结节性甲状腺肿实时超声造影误诊分析

Analysis of misdiagnosis with contrast-enhanced ultrasound in nodules goiter

目的分析结节性甲状腺肿实时超声造影误诊情况，以期提高结节性甲状腺肿的诊断准确率。方法对265例结节性甲状腺肿患者的超声造影图像进行回顾性分析，主要分析与病理结果不符的44例患者48个结节的误诊原因并讨论结节的大小、数目及钙化情况对超声造影结果的影响。结果本组病例共874个结节性甲状腺肿病灶中42个误诊为甲状腺癌，5个误诊为甲状腺腺瘤，1个误诊为亚急性甲状腺炎。超声造影以均匀等增强诊断结节性甲状腺肿的误诊率为5．49％（48／874）；甲状腺结节大小和不同钙化情况对超声造影结果具有显著影响，其中结节长径〈10mm比〉10mm的误诊率明显偏高，粗大钙化比微钙化的误诊率明显偏高，差异均具有统计学意义（P〈0．05）。结论结节性甲状腺肿病灶长径〈10mm或伴粗大钙化是影响超声造影结果的主要因素，分析误诊原因有助于提高该病的诊断准确率。

Objective To analyze the misdiagnosed cases of the nodular goiter（NG） in real-time contrast-enhanced ultrasound（CEUS）,in order to improve the diagnostic accuracy of NG. Methods Two- hundred and sixty-five cases of NG CEUS images, especially the 48 nodules in 44 misdiagnosis cases, were retrospectively analyzed to find out the main reasons of the misdiagnosis. In addition, the factors which effected the results of CEUS such as size,number and calcification of NG nodules were summarized. Results There were 42 nodules misdiagnosed as thyroid cancer, 5 nodules misdiagnosed as thyroid adenoma and I nodular goiter misdiagnosed as subacute thyroiditis in 874 nodular goiter cases. The misdiagnosis rate of nodular goiter was 5.49~ （48/874） by the diagnostic criterion of homogeneous enhancement in CEUS.The differences size and calcification of nodules had a significant impact on CEUS. The misdiagnosis rate of the NG nodules with major diameter less than 10 mm was much higher than that of more than 10 mm, the misdiagnosis rate of NG nodules with coarse calcification was much higher than the situation of microcalcification（ P〈0.05）. Conclusions Major diameter less than 10mm and coarse calcifications of NG nodular are the main factors which influence the results of CEUS.