超声造影在鉴别伴有钙化的甲状腺结节良恶性中的价值

Differential diagnostic value of contrast-enhanced ultrasound in calcified thyroid nodules

目的评价超声造影在鉴别伴有钙化的甲状腺结节良恶性中的价值。方法对2009年2月至2012年9月期间的179例伴有钙化的甲状腺结节患者经浅静脉注入造影剂微泡行超声造影检查，观察结节的造影剂灌注过程，并采用TomTee软件进行量化分析，获得造影定量参数，患者术后均经病理证实，以评估其灵敏性、特异性、阳性预测值、阴性预测值和诊断符合率。结果良性结节110例，其中结节性甲状腺肿中46例伴粗大钙化和16例伴微钙化；腺瘤中28例粗大钙化和1例微钙化；桥本甲状腺炎中13例伴粗大钙化和4例伴微钙化，2例缝线肉芽肿均伴微钙化。恶性结节69例，其中乳头状癌中60例伴微钙化和8例伴粗大钙化，1例髓样癌伴微钙化。恶性结节主要表现为不均匀弱增强，峰值强度（51．38±14．33）dB，低于良性结节（92．37±33．36）dB，而良性结节为等增强或高增强，二者差异有统计学意义（t=14．33，P〈0．05），但是造影定量参数中始增时间与达峰时间良恶性结节相比差异无统计学意义。超声造影诊断伴有钙化的甲状腺结节良恶性的灵敏性、特异性、阳性预测值、阴性预测值、诊断符合率分别为92．75％、90．91％、86．49％、95．24％、91．62％。结论超声造影对伴有钙化的甲状腺结节有较高的鉴别诊断价值。

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound（CEUS） in calcified thyroid nodules. Methods A total of 179 cases with calcified thyroid nodules between February 2009 and September 2012 underwent CEUS by injection of microbubbles via superficial vein was included in the study. Pathological diagnosis as a gold standard, the sensitivity, specificity, positive predictive, negative predictive and diagnostic coincidence rate of CEUS were evaluated. Results Among 110 cases of benign nodules, 62 cases were nodular goiter （46 cases with macrocalcification and 16 cases with microcalcification）; 29 cases were adenoma （28 cases with macrocalcification and 1 case with microcalcification） ; 17 cases were Hashimoto＇s thyroid （13 cases with macrocalcification and 4 cases with microcalcification） ; and 2 cases were granuloma with microcalcification. Among 69 cases of malignant nodules（t = 14. 33,P 〈 0.05）, 68 cases were papillary carcinoma （60 cases with microcalcification and 8 cases with macrocalcification） , and 1 case of medullary carcinoma with microcalcification. Malignant nodules mainly showed weak inhomogeneous enhancement, with the mean; peak intensity （51.38± 14. 33）dB that was lower than that （92. 37 ± 33.36 ）dB in benign nodules, and benign nodules showed isoenhancement or hyperenhaneement, with significant differences compared to malignant nodules （ t = 14. 33, P 〈 0. 05 ） , however, there were significant differences in the enhanced time and the time to peak between benign and malignant nodules. The sensitivity, specificity, positive predictive, negative predictive and diagnostic coincidence rate of CEUS for the diagnoses of thyroid nodules were 92. 75% , 90. 91% , 86.49% , 95.24% and 91.62%, respectively. Conclusion CEUS has high value in differential diagnosis of benign and malignant calcified thyroid nodules.