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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 (07) : 532 -537. doi: 10.3877/cma.j.issn.1672-6448.2017.07.010

所属专题： 文献；

浅表器官超声影像学

甲状腺富血供病灶的超声造影诊断价值
张艳1, 罗渝昆1,†(), 杨明1, 张明博1, 张颖1, 李杰2   
  1. 1. 100853　北京，解放军总医院超声诊断科
    2. 100853　北京，解放军总医院病理科
  • 收稿日期:2017-03-24 出版日期:2017-07-01
  • 通信作者: 罗渝昆
  • 基金资助:
    国家自然科学基金项目(81471681); 解放军总医院扶持基金特色优势项目(2015PC-TSYS-2022)

The diagnostic value of thyroid rich blood supply lesions by using contrast-enhanced ultrasound

Yan Zhang1, Yukun Luo1,†(), Ming Yang1, Mingbo Zhang1, Ying Zhang1, Jie Li2   

  1. 1. Department of Ultrasound, Chinese People′s Liberation Army General Hospital, Beijing 100853, China
    2. Department of Pathology, Chinese People′s Liberation Army General Hospital, Beijing 100853, China
  • Received:2017-03-24 Published:2017-07-01
  • Corresponding author: Yukun Luo
  • About author:
    Corresponding author: Luo Yukun, Email:
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引用本文：

张艳, 罗渝昆, 杨明, 张明博, 张颖, 李杰. 甲状腺富血供病灶的超声造影诊断价值[J]. 中华医学超声杂志（电子版）, 2017, 14(07): 532-537.

Yan Zhang, Yukun Luo, Ming Yang, Mingbo Zhang, Ying Zhang, Jie Li. The diagnostic value of thyroid rich blood supply lesions by using contrast-enhanced ultrasound[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(07): 532-537.

目的

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。

方法

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。

结果

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%）。

结论

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。

关键词: 超声检查, 甲状腺肿瘤, 造影剂
Objective

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

Methods

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.

Results

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%).

Conclusions

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.

Key words: Ultrasonography, Thyroid neoplasms, Contrast media
表1 甲状腺病灶内部及周边增强模式与病理结果
组别 例数 均匀高增强 不均匀高增强 规则环状高增强 不规则环状高增强 不规则环状无增强 高增强范围扩大
良性组 39 16 23 25 1 0 0
恶性组 23 1 22 0 5 3 5
χ2值 ? 9.78 29.37 6.52
P值 ? 0.002 0.00 0.01
图1~4 甲状腺腺瘤常规超声及超声造影图像。图1常规超声示甲状腺左叶可见一中等偏低回声结节，边界清楚，形态规则，内回声不均匀；图2 CDFI示结节周边及内部均可见血流信号；图3超声造影示结节内呈不均匀高增强表现，边界清楚，周边可见规则环状高增强；图4示甲状腺腺瘤灰阶图像
图5~8 甲状腺乳头状癌常规超声及超声造影图像。图5常规超声示甲状腺右叶可见一低回声结节，部分边界不清，形态不规则；图6CDFI示结节内可见丰富血流信号；图7超声造影显示结节内呈均匀高增强表现，形态不规则，高增强范围为1.0 cm×0.8 cm；图8灰阶超声示结节大小0.8 cm×0.7 cm
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