甲状腺微小乳头状癌颈部淋巴结转移的常规超声与超声造影征象比较

Comparsion of sign of conventional ultrasound and contrast-enhanced ultrasound in cervical lymph node metastasis of papillary thyroid microcarcinoma

目的比较分析常规超声及超声造影用于甲状腺微小乳头状癌颈部淋巴结转移的超声征象特征。方法选择我院收治的50例甲状腺微小乳头状癌患者为研究对象,以术后石蜡切片病理检查结果为金标准,将患者分为无淋巴结转移组(n=22)与淋巴结转移组(n=28),两组患者均行常规超声及超声造影检查。比较两组纵横比、边界、钙化、血流信号、增强时间、增强程度、增强方式、增强强度、边界是否清晰、环状增强、峰值强度(PEAK)、达峰时间(TTP)、局部血容量(RBV)、局部血流量(RBF)、平均通过时间(MTT)、最大灌注强度(SImax)及平均灌注强度(SImean)。结果淋巴结转移组纵横比>1、边界不清晰、结节内钙化、血流信号0～Ⅰ患者显著多于无淋巴结转移组(P<0.05);淋巴结转移组增强时间慢进、增强程度不均匀、低/等增强、边界不清晰、结节周边无环状增强患者显著多于无淋巴结转移组(P<0.05)。淋巴结转移组PEAK、RBF、SImax、SImean显著低于无淋巴结转移组(P<0.05)。结论结节内微钙化、血流分级是常规超声检查甲状腺微小乳头状癌颈部淋巴结转移的重要指标,而增强时间慢进、增强程度不均匀、低/等增强、边界不清晰、结节周边无环状增强及PEAK、RBF、SImax、SImean则是超声造影检查甲状腺微小乳头状癌颈部淋巴结转移的重要指标,可为甲状腺微小乳头状癌治疗方案的选择提供依据,具有较高的临床应用价值。

Objective To analyze and compare the sign of conventional ultrasound and contrast-enhanced ultrasound in cervical lymph node metastasis of papillary thyroid microcarcinoma.Methods Fifty patients with papillary thyroid microcarcinoma admitted in our hospital were selected as the research objects.The pathological examination results of paraffin section after operation were taken as gold standard.The patients were divided into non-lymph node metastasis group(n=22)and lymph node metastasis group(n=28).Conventional ultrasound and contrast-enhanced ultrasound were performed in both groups.The aspect ratio,boundary,calcification,blood flow signal,time,degree,mode and intensity of enhancement,boundary clarity,ring enhancement,peak intensity(PEAK),time to peak(TTP),regional blood volume(RBV),regional blood flow(RBF),mean transit time(MTT),maximum perfusion intensity(SImax)and mean perfusion intensity(SImean)were compared between the two groups.Results The number of patients with aspect ratio>1,unclear boundary,calcification in nodules and blood flow signal 0-Ⅰin lymph node metastasis group were more than those of the non-lymph node metastasis group(P<0.05).The number of patients with slow progression of enhancement time,uneven enhancement,low/equal enhancement,unclear boundary and no circular enhancement around nodules in the lymph node metastasis group were significantly more than those of the non-lymph node metastasis group(P<0.05).The PEAK,RBF,SImax and SImean in the lymph node metastasis group were significantly lower than those in the non-lymph node metastasis group(P<0.05).Conclusion Microcalcification and blood flow signal in nodules are important indicators of cervical lymph node metastasis in papillary thyroid microcarcinoma by conventional ultrasound,slow progression of enhancement time,uneven enhancement,low/equal enhancement,unclear boundary,no circular enhancement around nodules and the PEAK,RBF,SImax and SImean are important indicators of which by contrast-enhanced ultrasound,and those indexes can provide a basis for the choice of treatment options for thyroid papillary microcarcinoma and has high clinical application value.