探讨桥本甲状腺背景下伴有甲状腺恶性结节与伴有良性结节的腺体实质超声表现的不同，以鉴别桥本甲状腺炎合并结节的良恶性。

回顾性选取2012年12月至2019年6月在上海瑞金医院行甲状腺手术、经病理确诊为桥本甲状腺炎且术前超声影像资料完整的患者456例。以术后病理结果为"金标准"，将患者分为桥本甲状腺炎合并良性结节组175例；桥本甲状腺炎合并恶性结节组281例。对2组的甲状腺腺体大小、实质回声类型及实质血供进行比较分析。

合并恶性结节的患者甲状腺两腺叶的前后径、左右径及峡部厚度均小于合并良性结节的患者（P均<0.01）。恶性结节组甲状腺实质最常见的回声类型为网格样改变（112/281，39.9%），而良性结节组最常见的为斑片状减低（80/175，45.7%）。良性结节组中斑片状减低型和结节样改变型的占比大于恶性结节组，差异均有统计学意义（χ²=3.986、4.100，P均<0.05），恶性结节组的网格样改变型占比大于良性结节组，且差异有统计学意义（χ²=4.818，P<0.05）。恶性结节组最常见的是血供类型为无明显改变或轻度增多型（180/281，64.1%），占比大于良性结节（64/175，36.6%）；良性结节组最常见的血供类型为中度增多型（85/175，48.6%），占比大于恶性结节（61/281，21.7%）；2组间比较差异均有统计学意义（χ²=32.748、35.753，P均<0.01）。

形态较小、实质呈网格样改变、血供正常或轻度增加的桥本甲状腺炎腺体背景更易伴发恶性结节，腺体的超声影像学评估有助于桥本甲状腺炎合并结节的良恶性鉴别。

To compare the ultrasonographic features of thyroid parenchyma of patients with Hashimoto thyroiditis (HT) concomitant with benign and malignant thyroid nodules to investigate if features of thyroid parenchyma can help diagnose malignant nodules in patients with HT.

A total of 456 patients who had HT concomitant with thyroid nodules and underwent thyroidectomy at Shanghai Ruijin Hospital between December 2012 and June 2019 were retrospectively included. The patients were divided into two groups: HT with benign nodules (n=175) and HT with malignant nodules (n=281). The size of the thyroid gland and echo type and blood supply of thyroid parenchyma were evaluated and compared between the two groups.

The anteroposterior diameter, transverse diameter, longitudinal diameter, and isthmus thickness of thyroid lobes in patients with malignant nodules were smaller than those in patients with benign nodules (P<0.01). The most common echo type of thyroid parenchyma in the malignant group was grid like changes (112/281, 39.9%), while the most common type in the benign group was micronodular hypoechoic changes (80/175, 45.7%). The percentages of patients with micronodular hypoechoic changes and nodular changes in the benign group were significantly higher than those in the malignant group (χ²=3.986 and 4.100, P<0.05). The percentage of patients with grid like changes in the malignant group was significantly higher than that in the benign group (χ²=4.818, P<0.05). The most common type of blood supply in the malignant group was normal or slight increase of blood supply (180/281, 64.1%), which was significantly more frequent than that in the benign group (64/175, 36.6%; χ²=32.748, P<0.01). In the benign group, moderately increased blood supply of the parenchyma is the most common type (85/175, 48.6%), which was significantly more frequent than that in the malignant group (61/281, 21.7%; χ²=35.753, P<0.01).

Evaluating the sonographic features of thyroid parenchyma is helpful to differentiate benign and malignant nodules in patients with HT. A smaller size of the thyroid gland and normal or slightly increased blood supply with grid like changes of the parenchyma often indicate a greater chance of having malignant nodules.