超声弹性成像鉴别Graves病与桥本氏甲状腺炎的临床价值

Value of ultrasound elastography in the diagnosis of Graves disease and Hashimoto's thyroiditis

目的:探讨超声弹性成像对弥漫性毒性甲状腺肿(Graves病)与桥本氏甲状腺炎(HT)的鉴别意义。方法:选取2011年5月至2013年11月在我院初诊为Graves病和HT的患者220例,分为Graves组(n=112)和HT组(n=108)。采用常规彩超观察并记录甲状腺大小、形态、回声特征、血流情况,采用弹性成像分析并记录甲状腺弹性评分、相对应变值平均值(MEAN)和蓝色面积比例(%AREA)。对比常规彩超与联合超声的诊断准确率。结果:2组甲状腺体积、回声分级和血流分级差异无统计学意义(P>0.05)。Graves组以散在低回声为主,HT组以弥漫性低回声为主,有网格样强回声。Graves组收缩期峰值流速(PSV)、舒张末期流速(EDV)均大于HT组,差异有统计学意义(P<0.05)。弹性成像分析显示,HT组弹性评分、%AREA均大于Graves组,但MEAN小于Graves组,差异有统计学意义(P<0.05)。彩超联合弹性成像对Graves病、HT鉴别诊断准确率高于常规彩超组,差异有统计学意义(P<0.05)。结论:弹性成像能够提高超声诊断Graves病、HT的准确率。

Objective： To investigate the value of ultrasound elastography in the diagnosis of Graves disease and Hashimoto＇s thyroiditis. Methods： One hundred and twelve patients with Graves disease and 108 patients with Hashimoto＇s thyroiditis（HT） were included in this study between May 2011 and November 2013 in our hospital. Thyroid size, shape, echo characteristics, blood condition were observed and recorded by color Doppler ultrasound. In addition, elastic score, the average value of the relative strain（MEAN） and the blue area ratio（AREA） were gained by ultrasound elastography. The diagnostic accuracy of color Doppler ultrasound and ultrasound elastography were compared. Results： No significant difference was detected in thyroid size, echo characteristics and blood flow classification（P〉0.05）. Graves group was mainly charactered by scattered hypoechoic echo-based distribution, and HT group was mainly charactered by diffuse hypoechoic echo-based distribution. PSV, EDV in Graves group were significantly higher than those in HT group（P〈0.05）. Elastic score and %AREA in HT group were significantly higher, but MEAN in HT group was significantly lower. The diagnostic accuracy of color Doppler ultrasound combined elastography was significantly higher than that of color Doppler ultrasound（P〈0.05）. Conclusion： Color Doppler ultrasound combined with ultrasound elastography may play a role in the diagnosis of Graves disease and Hashimoto＇s thyroiditis.