不同大小的甲状腺乳头状癌超声造影的差异及其诊断意义探讨

Differences of Ultrasonography in Different Sizes of Thyroid Papillary Carcinoma and its Diagnostic Significance

目的探讨不同大小的甲状腺乳头状癌其超声造影表现是否存在差异,以及其在诊断方面的意义。方法选取甲状腺结节131个,在常规超声检查后进行超声造影检查,观察其超声造影表现。根据术后病理结果将结节分为良性结节、乳头状癌、微小癌3组,对比其超声造影表现及超声造影曲线分析参数峰值增强强度P(peak)、开始增强时间(RT)区别。结果甲状腺良性结节大部分呈中等增强(32/39、82. 1%)及均匀增强(30/39、76. 9%),而乳头状癌组则以低增强(35/42、83. 3%)及不均匀增强(28/42、66. 7%)为主要表现,微小癌组以低增强(37/50、74%)及均匀增强(41/50、82%)为主要表现。63例恶性肿瘤进行超声造影曲线分析,乳头状癌及微小癌比较,Peak、RT、△P_1、△T_1均数t检验,两组均数比较差异无统计学意义(P均> 0. 05),而△P_2、△T_2均数t检验,差异有统计学意义(P <0. 05)。造影曲线分析△P_1、△T_1差异无统计学意义,印证了甲状腺乳头状癌与微小癌均呈低增强表现,△P_2、△T_2差异有统计学意义,则印证乳头状癌呈不均匀增强而微小癌呈均匀增强表现。结论甲状腺良恶性结节超声造影表现差异有统计学意义,但因不同大小的甲状腺乳头状癌超声造影表现不同,需要根据结节大小分别探讨其超声造影表现。

Objective To investigate the difference in ultrasound contrast between different sizes of thyroid papillary carcinoma and its diagnostic significance. Methods Totally 131 thyroid nodules were selected, and the ultrasound contrast examination was performed after routine ultrasound examination, and the ultrasound contrast was observed. According to postoperative pathological findings, the nodules were divided into three groups： benign nodule, papillary carcinoma and microcarcinoma. Contrast-enhanced ultrasound and ultrasound contrast curve were used to analyze the difference between peak intensity and P （Peak） and initial enhancement time （RT）. Results Most of benign thyroid nodules showed moderate enhancement （32/39, 82.1%） and homogeneous enhancement （30/39, 76.9%）, papillary carcinoma group with low enhancement （35/42, 83.3%） and inhomogeneous enhancement （28/42, 66.7%） as the main performance, microcarcinoma group with low enhancement （37/50, 74%） and homogeneous enhancement （41/50, 82%） as the main performance. Analysis of ultrasound contrast curve of 63 cases of malignant tumors, compared with papillary carcinoma and microcarcinoma, Peak, RT, Delta P 1, Delta T 1 mean t test, two group mean differences were not statistically significant（ P 〉0.05）, while the delta P 2, Delta T 2 mean t test, the difference was statistically significant（ P 〈0.05）.In Contrast curve analysis of delta P 1 Delta T 1, there was no significant difference between confirmed papillary thyroid carcinoma and microcarcinoma which showed low enhancement performance.In Delta P 2, Delta T 2 statistically confirmed papillary carcinoma which showed heterogeneous enhancement and microcarcinoma were evenly enhanced performance. Conclusion There are significant differences in contrast enhanced ultrasound findings of benign and malignant thyroid nodules. However, because of the different performance of contrast-enhanced ultrasound in different size of papillary thyroid carcinoma, it is necessary to discuss the performance of contrast-enhanced ultrasound according to the size of nodules.