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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） ›› 2020, Vol. 17 ›› Issue (12) : 1173 -1177. doi: 10.3877/cma.j.issn.1672-6448.2020.12.005

所属专题： 文献；

浅表器官超声影像学

甲状腺髓样癌高频超声图像特征分析
王换芳1, 李俊康2, 张明博1,†()   
  1. 1. 100853 北京 ，解放军总医院第一医学中心超声诊断科
    2. 621000 绵阳 ，解放军63820医院超声科
  • 收稿日期:2020-02-14 出版日期:2020-12-01
  • 通信作者: 张明博

High-frequency ultrasound characteristics of medullary thyroid carcinoma

Huanfang Wang1, Junkang Li2, Mingbo Zhang1,†()   

  1. 1. Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
    2. Department of Ultrasound, Chinese PLA 63820 Hospital, Mianyang 621000, China
  • Received:2020-02-14 Published:2020-12-01
  • Corresponding author: Mingbo Zhang
  • About author:
    Corresponding author: Zhang Mingbo, Email:
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引用本文：

王换芳, 李俊康, 张明博. 甲状腺髓样癌高频超声图像特征分析[J]. 中华医学超声杂志（电子版）, 2020, 17(12): 1173-1177.

Huanfang Wang, Junkang Li, Mingbo Zhang. High-frequency ultrasound characteristics of medullary thyroid carcinoma[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(12): 1173-1177.

目的

分析甲状腺髓样癌高频超声图像特征，并比较最大径＞1.0 cm及≤1.0 cm的超声图像特征的差异。

方法

回顾性分析2016年1月至2019年12月在解放军总医院第一医学中心接受超声检查及手术切除的36例甲状腺髓样癌患者的临床资料、超声图像及病理结果。总结甲状腺髓样癌病灶的超声特征，并依病灶最大径分为＞1.0 cm及≤1.0 cm两组，比较两组间超声图像表现的差异。

结果

甲状腺髓样癌病灶共42个，最大径为（2.6±1.5）cm（0.4~5.4 cm）。甲状腺髓样癌主要分布于甲状腺中上极（32个，76.2%），所有病灶均为低回声，以实性为主（39个，92.8%），多数伴有钙化（25个，59.5%）。与≤1.0 cm的病灶相比，＞1.0 cm的甲状腺髓样癌病灶血流信号多丰富（65.5% vs 7.7%，P=0.001），颈部淋巴结转移比例更高（79.3% vs 15.4%，P＜0.001），病灶超声诊断准确性更高（93.1% vs 61.5%，P=0.037）。

结论

甲状腺髓样癌病灶主要分布于甲状腺中上极，实性低回声为主，多数伴有钙化。不同大小甲状腺髓样癌超声特征不同，准确理解这些特征有助于甲状腺髓样癌的早期诊断和治疗。

关键词: 甲状腺, 髓样癌, 超声检查
Objective

To analyze the high-frequency ultrasound (US) features of medullary thyroid carcinoma (MTC), and to compare the differences between MTC with the maximum diameter of ＞1.0 cm and ≤1.0 cm.

Methods

The clinical data, US images, and pathological results of 36 MTC patients who underwent high-frequency US examination and surgical resection at the First Medical Center of Chinese PLA General Hospital from January 2016 to December 2019 were analyzed retrospectively. The US features of MTC were summarized and a comparative study was performed between subgroups with the maximum diameter of ＞1.0 cm and ≤1.0 cm.

Results

Forty-two MTC lesions with the maximum mean diameter of (2.6±1.5) cm (range, 0.4-5.4 cm) were enrolled in this study. MTC lesions were mainly distributed in the middle and upper poles of the thyroid (32, 76.2%); all were hypoechoic, 39 of them were mainly solid (39, 92.8%), and most of them had calcifications (25, 59.5%). Compared with lesions with the maximum diameter of ≤1.0 cm, the blood flow signal of lesions with the maximum diameter of ＞1.0 cm was more abundant (65.5% vs 7.7%, P=0.001); the rate of cervical lymph node metastasis in patients with lesions ＞1.0 cm was higher (79.3% vs 15.4%, P＜0.001), and US diagnosis accuracy in these cases was higher (93.1% vs 61.5%, P=0.0.037).

Conclusion

Most MTCs are located in the middle and upper poles of the thyroid, with solid component, hypo-echogenicity, and calcifications. Different sizes of MTC have different US features. Accurate differentiation of these US features is helpful for the early diagnosis and treatment of MTC.

Key words: Thyroid, Medullary carcinoma, Ultrasonography
图1 甲状腺髓样癌36岁男性患者超声表现。图a为灰阶超声可见甲状腺左侧叶中下部低回声实性结节，边界尚清，内部可见多发微小钙化；图b为彩色多普勒血流显像内部可见丰富血流信号　图2　甲状腺髓样癌56岁女性患者超声表现。图a为灰阶超声可见甲状腺右叶中上部低回声实性结节，边界不清，内部可见粗大钙化；图b为彩色多普勒血流显像示内部未见血流信号
表1 甲状腺髓样癌的超声特征 [例(%)]
超声特征

总数

（n=42）

＞1 cm

(n=29)

≤1 cm

（n=13）

 χ2值 P值
内部结构 - 0.540

实性

 39(92.9) 26(89.7) 13(100)

囊实性

 3(7.1) 3(10.3) 0(0)
回声 - 0.222

低回声

 39(92.9) 28(99.6) 11(84.6)

极低回声

 3(7.1) 1(3.4) 2(15.4)
边界 - 0.264

边缘光整

 21(50.0) 12(41.4) 9(69.2)

边界不清

 9(21.5) 6(20.7) 3(23.1)

分叶状或毛刺状

 8(19.0) 7(24.1) 1(7.7)

甲状腺外侵犯

 4(9.5) 4(13.8) 0(0)
纵横比 0.252 0.036

＞1

 25(59.5) 18(62.1) 7(53.8)

≤1

 17(40.5) 11(37.9) 6(46.2)
钙化 - 0.163

微小钙化

 7(16.7) 5(17.2) 2(15.4)

粗大钙化

 18(42.8) 15(51.8) 3(23.1)

无钙化

 17(40.5) 9(31.0) 8(61.5)
声晕 - 0.423

厚而光滑

 2(4.8) 2(6.9) 0(0)

薄而光滑

 1(2.4) 1(3.4) 0(0)

不规则

 4(9.5) 4(13.8) 0(0)

无晕

 35(83.3) 22(75.9) 13(100)
血流 - 0.001

丰富血流

 20(47.6) 19(65.5) 1(7.7)

少量血流

 10(23.8) 6(20.7) 4(30.8)

无血流

 12(28.6) 4(13.8) 8(61.5)
图3 甲状腺髓样癌伴颈部淋巴结转移46岁男性患者超声表现。图a为灰阶超声可见甲状腺右侧叶中部实性低回声结节，边界不清，内部可见多发粗大钙化；图b为灰阶超声可见右侧颈部Ⅲ区低回声结节，内部结构不清，可见多发钙化
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