超声在结节性甲状腺肿和甲状腺腺瘤诊断中的价值

The Value of Ultrasound in the Diagnosis of Nodular Goiter and Thyroid Adenoma

目的:探究超声在结节性甲状腺肿和甲状腺腺瘤诊断中的价值。方法:选取2021年1月至2022年5月徐州市肿瘤医院超声科收治的经病理学诊断确诊为甲状腺疾病患者90例作为研究对象,依据病理学诊断结果将其分为结节性甲状腺肿组(结甲组,59例)和甲状腺腺瘤组(腺瘤组,31例),两组均接受彩色多普勒检查,以病检结果作为金标准,对比两组的诊断效能、影像学特点、血流信号分型、结节内部与周边血流参数[舒张期最低流速(Vmin)及收缩期时的最大血流速(Vmax)、阻力指数(RI)]的差异性。结果:超声对结甲正确诊断56例(94.92%),误诊为腺瘤者3例(5.08%);对腺瘤正确诊断26例(89.66%),误诊为结甲5例(17.24%)。在结节数目比较上,结甲组单发占比8.47%,多发占比91.53%,腺瘤组单发占比90.32%,多发占比9.68%,结甲组单发占比低于腺瘤组,其多发占比高于腺瘤组(P<0.05);在结节大小比较上,结甲组<1cm、1-3cm、>3cm者占比分别为55.94%、28.81%和15.25%,腺瘤组则分别为16.13%、45.16%和38.71%,结甲组<1cm占比高于腺瘤组,但其1-3cm、>3cm者占比均低于对照组(P<0.05);在晕环比较上,结甲组晕环、无晕环分别为5.08%和94.92%,腺瘤组则分别为22.58%和77.42%,结甲组晕环占比低于腺瘤组,无晕环占比高于腺瘤组(P<0.05)。结甲组血流信号Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型分别占比47.46%、33.90%、11.86%和6.78%。腺瘤组则分别为6.45%、22.58%、38.71%和32.26%,结甲组血流信号Ⅰ型、Ⅱ型占比高于腺瘤组,其血流信号Ⅲ型、Ⅳ型占比低于腺瘤组(P<0.05)。腺瘤组在结节周边血流参数的Vmax与RI均高于结甲组(P<0.05),两组的结节内部血流分布参数以及Vmin比较均无统计学差异(P>0.05)。结论:结节性甲状腺肿和甲状腺腺瘤具有不同的超声特征,前者为甲状腺双侧叶内多发病灶,无明显的包膜,彩超示内部可无血流信号或少量血流信号;而后者则多为单侧单发,有声晕,彩超显示肿块周边有明显的血流环绕,可探及血流信号。临床可依据二维超声图像特征对甲状腺结节的大小、数目、形态、位置、囊实性变等对二者做出较为准确的诊断及鉴别,防止临床过度治疗或治疗不足情况的出现。

Objective:To explore the value of ultrasound in the diagnosis of nodular goiter and thy⁃roid adenoma.Methods:90 patients with pathological diagnosis of thyroid diseases in our hospital from January 2021 to May 2022 were selected as research subjects.They were divided into nodular goiter group(thyroid group,59 cases)and thyroid adenoma group(adenoma group,31 cases)based on the patho⁃logical diagnosis results.Both groups received color Doppler examination,and the results of the examination were used as the gold standard to compare the differences between the two groups in diagnostic effi⁃cacy,imaging characteristics,blood flow signal typing,blood flow parameters(minimum diastolic flow ve⁃locity(Vmin),maximum systolic flow velocity(Vmax),and resistance index(RI)within and around nod⁃ules.Results:Ultrasound correctly diagnosed 56 cases(94.92%)of thyroid nodules,and misdiagnosed 3 cases(5.08%)as adenomas;Adenomas were correctly diagnosed in 26 cases(89.66%)and misdiagnosed as thyroid nodules in 5 cases(17.24%).In terms of the number of nodules,the single and multiple nod⁃ules accounted for 8.47%and 91.53%in the thyroid group,while the single and multiple nodules ac⁃counted for 90.32%and 9.68%in the adenoma group.The single and multiple nodules accounted for a lower proportion in the thyroid group than that in the adenoma group,and the multiple nodules accounted for a higher proportion than that in the adenoma group(P<0.05);In comparison of nodule size,the propor⁃tions of nodules<1 cm,1-3 cm,>3 cm in the thyroid group were 55.94%,28.81%,and 15.25%,respec⁃tively,while those in the adenoma group were 16.13%,45.16%,and 38.71%,respectively.The propor⁃tions of nodules<1 cm in the thyroid group were higher than those in the adenoma group,but the propor⁃tions of nodules<1 cm,>3 cm were lower than those in the control group(P<0.05);in terms of halo ring comparison,the halo ring and halo free ring in the thyroid group were 5.08%and 94.92%,respectively,while those in the adenoma group were 22.58%and 77.42%,respectively.The halo ring ratio in the thy⁃roid group was lower than that in the adenoma group,while the halo free ring ratio was higher than that in the adenoma group(P<0.05).The proportions of blood flow signals of type Ⅰ,type Ⅱ,type Ⅲ,and type Ⅳin group A were 47.46%,33.90%,11.86%,and 6.78%,respectively.In the adenoma group,the blood flow signals were 6.45%,22.58%,38.71%,and 32.26%,respectively.The proportion of blood flow sig⁃nals of type Ⅰ and type Ⅱin the nodule A group was higher than that of the adenoma group,while the pro⁃portion of blood flow signals of type Ⅲand type Ⅳin the nodule A group was lower than that of the ad⁃enoma group(P<0.05).The Vmax and RI of blood flow parameters around the nodules in the adenoma group were higher than those in the thyroid group(P>0.05).Conclusion:Nodular goiter and thyroid ad⁃enoma have different ultrasound characteristics.The former is multiple intralobular lesions in both sides of the thyroid without obvious capsule,and color Doppler ultrasound can show there is no or a small amount of internal blood flow signal;The latter is mostly unilateral and has a sound halo.Color Doppler ultrasound shows there is a clear blood flow surrounding the mass,which can detect blood flow signals.Clinically,accurate diagnosis and differential diagnosis can be made based on the size,number,shape,lo⁃cation,and cystic and solid changes of thyroid nodules according to the characteristics of two dimensional ultrasound images,so as to prevent the occurrence of clinical overtreatment or insufficient treatment.