桥本甲状腺炎超声声像图分析  

Hashimoto's thyroiditis ultrasound manifestation under fine needle aspiration

作　　者：李传红[1] 宋修芹 张良岩[2] 王允芹[1] 张忠英[1] 史少华[1] 

机构地区：[1]山东省烟台市烟台山医院超声科,264000 [2]山东省烟台市烟台山医院内分泌科,264000

出　　处：《中华医学超声杂志（电子版）》2012年第1期57-59,共3页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的以超声引导细针穿刺作为诊断桥本甲状腺炎的金标准,探讨桥本甲状腺炎超声表现。方法回顾性总结216例超声引导下细针穿刺确诊的桥本甲状腺炎患者超声表现。超声观察指标为:甲状腺两侧叶大小及峡部厚度、内部回声特点、甲状腺内血流分布、甲状腺上动脉血流速度、甲状腺周围有无肿大淋巴结。根据患者甲状腺功能分成甲状腺功能亢进组、甲状腺功能减低组、甲状腺功能正常组,比较3组患者的甲状腺上动脉血流速度。结果仅84例患者(38.9%,84/216)具有经典桥本甲状腺炎超声表现:甲状腺两侧叶及峡部体积增大,回声减低,血流丰富;132例患者(61.1%,132/216)具有不典型桥本甲状腺炎超声表现:甲状腺体积不大,实质回声增粗或呈局限片状低回声。25.0%(54/216)合并实性结节,2.8%(6/216)合并甲状腺乳头状癌。桥本甲状腺炎甲状腺内血流分布较正常增多,甲状腺功能亢进组甲状腺上动脉血流平均速度为(39.0±20.5)cm/s,甲状腺功能减低组为(41.1±21.4)cm/s,甲状腺功能正常组为(35.6±17.1)cm/s,3组间差异无统计学意义(F=0.39,P=0.68)。93.1%(201/216)的桥本甲状腺炎甲状腺下极周围可见肿大淋巴结。结论具有经典桥本甲状腺炎超声图像患者仅占少部分,应重视不典型桥本甲状腺炎超声表现,减少漏诊。桥本甲状腺炎甲状腺内血流不能成为判断甲状腺功能的指标;甲状腺下极周围淋巴结的检出可协助该病诊断。Objective To discuss the ultrasound manifestation of Hashimoto＇s thyroiditis by using ultrasonic guided fine needle aspiration（U-FNA）as the gold standard of Hashimoto＇s thyroiditis.Methods The ultrasound images of 216 patients with Hashimoto＇s thyroiditis were retrospectively investigated,with observation of the following indexes：the size of two lateral lobes,the thickness of isthmus,the echo pattern,blood flow distribution,superior thyroid artery flow velocity and enlarged lymph nodes.According to the throid function,all Hashimoto＇s thyroiditis were divided in to the hyperthyroidism group,the hypothyroidism group and the euthroidism group,and the superior thyroid artery flow velocity was compared among the three groups.Results Sonographic features of typical Hashimoto＇s thyroiditis were only showed in 38.9% cases（84/216）.Sonographic characteristics of atypical Hashimoto＇s thyroiditis included normal thyroid volume,coarse parenchyma echo,partial hypoechoic area,25.0%（54/216）with solid nodules,and 2.8%（6/216）associated with thyroid carcinoma.Blood flow distribution was more abundant in Hashimoto＇s thyroiditis than in normal thyroid.The superior thyroid artery mean flow velocity was（39.0±20.5）cm/s in the hyperthyroidism group,it was（41.1±21.4）cm/s in the hypothyroidism group and it was（35.6±17.1）cm/s in the euthroidism group.There was no significant difference among the three groups（F=0.39,P=0.68）.93.1%（201/216）,enlarged lymph nodes were detected in the lower pole area of Hashimoto＇s thyroiditis cases.Conclusions Only a small portion of Hashimoto＇s thyroiditis cases presented the typical sonographic features.Attention should be paid to those with atypical sonographic features to avoid misdiagnosis.Blood flow velocity of thyroid artery in Hashimoto＇s thyroiditis is not well-correlated with thyroid function;detection of lymph nodes at thyroid lower pole area might be helpful for diagnosis.

关 键 词：超声检查 桥本甲状腺炎 细针穿刺活检 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581.4[医药卫生—诊断学]