正常甲状旁腺超声图像特点及位置分析

Analysis of location and characteristics of normal parathyroid ultrasound images

目的探讨正常甲状旁腺的超声影像特征和位置,为甲状腺切除术中避免误伤正常甲状旁腺提供指导性依据。方法选取220例正常成人和60例甲状腺肿瘤拟行甲状腺全切除患者,均行高频超声、彩色及能量多普勒超声检查,其中50例正常成人同时行超声弹性成像检查,20例正常成人同时行超声造影检查,分析总结正常甲状旁腺的超声影像特征并确定位置。60例甲状腺全切除患者分为术中行超声检测30例(A组),未行超声检测30例(B组),比较两组术后甲状旁腺功能低下的发生率。结果①280例受检者中甲状旁腺显示217例,高频超声显示率77.5%,多表现为边界清晰的椭圆形高回声及稍高回声小结;共显示412枚甲状旁腺,位于甲状腺上极后方36枚(8.7%)、体部后方138枚(33.5%)、下极后方179枚(43.5%)、侧叶下方2cm内59枚(14.3%)。②彩色及能量多普勒超声示301枚(73.0%)甲状旁腺可探及血流信号。③50例正常成人超声弹性成像测得甲状旁腺弹性值为(12.3±2.1)kPa,相邻正常甲状腺弹性值为(27.2±2.5)kPa,两者比较差异有统计学意义(P<0.05)。④20例正常成人超声造影显示甲状旁腺造影剂灌注持续时间约(4.8±2.4)s,呈整体均匀增强、轮廓清,与相邻正常甲状腺实质比较呈等增强。⑤B组有6例术后发生甲状旁腺功能低下,A组仅2例,两组比较差异有统计学意义(P<0.05)。结论正常甲状旁腺超声多表现为椭圆形高回声及稍高回声小结,位于甲状腺下极附近居多,其内可探及血流信号,超声造影表现为均匀等灌注,超声弹性成像表现为较甲状腺硬度稍软。甲状腺全切除患者术中使用超声检测可减少术后甲状旁腺功能低下的发生。

Objective To explore the location of normal parathyroid glands and the characteristics of ultrasound imaging,and to provide guidance for the protection of normal parathyroid gland in clinical thyroidectomy. Methods Totally 220 cases of normal adults and 60 cases of thyroid tumors underwent total excision of the thyroid gland. All patients underwent high frequency ultrasound color Doppler ultrasound and power Doppler ultrasoud examination. Among them,50 cases of normal adults underwent ultrasound elastography at the same time,20 cases of normal adults underwent contrast-enhanced ultrasound examination at the same time,the ultrasound images of normal parathyroid were analyzed and the position was determined. Then 60 cases of total thyroidectomy were divided into 30 cases of intraoperative ultrasound examination(group A)and 30 cases of non-ultrasonic examination(group B),and the incidence of postoperative hypoparathyroidism was compared between the two groups. Results ①There were 217 cases of parathyroid gland in 280 cases,and the high frequency ultrasound display rate was 77.5%,most of them showed a clear elliptical hyperechoic and a slightly higher echogenic nodule. A total of 412 parathyroid glands were found,36 lesions(8.7%)were located behind the upper thyroid pole,138 lesions(33.5%)were behind the body, 179 lesions(43.5%)were behind the lower thyroid pole,and 59 lesions(14.3%)were within 2 cm below the lateral lobe.②301 parathyroid glands were detected blood flow signals by color and energy Doppler ultrasound.③ The elasticity of 50 normal parathyroid glands measured by ultrasonography was(12.3±2.1)kPa,and the elastic value of adjacent normal thyroid gland was (27.2±2.5)kPa,the difference was statistically significant(P<0.05).④ Contrast-enhanced ultrasonography of 20 normal adults showed that the perfusion duration of parathyroid contrast agent was about(4.8±2.4)s,which showed uniform enhancement and clear contour,and equal enhancement compared with adjacent normal thyroid parenchyma.⑤ There were 6 cases of hypoparathyroidism after operation in group B,and only 2 cases in group A,the difference was statistically significant(P<0.05). Conclusion The normal parathyroid ultrasonography usually presents elliptical hyperechoic and slightly hyperechoic nodules, which are mostly located near the lower pole of the thyroid gland.The blood flow signals can be detected in the thyroid gland.The contrast-enhanced ultrasonography showed uniform perfusion. Ultrasound elastography showed that the thyroid is lightly soft. The use of ultrasound in total thyroidectomy can reduce the incidence of postoperative hypoparathyroidism.