征象,可提高结节性甲状腺肿合并甲状腺癌的诊断准确性。

Objective To investigate the diagnostic value of two-dimensional US and color Doppler flow imaging （CDFI） for nodular goiter concurred with thyroid cancer. Methods Totally 137 cases with nodular goiter concurred with thyroid cancer proved by pathology underwent 2-DUS and color Doppler flow imaging （CDFI）. Sixty-seven patients with 81 malignant nodules in the 137 cases proved to have definite position on 2-DUS were included in the malignant （M） group. Sixty-nine thyroid goiter patients with 119 benign nodules served as the benign control （B） group. The color Doppler was classified into 0, Ⅰ , Ⅱ and m grades, and the peak systolic velocity（PSV） and resistance index（RI） were measured. The results of the 2 groups were retrospectively analysed and compared. Results Of the malignant nodes, 81 showed sonographically as follows： 1. 63/81,77.78% of malignant nodules were with low echoes and border spurs in 54/81, 66.67%, and irregular in 46/81,56.79% ; 2. intra-calcifications were found in 64/81,79.01% of malignant nodes, in which micro-calcification displayed in 50/81, 61.73% ; positive rates of low echoes, spurs and micro-calcification significantly elevated in malignant nodules, compared with the benign ones （P 〈 0.01 ）. There were significant difference in distribution of blood flow between the malignant nodules and benign ones（ P 〈 0.01 ） , but no difference was found in PSV and RI （P 〉 0.05 ）in the two groups. Conclusions Ultrasound is of important clinical value for differentiation between malignant tumors and benign thyroid goiters. Diagnostic accuracy may be increased for nodular goiter concured with thyroid cancer via synthetic analysis of 2-DUS and CDFI.