超声与磁共振对甲状腺乳头状癌病灶大小、边缘及淋巴结转移判断的价值比较

Comparison of the Value of Ultrasound and Magnetic Resonance in the Diagnosis of the Size and Boundary of the Thyroid Papillary Carcinoma

目的 比较超声成像（US）与磁共振成像（MR）在甲状腺乳头状癌（papillary thyroid carcinoma,PTC）病灶大小、边缘情况及淋巴结转移判断中的价值,为临床提供参考.方法 回顾性分析2013年8月—2016年11月就诊的35例PTC患者肿瘤病灶的US及MR图像,记录病灶最大径及边缘情况,分别将两种影像学检查所得出结果 与病理进行比较.结果35例患者,男性4例,女性31例,平均年龄（43±12）岁,共发现病灶38枚,超声检查中,所有病灶均能完整显示,平均最大径12.89 mm,12枚边缘光滑,26枚边缘模糊;在MRI-DWI序列中,有15枚病灶未能显示,余病灶平均最大径16.09 mm,13枚边缘光滑,10枚边缘模糊;在MRI-T2WI压脂序列中,有1枚病灶未能显示,余病灶平均最大径14.38 mm,25枚边缘光滑,12枚边缘模糊;在MRI-T1WI增强序列中,有2枚病灶未能显示,余病灶平均最大径14.08 mm,21枚边缘光滑,15枚边缘模糊;手术病理中,病灶平均最大径10.89 mm,9枚边缘光滑,29枚边缘模糊.T2WI压脂序列所测得的病灶长径与病理结果差异具有统计学意义,余MRI成像序列及超声与病理结果间差异无统计学意义;超声对PTC边缘情况的评估结果与病理结果差异无统计学意义,而MRI各扫描序列与病理结果差异均有统计学意义.35例患者中,MRI共发现8例伴有颈部及/或锁骨上、下区单发或多发淋巴结肿大,超声发现5例颈部淋巴结肿大,均被病理证实为转移性淋巴结.结论 二维高频超声较MRI能更精确地显示PTC的大小以及边缘情况,而MRI在颈部中央区及锁骨上、下区淋巴结转移的评估中具有较大优势,可作为PTC的辅助性评估手段.

Objective To compare the diagnostic value of ultrasound imaging （US） and magnetic resonance imaging （MR） in the size and boundary of papillary thyroid carcinoma （PTC）, so as to provide reference for clinical practice. Methods We retrospectively analyzed the MR and US images of 35 patients with PTC in our hospital from August 2013 to November 2016, and recorded the maximum diameter and boundary of the lesions. The results of two imaging examinations were compared with those of pathology. Results Of the 35 patients, there were 4 male and 31 female, the average age （43 ±12） years, 38 lesions were found. In US examination, all lesions were fully demonstrated, the average maximum diameter of 12.89 mm, edge of 12 cases were smooth, 26 cases were unclear. In the MRI-DWI sequence, 15 lesions were undiscovered, and the average maximum diameter of the rest of lesions was 16.09 mm, 13 cases with smooth edge, 10 cases with unclear edge. In the MRI- T2WI sequence, 1 lesion was undiscovered, and the average maximum diameter of the rest of lesions was 14.38 mm, 25 cases with smooth edge, 12 cases with unclear edge. In the MRI-T1WI contrast-enhanced sequence, 2 lesions were undiscovered, and the average maximum diameter of the rest of lesions was 14.08 mm, 21 cases with smooth edge, 15 cases with unclear edge. In surgical pathology, the average maximum diameter of the lesions was 10.89 mm, 9 cases with smooth edge and 29 cases with unclear edge. The difference between the diameter of the lesion measured by T2WI and pathology was significant. There was no significant difference between the rest MRI sequence and ultrasound findings. There was no significant difference of the edge between the ultrasound and pathology, but there was significant difference between the MRI and the pathology. In 35 patients, 8 cases of MRI were found with single or multiple lymph nodes in neck and/or supraclavicular region and 5 cases of cervical lymph node enlargement were identified by ultrasound. All of the enlarged lymph nodes were confirmed by pathology as metastatic lymph nodes. Conclusion 2D high-frequency ultrasound can display the size of PTC and edge more accurately than MRI, and MRI has great advantages in the assessment of central neck and supraclavicular lymph node metastasis, so can be used as auxiliary means in evaluation of thyroid carcinoma.