核素显像随访诊断甲状腺结节癌变（附19例报告）

目的：探讨核素显像在随访诊断甲状腺结节癌变中的价值。方法：回顾性分析19例经手术病理证实为甲状腺结节癌变患者的临床资料和核素显像表现。结果：19例患者，手术前核素显像表现为单发或多发的“冷”结节或“凉”结节，考虑恶变可能性大，手术病理结果显示：19例甲状腺结节恶变中，13例为甲状腺乳头状癌，4例为滤泡癌及2例未分化癌。结论：核素显像随访诊断甲状腺结节癌变具有重要的意义和价值。     

核素显像在甲状腺疾病诊断中的应用

甲状腺疾病是一种常见多发病,其发病率并没有随着生活水平的提高而下降,相反由于环境因素、工作压力及饮食习惯等的改变,甲状腺疾病的检出率逐年增加。目前约20人中即有1人患有某种程度的甲状腺疾病．据不完全统计全世界约有2亿多人患病。临床上常见的甲状腺疾病包括甲状腺功能亢进症、甲状腺结节、甲状腺腺瘤、甲状腺癌、慢性甲状腺炎（桥本氏甲状腺炎）、亚急性甲状腺炎、急性化脓性甲状腺炎、单纯性甲状腺肿、缺碘性甲状腺肿、甲状腺功能减退症、甲状腺囊肿、异位甲状腺等。     

超声、核素显像与两者联合诊断甲状腺结节的价值比较

目的探讨超声、核素显像与两者联合对甲状腺结节的诊断价值和意义。方法对102个手术切除的甲状腺结节的超声、核素显像和两者联合应用与病理诊断结果进行回顾性分析。结果单纯超声诊断甲状腺结节的符合率为84.3%,核素显像的诊断符合率为80.4%,两者联合的诊断符合率为91.2%。对于判别结节良恶性,两者联合与单纯超声、单纯核素显像相比,差异无统计学意义(P>0.05)。结论两者联合虽然不能明显提高诊断符合率,但由于超声和核素成像机制的不同,两者联合可对甲状腺结节性质做出较为全面的准确诊断。     

甲状腺体积简易检测方法的研究

本文根据１０３例甲状腺疾病患者及２１６例健康受检者的甲状腺超声显像观察，提出了甲状腺侧叶近似于“上锥＋中柱＋下锥”的三段复合体几何构型设想。根据这种构型设想，由数学方法导出了甲状腺侧叶的体积公式：ＶＩ＝〔１３（ｈ－ｈｃ）＋ｈｃ〕·Ａ及其简化式：ＶＩ＝０．６４７Ａｈ。式中，ｈ（ｃｍ）为甲状腺侧叶上下径，ｈｃ（ｃｍ）为中柱段之高，Ａ（ｃｍ２）为侧叶最大横断面积。用这两个公式计算的甲状腺体积与甲状腺手术实测体积之间存在着高度相关关系（ｒ＝０．９９０７，Ｐ＜０．００１及ｒ＝０．９４３９，Ｐ＜０．００１），两个公式的平均相对误差分别为５．７％及８．６％。     

核素显像和B超诊断甲状腺结节的比较研究

为探讨甲状腺结节的诊断方法，对１００例甲状腺结节进行核素显像和Ｂ超检查。将单纯核素显像，单纯Ｂ超检查以及核素显像和Ｂ超联合检查的术前诊断结果，与术后病理结果进行比较。结果；联合检查对８１例良性结节和１９例恶性结节的术前诊断符合率分别为９６．３％和９４．７％，优于单纯Ｂ超和单纯核素显像检查，均有显著差异。     

核素显像和B超诊断甲状腺结节的比较研究

为探讨甲状腺结节的诊断方法，对１００例甲状腺结节进行核素显像和Ｂ超检查。将单纯核素显像、单纯Ｂ超检查以及核素显像和Ｂ超联合检查的术前诊断结果，与术后病理结果进行比较。结果：联合检查对８１例良性结节和１９例恶性结节的术前诊断符合率分别为９６３％和９４７％，优于单纯Ｂ超和单纯核素显像检查（Ｐ＜００１和Ｐ＜００５），均有显著差异。结论：联合检查对甲状腺结节的术前定性诊断有重要的临床价值。     

