Graves病与桥本氏甲状腺炎的彩色多普勒超声鉴别诊断分析

Differential diagnosis analysis of Graves disease and Hashimoto's thyroiditis using color Doppler ultrasound

目的分析Graves病与桥本氏甲状腺炎(HT)应用彩色多普勒超声鉴别诊断的价值。方法回顾性分析39例Graves病患者与41例HT患者的资料。所有患者均接受彩色多普勒超声检查,观察分析HT与Graves病患者甲状腺超声图像特点,比较HT与Graves病患者甲状腺回声和甲状腺血流情况。结果Graves病的甲状腺体积明显增大,边界较为清晰,峡部增厚,形态饱满,边缘规则,包膜完整,腺体回声欠均匀,呈弥漫性异常,双侧颈部末端可见明显肿大的淋巴结。HT患者甲状腺体积增大,形态饱满,边界清晰,峡部增厚,包膜完整,边缘规则,腺体回声欠均匀,呈弥漫性异常,部分腺体正常,轻度不匀,回声减低,呈条状中强回声,实质呈网格状或分隔状。HT患者腺体内低回声2级发生率56.10%及有网络样强回声发生率80.49%高于Graves病患者的23.08%、5.13%(P<0.05);HT与Graves病患者的甲状腺回声分级比较,结果未见差异性(P>0.05)。HT患者动脉舒张末期峰值血流速度(41.24±5.08)cm/s、动脉收缩期血流速度(82.08±9.68)cm/s均低于Graves病患者的(48.05±5.58)、(121.45±8.98)cm/s(P<0.05);HT与Graves病患者的阻力指数比较,结果未见差异性(P>0.05)。结论通过彩色多普勒超声观察甲状腺回声与甲状腺血流情况可以有效鉴别诊断Graves病与HT,为临床诊疗工作提供重要的参考信息。

Objective To analyze the value of color Doppler ultrasound in differential diagnosis of Graves'disease and Hashimoto's thyroiditis(HT).Methods A retrospective analysis was conducted on the data of 39 patients with Graves'disease and 41 patients with HT.All patients underwent color Doppler ultrasound examination to observe the characteristics of thyroid ultrasound in patients with HT and Graves'disease,and to compare the thyroid echogenicity and thyroid blood flow in patients with HT and Graves'disease.Results In Graves'disease,the thyroid gland was markedly enlarged in size,with relatively clear borders,thickened isthmus,full morphology,regular margins,intact peritoneum,and glandular echogenicity was less than homogeneous and diffuse abnormality,and markedly enlarged lymph nodes can be seen in the end of the neck bilaterally.In HT patients,the thyroid gland was enlarged in size,full in morphology,with clear borders,thickened isthmus,intact peritoneum,regular margins,glandular echogenicity was non-uniform,and diffuse abnormality,and some of the glands are normal,mildly inhomogeneous,hypoechoic,and streak-like medium-strong echogenicity,and the parenchyma was lattice or segregation-like.The incidence rates of grade 2 hypoechogenicity and network like hyperechogenicity were 56.10%and 80.49%in the HT patients,which were higher than 23.08%and 5.13%in the Graves'disease patients(P<0.05).There was no significant difference in thyroid echogenicity grading between patients with HT and Graves'disease(P>0.05).The end diastolic blood flow velocity in the HT patients was(41.24±5.08)cm/s and the peak systolic blood flow velocity was(82.08±9.68)cm/s,which were lower than(48.05±5.58)and(121.45±8.98)cm/s in the Graves'disease patients(P<0.05),and there was no significant difference in resistance index between patients with HT and Graves'disease(P>0.05).Conclusion Color Doppler ultrasound can effectively distinguish and diagnose Graves'disease and HT by observing thyroid echogenicity and thyroid blood flow,thus providing important reference information for clinical diagnosis and treatment.