探讨超声造影（CEUS）对甲状腺富血供病灶的良恶性鉴别诊断价值。

选取2016年2月至2017年1月在解放军总医院行常规超声及CEUS检查且病灶呈高增强表现的患者62例，所有患者均行甲状腺结节穿刺活检，分析病灶内部及周边的CEUS增强模式，并将高增强范围与常规超声显示病灶大小进行比较。以病理结果为"金标准"，39例为甲状腺良性病灶组，23例为甲状腺恶性病灶组。采用χ²检验比较良、恶性病灶CEUS特征的差异。

高增强的均匀程度在良、恶性组间比较，差异有统计学意义（χ²=9.78，P=0.002）。不均匀高增强类型中，高增强伴灌注缺损及强弱分布不均在良、恶性组间的比较，差异有统计学意义（χ²=10.77，P=0.001），前者主要见于良性。病灶高增强范围扩大全部见于恶性，差异有统计学意义（χ²=6.52，P=0.01）。CEUS诊断高增强病灶性质的敏感度、特异度、准确性分别为95.83%、78.95%、85.48%，均高于常规超声（87.5%、68.42%、75.81%）。

甲状腺良恶性高增强病灶的CEUS表现有差异，病灶内强弱分布不均、周边不规则环状增强及高增强范围扩大均提示恶性。

To investigate the differential diagnostic value for thyroid rich blood supply lesions by contrast-enhanced ultrasound (CEUS).

From February 2016 to January 2015, patients who suffered with thyroid nodules underwent conventional ultrasound and CEUS before biopsy. Sixty-two lesions with high-enhancement features were included in the final data. The enhancement patterns within and around lesions of CEUS were analyzed, and the high-enhancement ranges were compared with lesions sizes displayed on conventional ultrasound imaging. When pathology was regarded as the golden standard, 39 nodules of 62 were benign, and 23 were malignant. The difference of CEUS characteristics between benign and malignant lesion was compared using χ² test.

The homogeneity or not had significant difference between benign and malignant lesions with high-enhancement features (χ²=9.78, P=0.002). The features of high-enhancement with cystic area and uneven distribution of high-enhancement area had significant difference between benign and malignant lesions (χ²=10.77, P=0.001), and the former were frequently seen in benign lesions. Peripheral regular and irregular rings had significant difference between the benign and malignant lesions (χ²=24.33, P<0.001). All lesions showed large high-enhancement area were malignant (χ²=6.52, P=0.01). The diagnostic sensitivity, specificity and accuracy of CEUS were 95.83%, 78.95% and 85.48% for thyroid rich blood supply lesions, which were better than those of conventional ultrasound (87.5%, 68.42%, 75.81%).

There are different features in CEUS between the benign and malignant thyroid lesions with rich blood supply. Heterogeneous high-enhancement, peripheral irregular rings and extensive high-enhancement area were malignant features.