甲状腺微小癌高频超声影像学特征及诊断价值

目的 探讨高频超声对甲状腺微小癌(TMC)的诊断价值.方法 回顾性分析经手术、病理证实84例TMC112个结节的二维超声表现及彩色多普勒血流显像(CDFI)特征.结果 术前TMC 超声诊断符合率为86.9%(73/84).112个结节中98个呈不规则低回声(87.5%);82个结节形态不规则(73.2%);74个瘤体边界不清或呈毛刺样(66.1%);60个结节内见微小钙化灶(53.6%);部分瘤体超声表现与上述特征有明显不同.CDFI示Ⅱ、Ⅲ型血流信号占66.1%(74/112),脉冲多普勒(PW)测最大流速(Vmax)和阻力指数(RI)的平均值分别为21.2cm/s和0.72.颈部淋巴结癌转移率为22.6%(19/84).结论 高频超声是检诊TMC的首选方法和最佳手段,任何单一声像图特征和CDFI表现对TMC的诊断意义有限,对"同病异影、同影异病"现象临床应注意鉴别和警惕.

Characteristics and diagnostic value of high frequency ultrasound imaging for thyroid microcarcinoma

Objective To study the diagnostic value of high frequency ultrasound for thyroid microcarcinoma(TMC).Methods Characteristics of 2D ultrasound and color Doppler blood flow imaging(CDFI)for 84 patients(112 nodules) were retrospectively analyzed.Results The accurate diagnosis rate of ultrasound was 86.9%(73/84)for TMC before operation.Of the 112 nodules,98(87.5%) were low echo nodules,82(73.2%) were irregular nodules,74(66.1%) had fuzzy or spicule-like boundaries,60(53.6%)showed microcalcification foci.The ultrasound findings in some tumor bodies were significantly different from those described above.The CDFI findings showed that typesⅡandⅢblood flow signals accounted for 66.1%(74/112).The mean value of maximal systolic blood flow velocity(Vmax)and resistance index(RI)measured by pulse Doppler were 21.2cm/s and 0.72,respectively.The metastatic rate of neck lymph node carcinoma was 22.6%(19/84).Conclusion High frequency ultrasound is the first choice of method for the diagnosis of TMC.Single ultrasound characteristics and CDFI findings are limited for the diagnosis of neck TMC.Attention should be paid to "different imaging of the same disease and identical imaging of a different disease" in differential diagnosis of TMC.