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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2017, Vol. 14 ›› Issue (04) : 269 -273. doi: 10.3877/cma.j.issn.1672-6448.2017.04.007

所属专题： 妇产科超声影像学； 文献；

浅表器官超声影像学

甲状腺乳头状癌微血管灌注模式的量化评估及其病理学基础
杨萌1, 苏娜1, 王亮1, 李文波1, 朱庆莉1, 戴晴1, 姜玉新1,†()   
  1. 1. 100730　中国医学科学院　北京协和医学院　北京协和医院超声医学科
  • 收稿日期:2017-01-19 出版日期:2017-04-01
  • 通信作者: 姜玉新
  • 基金资助:
    国家自然科学基金青年基金(81301268); 北京市科技新星计划(131107000413063); 国家国际科技合作专项(2015DFA30440)

The contrast enhanced perfusion pattern and pathological changes of papillary thyroid cancer

Meng Yang1, Na Su1, Liang Wang1, Wenbo Li1, Qingli Zhu1, Qing Dai1, Yuxin Jiang1,†()   

  1. 1. Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
  • Received:2017-01-19 Published:2017-04-01
  • Corresponding author: Yuxin Jiang
  • About author:
    Corresponding author: Jiang Yuxin, Email:
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引用本文：

杨萌, 苏娜, 王亮, 李文波, 朱庆莉, 戴晴, 姜玉新. 甲状腺乳头状癌微血管灌注模式的量化评估及其病理学基础[J]. 中华医学超声杂志（电子版）, 2017, 14(04): 269-273.

Meng Yang, Na Su, Liang Wang, Wenbo Li, Qingli Zhu, Qing Dai, Yuxin Jiang. The contrast enhanced perfusion pattern and pathological changes of papillary thyroid cancer[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(04): 269-273.

目的

探讨甲状腺乳头状癌（PTC）超声微血管成像灌注差异的定量评估方法，研究微血管灌注差异与CD34微血管密度分级（MVD）的相关性。

方法

选取2008年4月至2010年2月在北京协和医院行甲状腺超声造影的手术患者39例，采用低机械指数实时灰阶谐波超声造影技术，对39例病理诊断证实的散发型PTC患者行超声微血管成像，包括经典型PTC患者33例，滤泡型PTC患者6例。采用病灶与甲状腺实质感兴趣区域（ROI）时间-强度曲线峰值强度差△ROI，定量评估PTC微血管成像的灌注特点。术后石蜡标本行CD34免疫组织化学染色，采用Spearman相关分析PTC微血管灌注量化指标△ROI与CD34的相关性。

结果

根据病灶CD34染色的微血管计数结果，将PCT的CD34染色分为1~3级，其中1级12例，2级15例，3级12例。△ROI与CD34分级呈正相关（r=0.799，P<0.001），CD34不同分级组间的△ROI分布存在显著性差异，且3组间△ROI均值的95%置信区间完全没有重叠；依据CD34分级组内的△ROI的阈值范围结合时间-强度曲线达峰时病灶与实质间的回声特点，将PTC的灌注模式定义为低增强17例（43.59%），局部增强10例（25.64%），高增强14例（35.9%），其样本分布特点与CD34一致性较好。

结论

甲状腺病灶与实质ROI的时间-强度曲线峰值强度差△ROI与病理学CD34具有较好的相关性；△ROI作为一种较客观的量化指标，可用于量化评价PTC的微血管灌注模式和强度。

关键词: 甲状腺肿瘤, 超声检查, 抗原，CD34
Objective

To evaluate the contrast enhanced perfusion pattern of PTC micro-vascular imaging (MVI) quantitatively. Investigate the correlation between PTC MVI features and CD34 micro-vascular density (MVD).

Methods

Thirty-nine pathological and clinical confirmed sporadic PTCs were evaluated with real-time gray-scale contrast-enhanced micro-vascular imaging under a low mechanical index. The micro-bubble agent was SoneVue. Of the 39 PTCs, 33 were classical PTCs, 6 were PTC with follicular variant (FVPTC). The △ROI ,which is the subtraction of peak echo intensity between the lesion region of interest (ROI) and normal thyroid parenchyma ROI, was used to evaluate the perfusion characteristics of PTC MVI quantitatively. The paraffined specimens were selected for immunohistochemical (IHC) staining for CD3, and the correlation between △ROI and the CD34 were evaluated.

Results

△ROI was strongly correlated with the CD34 expression (P=0.000), significant differences were detected in the distribution pattern of △ROI value among different CD34 expression levels, no overlapping of the mean △ROI values and the 95% confidence intervals was found among the 3 CD34 expression levels. The PTC MVI perfusion was classified into 3 patterns, low perfusion, focal perfusion and high perfusion, on the basis of combining △ROI values with the peak ehco pattern in time-intensity curve.

Conclusions

The △ROI is strongly correlated with the CD34 expression in papillary thyroid cancer. It can be used for the quantitative evaluation of PTC MVI pattern and intensity as an objective indicator.

Key words: Thyroid neoplasms, Ultrasonography, Antigens, CD34
图1 PTC患者病灶与甲状腺腺体实质ROI的时间-强度曲线图像
图2 甲状腺乳头状癌患者病灶病理CD34免疫组化强阳性病理图。单个或簇状分布的血管内皮细胞，染色阳性的内皮呈棕褐色着色点（En Vision两步法染色×200）
图3~5 甲状腺乳头状癌患者的超声造影灌注模式。图3示甲状腺癌超声造影低灌注；图4示甲状腺癌超声造影局部灌注；图5示甲状腺癌超声造影高灌注
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