超声造影对甲状腺良恶性结节的漏误诊分析

Misdiagnosis and missed diagnosis analysis of benign and malignant thyroid nodules by contrast-enhanced ultrasound

目的分析超声造影对甲状腺良恶性结节的漏诊和误诊原因,提高超声造影对其的诊断水平。方法回顾性分析我院经手术病理证实,超声造影误诊、漏诊的25例甲状腺结节患者的声像图资料,总结其超声造影特征。结果 25例甲状腺结节患者中,19例良性结节超声造影均误诊为甲状腺癌,其中13例为结节性甲状腺肿,6例为桥本氏甲状腺炎背景下的结节;6例漏诊的恶性结节均为甲状腺乳头状癌。超声造影图像中,误诊的结节有13例为低增强,6例为等增强,其中16例造影剂分布不均匀;漏诊的结节中有5例为等增强,1例为高增强,其中2例造影剂分布均匀。结论常规超声图像的影响、结节的体积过小及甲状腺良恶性结节之间相似的增强模式是影响超声造影诊断的主要因素。

Objective To investigate the reasons for mis-or missed diagnosis in benign and malignant thyroid noculesr by contrast-enhanced ultrasound(CEUS),and to improve cognition on CEUS.Methods The images of 25 thyroid nodules which were confirmed by pathology but mis-or missed diagnosed by CEUS were analyzed retrospectively. The sonographic feature of CEUS was summarized.Results In 25 nodules,19 benign nodules were misdiagnosed as malignant in which 13 nodules were nodular goiter and 6 nodules were coexisting with Hashimoto thyroiditis.6 missed malignant nodules were papillary thyroid carcinoma. Among 19 misdiagnosis nodules,hypo-enhancement and iso-enhancement were observed in 13 nodules and 6 nodules in CEUS respectively,and the distribution of microbubbles was inhomogeneous in 16 cases. Among 6 missed-diagnosis nodules,iso-enhancement and hyper-enhancement were observed in 5 nodules and 1 nodule in CEUS respectively,and the distribution of microbubbles was homogeneous in 2 nodules.Conclusion The influence of conventional ultrasound,the small volume of nodules and the overlapping imaging features between benign and malignant thyroid nodules in CEUS are the main influence factors for the diagnosis of CEUS.