92例甲状腺单发结节的超声鉴别诊断

The diagnosis of 92 cases of solitary thyroid nodules in ultrasound

目的:探讨二维及彩色多普勒超声在甲状腺单发结节鉴别诊断中的价值。方法:回顾分析经手术及病理证实的92例甲状腺单发结节,共分3组,其中甲状腺腺瘤组16例,结节性甲状腺肿组59例,甲状腺癌组17例。比较以上3组的二维及彩色多普勒声像图并与相应病理对照分析。结果:①在二维声像图上:对3组病例的甲状腺形状、边界、周边回声、晕环、囊变、钙化及颈部淋巴结肿大进行比较,其差异均有显著性意义(P<0.05)。②在彩色多普勒血流成像(CDFI)显示上:对3组病例的结节内部及周边血流的分布进行比较,其差异均有显著性(P<0.05)。③超声诊断甲状腺腺瘤的敏感度为100%,特异度为64.5%;诊断结节性甲状腺肿的敏感度为52.5%,特异度为100%;诊断甲状腺癌的敏感度为82.4%,特异度为94.7%。结论:病灶微小钙化和颈部淋巴结肿大的存在提示恶性后果,囊变的存在提示良性结果,二维及彩色多普勒超声对甲状腺腺瘤、单发性结节性甲状腺肿、甲状腺癌的鉴别诊断有帮助。但是单发性结节性甲状腺肿较易误诊为甲状腺腺瘤。

Aim： To investigate the value of two-dimensional （2D）ultrasound and color Dopple flow imaging （CDFI） in differential diagnosis of solitary thyroid nodule. Methods： To compare the features of 2D ultrasound and CDFI in 92 cases of solitary thyroid nodule confirmed by surgery and pathology, the relevant pathological study was also analyzed. Among the 92 cases, there were 16 cases of thyroid adenoma （TA）, 59 cases of mono-nodular goiter（NG）, and 17 cases of thyroid carcinoma（TC）. Results： ① In 2D ultrasound, three groups had markedly difference in shape, boundary, peripheral echoes, ＂halo＂ sign, cystic degeneration, calcification, and lymph node enlargement. The difference has statistical significance （P 〈 0. 05 ）. ②In CDFI, the internal and peripheral blood distribution of the nodules had obvious difference in three groups. The difference has statistical significance （P 〈 0. 05 ）. ③Ultrasound diagnosed thyroid adenoma with a sensitivity of 100%, a specificity of 64. 5%, and diagnosed mono-nodular goiter with a sensitivity of 52. 5%, a specificity of 100%, and diagnosed thyroid carcinoma with a sensitivity of 82. 4% ,a specificity of 94. 7%. Conclusion： The existence of micro-calcification in lesions and cervical lymph node enlargement point out the malignant consequences, by contrast, the cystic degeneration calls attention to benign results. 2D ultrasound and CDFI examination is helpful to differentiate thyroid adenoma, mono-nodular goiter, and thyroid carcinoma. However,the mono-nodular goiter is often misdiagnosed as thyroid adenoma.