高频超声与超声造影对甲状腺微小乳头状癌及其侵袭性的诊断价值

Diagnostic value of high frequency ultrasound and contrast-enhanced ultrasound for papillary thyroid micro-carcinoma and its invasiveness

目的:探讨高频超声与超声造影对甲状腺微小乳头状癌(PTMC)及对其侵袭性的诊断价值。方法 :选择81例单发甲状腺结节的临床及影像资料,术前均接受高频超声及超声造影检查,观察记录结节形态、边界、回声、增强强度等特点,按病理结果分为良性组和恶性组,比较2组声像图特点;对恶性组结节除观察结节高频超声及超声造影特征外,重点观察结节与甲状腺被膜的关系,评价超声对PTMC侵袭性的诊断效能。结果:2组超声特征比较,恶性组结节纵横比≥1及微钙化所占比例均高于良性组(均P<0.05);2组超声造影特征比较,不均匀增强、低增强、早期明显消退特征在恶性组中所占比例均高于良性组(均P<0.05);在高频超声基础上行超声造影检查判断PTMC被膜侵犯的敏感度94.40%,特异度87.20%,准确率89.47%,阳性预测值77.27%,阴性预测值97.14%。结论:PTMC的超声造影表现具有特征性,对判断肿瘤侵袭性具有较高的诊断价值。

Objective:To investigate the diagnostic characteristics of high frequency ultrasound and contrast-enhanced ultrasound(CEUS) for papillary thyroid micro-carcinoma(PTMC) and predictive value of its invasiveness. Methods:The medical records of81 patients with thyroid nodules who received surgical treatment were analyzed. All patients received high frequency ultrasound and CEUS examination before surgery,and the characteristics of nodules such as morphology,boundary,echo and enhancement intensity were observed and recorded. According to the pathological results,the patients were divided into benign group and malignant group,and the sonogram characteristics were compared. In addition to observing the characteristics of high frequency ultrasound and CEUS of nodules in the malignant group,the relationship between nodules and thyroid capsule was mainly observed to calculate the diagnostic efficacy of invasive PTMC. Results:Among the 81 nodules confirmed by surgery and pathology,the ultrasonic characteristics of the two groups showed that the ratio of aspect ratio ≥1 and the proportion of micro-calcification in the malignant group were significantly higher than those in the benign group(both P<0.05). The comparison of CEUS characteristics between the two groups showed that the proportion of the three characteristics of non-uniform enhancement,low enhancement and early significant regression in the malignant group was higher than that in the benign group,and the difference was statistically significant(all P<0.05). CEUS based on high frequency ultrasound inferred that PTMC was invasive with a sensitivity of 94.40%,a specificity of 87.20%,an accuracy of 89.47%,a positive prediction value of 77.27%,and a negative prediction value of 97.14%. Conclusion:PTMC could be diagnosed by CEUS with characteristic manifestations,CEUS has high diagnostic value in determining tumor invasion ability.