甲状腺髓样癌的超声成像特征分析及诊断价值评价

Ultrasonic imaging features analysis and diagnostic evaluation of medullary thyroid carcinoma

目的:分析甲状腺髓样癌(medullary thyroid carcinoma,MTC)的超声特征,研究并探讨超声成像对甲状腺髓样癌的诊断价值。方法:选取来我院就诊的49例甲状腺髓样癌(MTC)患者的68枚结节,与同期随机选取的60例甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的82枚结节做对比,分析两者的二维超声特点、剪切波弹性成像(shear wave elastography,SWE)的各参数及颈部淋巴结转移情况,病灶均有手术及病理评估。结果:MTC声像图表现为低回声(73.5%),边界清楚(50.0%),纵横比<1(89.7%),结节内伴钙化(60.2%),结节内存在血流(58.8%),合并颈部淋巴结转移(55.1%);与PTC相比,MTC多表现为结节较大,边界清楚,纵横比<1,结节内存在血流,结节内钙化多为粗大钙化,易发生淋巴结转移(P<0.05)。MTC的SWE各参数为Emax(48.4±19.1)kPa,Emean(32.3±14.5)kPa。淋巴结超声检查,MTC可疑淋巴结22例,诊断准确率为81.5%。结论:MTC既具有恶性结节的一般特点,又有相对特异的超声表现,超声成像对MTC的早期诊断及手术治疗有较大的参考依据。

Objective:To analyze the ultrasonographic features of medullary thyroid carcinoma(MTC)and to study and discuss the diagnostic value of ultrasonic imaging in medullary thyroid carcinoma.Methods:Sixty-eight nodules from 49 patients with medullary thyroid carcinoma(MTC)who were compared with eighty-two nodules of 60 patients with papillary thyroid carcinoma(PTC)rand-omly selected during the same period.Conventional ultrasound features and SWE elasticity imaging characteristics and lymph node metastasis were recorded.The lesions were evaluated by surgical operation and pathology.Results:Conventional ultrasound findings for MTC were hypoechogenicity(73.5%),smooth margins(50.0%),wider-than-tall(89.7%),calcification(60.2%),intranodular blood flow(58.8%),lymph node metastasis(55.1%).Compared with PTC,MTC tended to show large nodules,smooth margin,wider-than-tall,intranodular blood flow,more macro-calcifications,more lymph node metastasis(P<0.05).THE SWE imaging paremeters of MTC were E max(48.4±19.1)kPa and E mean(32.3±14.5)kPa.Through lymph node ultrasonography,MTC suspicious lymph nodes in 22 cases,the diagnostic accuracy was 81.5%.Conclusion:The sonographic findings of MTC are similar to the other thyroid malignancy and have their own characteristics.Ultrasonography can provide valuable information for early diagnosis and surgical treatment of these patients.