高频超声对甲状腺无增强表现结节病理性质的诊断  

High Frequency Ultrasound in the Diagnosis of Pathological Properties of Thyroid Nodules Without Enhancement

作　　者：任玲 罗渝昆[1] 宋青[1] 田晓琦 谢芳[1] 费翔[1] 朱亚琼[1] REN Ling;LUO Yukun;SONG Qing;TIAN Xiaoqi;XIE Fang;FEI Xiang;ZHU Yaqiong(Department of Ultrasound,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心超声科,北京100853

出　　处：《中国医学影像学杂志》2020年第3期174-177,共4页Chinese Journal of Medical Imaging

基　　金：首都临床特色应用研究(Z18110700170000)。

摘　　要：目的探讨高频超声特征对于超声造影表现为无增强的甲状腺结节良恶性的诊断价值。资料与方法回顾性分析超声造影检查表现为无增强的78例患者的高频超声图像。所有患者甲状腺结节甲状腺影像报告和数据系统(TI-ARDS)4类及以上,且最大径≤1 cm。以病理结果为"金标准",将患者分为良性组65例和恶性组13例。比较良、恶性甲状腺结节高频超声特征的差异,计算不同特征的诊断敏感度及特异度。结果良性组与恶性组患者超声特征比较,晕环、后方声影及粗大钙化的发生率差异均有统计学意义(χ~2=10.678、4.615、3.900,P<0.05),结节边界及纵横比差异无统计学意义(χ~2=1.738、0.504,P>0.05)。恶性组患者"双环征"的发生率为0(0/2),良性组患者发生率为23.8%(10/42),两组差异无统计学意义(P>0.05)。以病理结果为"金标准",甲状腺结节周边的"晕环征"诊断良性结节的敏感度为64.6%、特异度为84.6%,结节后方声影诊断良性结节的敏感度为38.5%、特异度为92.3%,结节内伴粗大钙化诊断良性结节的敏感度为35.4%、特异度为92.3%,"双边征"诊断良性结节的敏感度为23.8%、特异度为100.0%。结论当超声造影表现为无增强时,常规超声显示结节周边的"晕环征"、后方声影及结节内粗大钙化对于提示良性结节具有重要意义;尤其出现"双环征"时高度提示良性,从而减少不必要的穿刺活检及手术治疗。Purpose To explore the diagnostic value of high-frequency ultrasound in the differentiation of benign and malignant thyroid nodules with "absent" pattern in contrast-enhanced ultrasound. Materials and Methods Retrospective analysis of thyroid nodules of TIARDS category 4 and above with a maximum diameter of 1 cm or less, and parallel ultrasonography showed almost no enhancement in high-frequency ultrasound images of 78 patients. Pathological results were used as the "gold standard", the study subjects were divided into benign group(n=65) and malignant group(n=13), and the differences between high-frequency ultrasound characteristics of benign and malignant nodules were compared, then the diagnostic sensitivity and specificity of different characteristics were also calculated. Results The incidences of halo, posterior shadowing and macro-calcification in the benign group were statistically higher than those in the malignant group(χ~2=10.678, 4.615, 3.900, P<0.05). There was no significant difference in border and aspect ratio between the two groups(χ~2=1.738, 0.504, P>0.05). The incidence of double-ringed in malignant group and benign group was 0(0/2) and 23.8%(10/42), respectively, with no statistically significant(P>0.05). Based on the pathological results as the "gold standard", the sensitivity of halo ring signs around the thyroid nodule was 64.6%, and the specificity was 84.6%. The sensitivity of the sound-behind diagnosis behind the nodule was 38.5%, and the specificity was 92.3%, Nodules with coarse calcification had a sensitivity of 35.4% and specificity of 92.3%, bilateral signs of benign sensitivity of 23.8% and specificity of 100.0%. Conclusion When the contrast-enhanced ultrasonography shows no enhancement, the halo, posterior shadowing and macro-calcification in the nodule are meaningful for the diagnosis of benign nodules, especially when bilateral rim appear, which are highly suggestive and can reduce unnecessary puncture biopsy and surgical treatment.

关 键 词：甲状腺结节 超声检查 造影剂 病理学 外科 诊断 鉴别 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]