常规超声联合彩超及超声弹性评分对甲状腺囊实性结节吸收后残留病灶与甲状腺乳头状癌的鉴别诊断  

Differential diagnosis of residual lesions and papillary thyroid carcinoma after absorption of cystic solid thyroid nodules by conventional ultrasound plus color Doppler ultrasound and ultrasonic elasticity score

作　　者：孙莹 杨琴 吴冬平 汪洋 SUN Ying;YANG Qin;WU Dongping;WANG Yang

机构地区：[1]湖北六七二中西医结合骨科医院,湖北武汉430079

出　　处：《中医临床研究》2022年第36期61-64,共4页Clinical Journal Of Chinese Medicine

摘　　要：目的:分析甲状腺囊实性结节吸收后残留病灶的常见超声表现,探讨常规超声、多普勒超声及超声弹性成像联合检测对鉴别囊实性结节吸收后残留病灶与乳头状癌的临床价值。方法:选取湖北六七二中西医结合骨科医院2018年3月-2020年6月收治的69例甲状腺囊实性结节病变患者,对所有患者均行常规超声检查、多普勒彩超及超声弹性评分检查,分析甲状腺囊实性结节吸收后残留病灶,评估患者病灶的形态、边界包膜情况、内部回声情况、内部钙化情况、纵横比、颈部淋巴结异常情况以及多普勒彩超和超声弹性评分分级分型,并与乳头状癌典型超声表现对比,分析鉴别诊断的临床价值。结果:甲状腺乳头状癌的超声特征表现主要为纵横比>1,无包膜、边界模糊,在病灶内部呈现不均匀低回声或出现微小钙化灶,血流丰富,多普勒彩超和超声弹性评分等级为高等,此外可观察到患者颈部出现形态饱满的异常淋巴结。甲状腺囊实性结节吸收后残留病灶的超声表现为形态规则、包膜完整、边界清晰,吸收后无钙化灶或可见粗大钙化灶,纵横比大多数<1。多普勒彩超表现:87.5%的囊实性结节吸收后病灶表现为无血管或边缘型点状、线状血管信号,同时其阻力指数(Resistance Index,RI)为(0.59±0.06),收缩期峰值速度(Peak Systolic Velocity,PSV)为(25.16±5.71)cm/s。超声弹性评分表现多为1~3分,硬度适中偏软。囊实性结节不会累及颈部领淋巴结。但两者的超声表现中均常常可见病灶内部低回声或极低回声。结论:甲状腺囊实性结节吸收后病灶与乳头状癌的超声表现具有较大差异,通过常规超声联合彩超及超声弹性评分能够很好地对这两种疾病进行鉴别诊断,但对于出现低回声或极低回声的患者,临床上应进一步对比其他超声表现并结合病史及其他检查结果进行综合评估。Objective:To analyze the common ultrasonic manifestations of residual lesions after absorption of cystic solid thyroid nodules,and to explore the clinical value of combined detection of conventional ultrasound,Doppler ultrasound and ultrasonic elastography in differential diagnosis of residual lesions after cystic solid nodules absorption and papillary carcinoma.Methods:A total of 69 patients with cystic solid thyroid nodules in Hubei 672 Orthopaedic Hospital of Integrated Traditional Chinese and Western Medicine from March 2018 to June 2020 were selected.All patients were examined by conventional ultrasound,Doppler ultrasound and ultrasonic elasticity score.The residual lesions after absorption of cystic solid thyroid nodules were analyzed.The shape,boundary envelope,internal echo,internal calcification,aspect ratio and neck lymph were evaluated.The clinical value of differential diagnosis was analyzed by comparing with the typical ultrasonic manifestations of papillary carcinoma.Results:The ultrasonographic features of thyroid papillary carcinoma were as follows:aspect ratio>1,with no capsule,fuzzy boundary,uneven low echo or tiny calcification in the lesion,rich blood flow,high color Doppler ultrasound and ultrasound elastic score,and plump abnormal lymph nodes in the neck of the patient.The ultrasonographic features of residual lesions after absorption of cystic solid thyroid nodules were regular shape,intact capsule,clear boundary,no calcification or coarse calcification after absorption,with aspect ratio less than 1.Color Doppler ultrasound showed that 87.5%of cystic solid nodules showed no blood vessels or marginal point or line vascular signals after absorption,and the RI was(0.59±0.06)and PSV was(25.16±5.71)cm/s.Most of the ultrasonic elasticity scores were 1-3,with moderate hardness and soft.Cystic solid nodules did not involve cervical lymph nodes.However,hypoechoic or extremely hypoechoic lesions were often found in both sonographic findings.Conclusion:The ultrasonographic features of the lesions an

关 键 词：甲状腺囊实性结节 甲状腺乳头状癌 超声检查 超声弹性评分 鉴别诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学]