探讨甲状腺结节合并环状钙化的超声特征在良恶性鉴别诊断中的价值。

选取2008年1月至2015年12月在中山大学肿瘤防治中心就诊的甲状腺结节合并环状钙化的患者60例，收集患者的超声特征，包括结节大小、边缘、内部回声、生长方式、后方回声、钙化环的连续性及钙化环周围有无低回声软组织影。以病理结果作为"金标准"，分析超声在合并环状钙化的甲状腺结节良恶性诊断中的价值。

60个病灶中，良性结节37例（61.7%），恶性结节23例（38.3%）。恶性结节钙化环连续性中断或内陷比率，以及环状钙化周围低回声软组织影出现率均明显高于良性结节。钙化环连续性中断、周围出现低回声软组织影超声特征对良恶性的诊断敏感度分别为85.7%、81.3%，特异度分别为89.4%、94.4%，阳性预测值分别为85.7%、92.9%，阴性预测值分别为89.4%、85.0%。恶性结节相较于良性结节，钙化环内部常为低回声（82.6% vs 40.5%），更易出现纵向生长（30.4% vs 2.7%），差异均有统计学意义（χ²=9.958、9.440，P均<0.01）。而良恶性结节的大小、边缘、后方回声比较，差异均无统计学意义（P均>0.05）。

环状钙化灶周边低回声软组织影与环状钙化连续性中断或内陷等超声征象在鉴别甲状腺结节的良恶性中有重要意义。

The aim of this study was to investigate the value of ultrasound in diagnosis of benign and malignant thyroid nodules with rim calcification.

Sixty thyroid nodules with rim calcifications from Sun Yat-sen University Cancer center which were detected on ultrasound from January 2008 to December 2015 were included in this study, and all the thyroid nodules had pathological results. Ultrasonic features of thyroid nodules, including the size, border, internal echo, growth pattern, rear echo, interruption or inner sink of the rim calcification and hypoechoic soft tissue extrusion around rim calcification were analyzed.

Thirty-seven nodules (61.7%) were confirmed to be benign, and twenty-three nodules (38.3%) were malignant. The ultrasonic features of interruption or inner sink of rim calcifications and hypoechoic soft tissue extrusion around rim calcification, were more often in malignant nodules than benign nodules. The sensitivity, specificity, the positive predictive values and the negative predictive values for interruption or inner sink of rim calcifications were 85.7%, 89.4%, 85.7% and 89.4%, respectively. The sensitivity, specificity, the positive predictive values and the negative predictive values for hypoechoic soft tissue extrusion around rim calcification were 81.3%, 94.4%, 92.9% and 85.0%, respectively. Internal hypoechogenicity was more frequently observed in the malignant nodules (82.6%) than in benign nodules (40.5%). The longitudinal growth pattern of thyroid was more frequently observed in malignant nodules (30.4%) than in benign nodules (2.7%). The differences of this two ultrasound features were statistically significant (χ²=9.958 and 9.440, both P<0.01). There were no significant differences in size, border and the rear echo between malignant and benign nodules (all P>0.05).

The interruption or inner sink of the rim calcification could be useful in differential diagnosis of thyroid nodules with rim calcification.