彩色多普勒超声与^(99m)TC核素SPECT显像鉴别良恶性甲状腺结节的价值分析

Value analysis of ^(99m)TC radionuclide imaging SPECT and color doppler ultrasonography in differential diagnosis befween benign and malignant thyroid nodule

目的分析高频彩超与核素显像检查甲状腺良恶性结节的影像特征,比较两者的优缺点,探讨两者联合应用的诊断价值。方法对68个甲状腺结节的彩超与核素检查结果对照病理进行回顾性分析。结果两种影像学检查方法都可以显示甲状腺的形态、位置、大小。68个结节,超声全部查出,核素扫描只能显示54个。超声对甲状腺结节的大小、结构及血流清晰的显示独具优势,尤其是小于1cm的结节、钙化及颈部淋巴结超声显示清晰,而核素则无法显示。核素显像可以反应甲状腺摄锝功能,通过"冷热温凉"的特性来判断结节的性质,特别是利用血流灌注显像或亲肿瘤显像可进一步区分结节的良恶性,本组病例超声诊断符合率86.7%;14例做了动态血流灌注显像,其诊断符合率为75%;38例"冷凉"结节均做了亲肿瘤显像,其诊断符合率为90.9%;二者结合诊断符合率提高为92.3%。超声难以显示甲状腺功能状态。超声表现的囊、实性结节和核素显示的"冷热温凉"特性之间无统计学意义。结论彩超与核素两种影像学检查方法各有特点、优势和不足,结合使用可进一步提高甲状腺良恶性结节鉴别的准确率。

Objective To analyze image features of thyroid nodules with high frequency color dopplar ultrasound and radionuclide imaging, to compare their advantages and disadvantages and to discuss the diagnostic value of the two means in combination. Methods The inspection results of color doppler ultrasound and radionuclide imaging of sixty-eight thyroid nodules were retrospectively analyzed in combination with of pathological findings. Results The shape, location, size of the thyroid nodules were detected by the two image methods. All of the 68 nodules can be detected by ultrasonic, but only 54 nodules racan be detected by dionuclide scanning. Ultrasonography had unique advantages in displaying the thyroid nod ule size, structure and flow characteristics and, in particular, the nodules less than 1cm in diameter, calcification in thyroid nodules, and cervical lymph nodes, but, radionuclide can not display. Radionuclide imaging can reflect function of uptake technetium by thyroid nodule, and can determine the nature of the nodules by the nodules＂ ＂hot and cold＂ properties, in particular, radionuclide imaging can further distinguish benign and malignant nodules by blood flow imaging or value of nuclein tumoraffin imaging. The ultrasound diagnostic rate of this work was 86.7%. 14 cases of thyroid nodules were made dynamic perfusion imaging, the diagnostic rate was 75 %, and 38 cases of ＂cold＂ thyroid nodules were made pro-tumor imaging, the diagnostic rate was 90.9 %. The ultrasound combined with radionuclide imaging could increase accuracy rate to 92.3%. Ultrasound could not display the function of thyroid nodules. Ultrasound showed cystic, solid thyroid nodules in the thyroid nodules and radionuclide displayed ＂hot and cold temperature cold＂, with no statistically significant between these characteristics. There was no statistically signification between cystic or solid thyroid nodules by ultrasound and ＂ hot and cold ＂ thyroid nodules by radionuclide. Conclusion Color doppler ultrasound or radionuclide observes the thyroid nodules in a different way. Both color Doppler ultrasound and nuclein scanning were effective and painless in the diagnosis of the thyroid nodules and each has its own superiority and deficiency. If the two methods were integrated, the sensitivity and accuracy will be improved.