探讨超声造影（CEUS）周边环状增强对甲状腺良恶性结节鉴别诊断的意义。

选取2014年8月至2015年11月因常规超声发现可疑结节，准备行甲状腺结节穿刺活检的患者进行常规超声及CEUS检查，CEUS时观察结节内部及周边增强特点，将内部增强模式及周边不同环状增强表现进行分类，并与病理结果进行对照分析。比较周边环状增强类型与结节大小之间的关系。

113例甲状腺结节周边可见环状增强，其中，良性结节85例，恶性结节28例。周边4种环状增强模式中，规则高增强环者76例均为良性，不规则高增强环者9例均为恶性，不规则无增强环者16例均为恶性，规则无增强环者9例为良性，3例为恶性。CEUS诊断结节性质的敏感度、特异度及准确性分别为96.43%、96.47%、96.46%。结节大小在4种环状增强类型之间的差异有统计学意义（H=18.73，P<0.01）。规则高增强结节最大径（2.29±1.32）明显大于其他3组（P值均<0.05）。

周边环状增强对甲状腺结节的鉴别诊断有重要价值，规则高增强环提示良性，不规则高增强或无增强环均提示恶性。

To investigate the diagnostic value for differentiating benign nodules from malignant by the peripheral rings in contrast-enhanced ultrasound (CEUS).

Conventional ultrasound and CEUS were performed in patients who suffered with thyroid nodules before the biopsy. During CEUS, both the enhancement patterns in nodule and the rings around nodules were observed and classified into different types. The diagnostic value of CEUS was obtained by comparing to pathology results. The relationship between peripheral rings of nodule with nodule′s size was analyzed.

Peripheral rings were found in 113 thyroid nodules, including 85 benign and 28 malignant nodules. In four types of peripheral rings, all 76 nodules with regular high-enhancement rings were benign, and all 9 nodules with irregular high-enhancement or no enhancement rings were malignant. Regular no enhancement rings were found in 9 benign nodules and 3 malignant nodules. The diagnostic sensitivity, specificity and accuracy of CEUS were 96.43%, 96.47% and 96.46%, respectively. Significant difference of nodule′s size was found in four types of peripheral rings (H=18.73, P<0.01). The maximum diameters of nodules with peripheral regular rings were larger than those of nodules with other three types of rings (all P<0.05).

Peripheral rings are very important for the differential diagnosis of thyroid nodules in CEUS. Regular high-enhancement rings indicate benign nodule, and irregular high-enhancement or no enhancement rings indicate malignant nodule.