甲状腺乳头状癌术后甲状腺窝低回声的超声诊断分析

Analysis of ultrasonic diagnosis of thyroid fossa low-echo after operation of papillary thyroid carcinoma

目的探讨常规超声和超声造影对甲状腺乳头状癌术后甲状腺窝低回声的诊断价值。方法回顾分析89例甲状腺乳头状癌术后甲状腺窝低回声的常规超声和超声造影表现并与病理结果作对照。结果甲状腺癌复发或转移39个,30个表现为不均匀低增强,4个表现为不均匀等增强,2个表现为不均匀高增强;炎性结节31个,26个表现为等增强,4个表现为无增强,1个表现为低增强;增生性腺瘤12个,9个表现为高增强,2个表现为等增强,1个表现为低增强;术后陈旧性积液(乳糜性)7个,均表现为无增强。以不均匀低增强作为诊断术后甲状腺窝低回声恶性的诊断标准,超声造影对术后甲癌复发或转移的准确度、灵敏度、特异度为91.01%、84.62%、96.00%;以无增强作为诊断术后陈旧性积液的诊断标准,超声造影诊断的准确度、灵敏度、特异度为95.51%、100.00%、95.12%。结论超声造影对甲状腺乳头状癌术后甲状腺窝低回声诊断有一定优势,是判断其良恶性的有效方法。

Objective To observe the value of conventional ultrasonography and contrast enhanced ultrasound （CEUS） in diagnosis of thyroid fossa low-echo after operation of papillary thyroid carcinoma. Methods Eighty-nine patients with thyroid fossa low echo underwent conventional ultrasonography and CEUS. Appearances were analyzed retrospectively and compared to pathological examination. Results Among 39 cases in which recurrence were found, 30 demonstrated heterogeneous hypo-enhancement, 4 heterogeneous iso-enhancement, and 2 heterogeneous hyper-enhancement; Inflammatory nodule were found in 31 cases, among which 26 cases showed iso-enhancement, 4 no enhancement and I low enhancement, respectively. Hyperplastic adenoma were found in 12 cases, among which 9 showed hyper enhancement, 2 iso enhancement, and 1 hypo enhancement. Chylous effusion were found in 7 cases, all of which showed no enhancement. If taking heterogeneous hypo enhancement as standard to determine malignant of thyroid fossa low-echo, the accuracy, sensitivity and specificity were91.1%, 84.61% and 96%, respectively. If taking no-enhancement as standard to diagnose chylous effusion, the accuracy, sensitivity and specificity were 95. 50%, 100%, and 93. 90% respectively. Conclusion CEUS has some advantages in the diagnosis of thyroid fossa low echo after the operation of papillary carcinoma and also provides an effective way to determine benign and malignant.