囊实性甲状腺结节的超声图像分析

Ultrasound image analysis of partially cystic thyroid nodules

目的探讨高频超声对甲状腺囊实性结节的良恶性的诊断价值。方法回顾分析2017年6月至2021年1月深圳市龙岗中心医院手术病理证实的159个甲状腺囊实性结节的术前超声特征。根据其超声表现分为四型:Ⅰ型,内部为带状分隔或絮状回声;Ⅱ型,壁上可见小乳头状中等回声突起;Ⅲ型,内部为带状分隔或絮状回声及小乳头状中等回声突起;Ⅳ型,内部以实性回声为主,内部为不规则小片状无回声及裂隙状无回声。观察各型的超声诊断与病理结果符合率。结果159个甲状腺囊实性结节中,22个为恶性,137个为良性。超声对Ⅰ、Ⅱ、Ⅲ、Ⅳ型囊实性甲状腺结节的诊断与病理结果符合率分别为97%(61/63)、80%(45/56)、90%(9/10)、67%(20/30)。Ⅰ型、Ⅱ型、Ⅲ型均以囊性成分为主,囊性成分≥50%;Ⅳ型以实性成分为主,囊性成分<50%,超声诊断与病理结果符合率最低。结论内部为带状分隔或絮状回声为良性囊实性结节的特征性超声表现;内部以实性回声为主,内部为不规则小片状无回声及裂隙状无回声的囊实性甲状腺结节超声诊断符合率最低,易误诊,仔细观察其实性部分特征可提高超声诊断正确率。

Objective To investigate the diagnostic value of high frequency ultrasound in benign and malignant thyroid partially cystic nodules.Methods The preoperative ultrasound features of 159 thyroid cystic and solid nodules confirmed by surgery and pathology in Shenzhen Longgang Central Hospital from June 2017 to January 2021 were retrospectively analyzed.According to the ultrasonic manifestations,it can be divided into four types:typeⅠ,band separation or flocculent echo in the interior;typeⅡ,the small papillary middle echo process was seen on the wall;typeⅢ,with band separation or flocculent echo and papillary medium echo process;typeⅣ,the internal was mainly solid echo,and the inner part was irregular small piece echo and fissure echo free echo.The coincidence rate of ultrasonic diagnosis and pathological results of all types was observed.Results Among 159 cystic and solid thyroid nodules,22 were malignant and 137 were benign.The coincidence rate of ultrasonic diagnosis and pathological results of typeⅠ,Ⅱ,ⅢandⅣcystic solid thyroid nodules were 97%(61/63),80%(45/56),90%(9/10)and 67%(20/30),respectively.TypeⅠ,typeⅡ,typeⅢwere mainly cystic components,with cystic components≥50%;In typeⅣ,solid component was the main component and cystic component was less than 50%.Conclusions The internal zonal separation or flocculent echo was the characteristic ultrasonic manifestation of benign cystic solid nodules;It is easy to be misdiagnosed because of the lowest coincidence rate of ultrasound diagnosis for cystic and solid thyroid nodules with internal solid echo,irregular small piece like and fissure like anechoic.Careful observation of the characteristics can improve the accuracy of ultrasound diagnosis.