三维超声体积自动测量系统精确测量甲状腺体积

目的 观察三维超声体积自动测量系统(VOCALTM)在甲状腺体积精确测量中的应用价值.方法 应用GE Voluson 730三维超声成像系统对水囊模型及活体甲状腺体积进行二维和三维测量.结果 ①三维超声测量的水囊模型体积与实际体积之间的相关性明显好于二维超声测量.三维超声的测量结果 更接近于实际体积.②在活体甲状腺上,以三维超声精确测量的甲状腺体积作为参考标准,利用直线回归方程推导出一个更为精确的二维超声测量甲状腺的新体积公式,根据此公式测算得出的甲状腺体积较传统的椭球体公式测算结果 误差小.结论 VOCALTM技术在精确测量甲状腺体积方面有较高的准确性和可重复性.     

65例亚急性甲状腺炎的甲状腺显像与B超检查结果的对比研究

本文对 6 5例亚急性甲状腺炎 (简称亚甲炎 )的甲状腺显像和 B超检查结果进行对比 ,旨在探讨两种检查方法在亚甲炎诊断中的临床价值。1　资料与方法1.1　一般资料　甲状腺细针抽吸细胞学检查确诊的亚甲炎6 5例 ,均为女性 ;年龄 17～ 6 5岁 ;病史 3天～ 1.5年。均有甲状腺肿大、疼痛、触痛、血沉升高。 47例低热 ,5 1例白细胞增高 ,43例有轻度代谢亢进表现。均经血清 FT3、FT4、TSH测定。 2 4小时吸 1 31　 率均减低。1.2　甲状腺显像　采用 SIEMENS orbit SPECT仪 ,静脉注射 99m Tc O- 4 185 MBq后 30分钟 ,用低能平行孔通用型准…     

干燥综合征腮腺超声与核素动态显像及唇腺活检的对比研究

目的探讨超声与核素动态显像检查在诊断干燥综合征中的作用和价值。方法对98例干燥综合征(SS)和30例非干燥综合征患者分别行超声和核素动态显像检查;所有病例均经唇腺活检病理证实。结果SS组患者腮腺声像图表现较为特异,与对照组比较腮腺厚度、实质点状回声增粗率、实质回声不均匀率、实质回声减低率增加,以Ⅲ、Ⅳ级多见,共56例。彩色多普勒血流成像(CDFI)显示SS组收缩期峰值流速(PSV)明显高于对照组,阻力指数RI则下降(P<0.01)。超声诊断的敏感度为93%,特异度91%;核素动态显像的敏感度为86%,特异度92%,两组比较差异无统计学意义(P>0.05)。结论对临床疑诊为干燥综合征的患者应先行超声检查,若超声表现不典型可行唇腺活检确诊。     

超声心动图与核素心室显像测定心力衰竭患者左心功能的对比研究

目的　评价超声心动图 (UCG)与平衡法放射性核素心室显像 (ERVI)测定心力衰竭病人左心功能的应用价值。方法　以UCG测量 2 9例心力衰竭病人左室内径 (LVDd) ,并将其分为两组 ,A组 :左室轻度扩大 ,LVDd≤ 60mm ;B组 :左室重度扩大 ,LVDd >60mm。用UCG与核素心室显像测 2 9例心力衰竭病人及 15例正常对照组的左室射血分数 (LVEF)。结果　正常对照组两种检测方法LVEF有相关性 (r =0 .79,P <0 .0 5 )。A组两种检测方法LVEF有相关性 (r =0 .66,P <0 .0 5 )。B组两种检测方法LVEF无相关性 (r =0 .42 ,P >0 .0 5 )。结论　左室内径正常或轻度扩大者可选用超声心动图检测左心功能。左室内径重度扩大的心力衰竭患者宜采用核素心室显像测定左心功能 ,以获得准确数据。     

