甲状腺腺瘤囊性变囊液吸收后改变的超声特征及其与甲状腺乳头状癌的鉴别诊断

Ultrasonographic characteristics of cystic degeneration of thyroid adenoma after absorption of cystic fluid and differential diagnosis of thyroid papillary carcinoma

目的探讨常规超声与超声造影、超声弹性成像的联合应用,研究甲状腺腺瘤囊性变囊液吸收后改变易被误诊为甲状腺乳头状癌的原因,旨在进一步提高超声影像学对甲状腺结节的诊断水平,为临床手术方法的选择以及指导治疗提供相关帮助。方法应用二维超声、彩色多普勒超声、超声造影及超声弹性成像技术对我院自2010年3月至2015年12月共13例手术及病理证实为甲状腺腺瘤囊性变且术前超声长时间随访的患者,总结甲状腺腺瘤囊性变囊液吸收后结节的超声特点,主要观察结节的形态、边界、包膜、内部回声、微小钙化、内部及周边血流分布特征、超声造影以及弹性成像等特点,之后与甲状腺乳头状癌的典型超声表现进行对比,进行鉴别诊断。结果 13例甲状腺腺瘤囊性变病灶纵横比>1的3例(23%),边界清晰11例(85%),8例(62%)可见完整的包膜,内部均未见微小钙化,彩色多普勒显像边缘血管为主型3例(23%),无血管型10例(77%),超声造影时环状增强为2例(15%),无增强为11例(85%),弹性评分以2~3分的中等偏软的硬度较多见,病灶周边及颈部未见形态饱满的异常淋巴结。结论甲状腺腺瘤囊性变与典型的乳头状癌病例相比,具有以下特征:(1)可详细询问病史或结合之前的检查报告,腺瘤囊性变时会较未囊性变时显著增大,之后囊性变的囊液吸收后结节会逐渐变小。(2)甲状腺腺瘤囊性变囊液吸收后结节在纵横比、边界、包膜、微小钙化、彩色多普勒显像、超声造影、弹性评分、颈部淋巴结方面综合分析,与典型的甲状腺乳头状癌可以鉴别。

Objective To investigate the causes of misdiagnosis on cyst fluid absorption of thyroid adenoma with thyroid papillary carcinoma by the application of combining conventional ultrasound, contrast-enhanced ultra-sound and ultrasound elastography.And to further improve the diagnosis of thyroid nodules by ultrasonography, which can provide help for the clinical treatments. Methods Thirteen cases in our hospital from March 2010 to December 2015 were chosen, whom were preoperative long time followed up by ultrasound and finally had surgical operation and pathologically diagnosed to thyroid adenoma, by using two-dimensional ultrasound, color Doppler, contrast-enhanced ultrasound and ultrasound elastography. We summarized the ultrasonographic characteristics of cystic fluid absorption of thyroid adenoma, which including morphology, boundary, capsule, internal echo, microcalcification, internal and peripheral blood flow distribution, observation on CEUS and ultrasound elastography. Then compared them to typical papillary thyroid carcinoma to do differential diagnosis. Results Among all 13 cases with cystic degeneration of thy-roid adenoma, 3 cases （23%）with aspect ratio 〉1, 11 cases with clear boundary （85%）, 8 cases （62%） showed com-plete capsule, mirocalcification were all not seen by ultrasound, color Doppler imaging of vascular edge type in 3 cas-es （23%）, no vascular type in 10 cases （77%）, CEUS showed ring enhancement in 2 cases （15%）, no enhancement in 22 cases （85%）, the elastic score 2？3 points to the intermediate soft hardness were more common, no lymph nodes were detected from lesion peripheral tissue and surrounding cervical tissue. Conclusion The cystic degeneration of thyroid adenoma has the following characteristics compared with the typical cases of papillary carcinoma：？ A detailed history of the disease or prior examination ultrasound report is important.The volume of the thyroid adenoma will sig-nificantly change if it hascystic degeneration, and after the cystic fluid absorption the volume will gradually become smaller. （2）We can differentiate cystic fluid absorption nodules of thyroid adenoma from typical papillary thyroid car-cinoma by the aspect ratio, boundary, capsule, microcalcification, color doppler imaging, CEUS, elastography score-andcervical lymph nodes.