甲状腺结节超声造影时间-强度曲线分析

Time-intensity analysis of contrast-enhanced ultrasonography in detection of thyroid nodules

目的探讨甲状腺结节的超声造影时间-强度曲线的变化特征及其临床意义。方法对69例患者的甲状腺结节（结节性甲状腺肿41例，恶性结节16例，炎性结节12例）行灰阶超声造影，动态影像经专用软件脱机分析，获得达峰时间（TTP）、峰值强度（PEAK）、局部血容量（RBV）、局部血流量（RBF）、造影剂平均通过时间（MTT）、最大灌注强度（Slmax）等参数。将各组数据进行对照分析。结果各种结节与正常甲状腺组织造影的时间-强度曲线形态均表现为上升支陡直，到达顶峰时先快速下降，随后平缓下降。炎性结节组TTP短于结节性甲状腺肿组和恶性结节组（均P〈0.05）。恶性结节组的丌P、MTT均晚于正常组织（均P〈0．05）；结节性甲状腺肿组的Slmax高于正常组织（P〈0.01）；两组其余各参数与正常组织比较差异均无统计学意义（均P〉0.05）。各组间PEAK、RBV、RBF值的差异无统计学意义（均P〉0.05）。结论超声造影时间-强度曲线定量分析显示甲状腺组织及结节的不同灌注情况，对临床鉴别诊断有一定价值。

Objective To investigate the characteristics of time-intensity curves from the gray-scale contrast-enhanced ultrasonography of thyroid nodules and their clinical applications. Methods Sixty nine thyroid nodules from 69 patients were examined by gray-scale contrast- enhanced ultrasonography. Pathological examination demonstrated that in 69 nodes 41 were nodular goiter, 16 were papillary thyroid carcinoma and 12 were hashimoto＇s thyroiditis with nodules. The dynamic images were analyzed by the specific off-line software Qontrast4.00, and TTP （Time-To-Peak）, PEAK （peak intensity）, RBV（regional blood volume）, RBF （regional blood flow）, MTr （mean transit time ）and Slmax （peak of the signal intensity） were calculated. Results The time-intensity curves of thyroid nodule and normal thyroid display a same pattern： firstly climb steeply up to the peak, then drop quickly and followed by a flat drop-off. The TTP of hashimoto＇s thyroiditis was shorter than both nodular goiter and papillary thyroid carcinoma （P〈0.05）; both TrP and MTT of papillary thyroid carcinoma was later than that of normal thyroid （P〈0.05）; the Slmax of thyroid nodule was higher than that of normal thyroid （P〈0.01）. For all other parameters, there was no statistically significant difference between normal thyroid and thyroid nodules （P〉0.05）. The values of PEAK, RBV and RBF were also not statistically different between groups （P〉 0.05）. Conclusion The quantitative analysis of the time-intense curve of contrast-enhanced ultrasonography can differentiate the perfusion status between normal thyroid tissue and thyroid nodules, and would be helpful to the clinical diagnosis of thyroid tumors.