超声测定甲状腺重量准确性研究

目的:研究超声法测定甲状腺重量(w(?))的准确性并分析使W_E产生误差的原因。方法:应用超声法测定了22例正常人和63例甲状腺机能亢进症(甲亢)病人甲状腺重量,并将甲亢组按X-CT测值(W(?))分四组对照分析结果:除W(?)≥70克组,W(?)与W_L间无相关关系外(γ=0.183,P＞0.05),其余各组,W(?)与W(?)间无差异(P＞0.05,并呈良好相关(γ=0.704~0.929,P均＜0.005),但尚存在一定的误差,51例小于70克甲亢病例误差率为(0.03±13.5%结论:B超可作为甲状腺重量测定的一种方法,它具有准确、简便、重复性好等优点,但当甲状腺重量≥70克时,超声测值偏小。     

Technetium-99m SPECT/US Hybrid Imaging Compared with Conventional Diagnostic Thyroid Imaging with Scintigraphy and Ultrasound

Side-by-side evaluation of thyroid ultrasound (US) and ^99mTcO₄ scintigraphy can lead to uncertainties in the correct topographic assignment of thyroid nodules. The aim of this study was to evaluate ^99mTcO₄ single-photon emission computed tomography/ultrasound (SPECT/US) fusion imaging. Seventy-nine patients were prospectively investigated. If conventional diagnostics of the thyroid gland (B-mode-US, scintigraphy) produced unclear findings, SPECT was performed and transferred to a US device for real-time sensor-navigated 3-D fusion US investigation. The data sets were manually matched according to their contours. Finally, SPECT/US versus conventional diagnostics was rated using an ordinal 4-point scale (SPECT/US >> conventional diagnostics, SPECT/US > conventional diagnostics, SPECT/US?=?conventional diagnostics, SPECT/US < conventional diagnostics). SPECT/US was superior (>>, >) in 84% and equivalent (=) in 16% of the cases, respectively. No statistically significant differences were observed for uni-, bi- and multinodular goiters (p ≥ 0.3). In 67%, the respective problem that arose after conventional diagnostics was clarified by SPECT/US. SPECT/US was feasible and was helpful for the clarification of uncertain functionality assessments of thyroid nodules.     

X-CT计算甲状腺体积(重量)方法的探讨

目的：探讨Ｘ－ＣＴ扫描计算甲亢患者甲状腺重量，为临床１３１Ｉ治疗甲亢计算甲状腺重量提供较准确的方法。方法：采用东芝ＴＣＴ－３００／ＥＺ全身ＣＴ扫描系统，４９例甲亢病人１３１Ｉ治疗前行甲状腺扫描，计算甲状腺体积（重量）。结果：４９例甲亢病人ＣＴ扫描计算的甲状腺重量为５１．５９９±２９．２０（１６．１６～１２６．８４）ｇ，与Ｂ超检查结果［４５．６３５±２３．０２（１４．９８～１０１．２９）ｇ］进行比较，ＣＴ测值要大于Ｂ超测值，但差异无显著性（Ｐ＞０．０５），两者间相关性良好（ｒ＝０．８８６，Ｐ＜０．００１）。结论：ＣＴ能够准确计算甲状腺体积（重量），为临床１３１Ｉ治疗甲亢时计算甲状腺重量开辟了另一条简单易行且较准确的途径和方法     

Ultrasound Strain Elastography for Circumscribed Solid Thyroid Nodules without Malignant Features Categorized as Indeterminate by B-Mode Ultrasound

The aim of this study was to evaluate the diagnostic performance of ultrasound strain elastography (USE) for circumscribed solid thyroid nodules without malignant or benign features seen on US. This retrospective study included 197 thyroid nodules in 196 patients who underwent USE with color mapping and strain ratio measurement between 2010 and 2014. Of the 197 nodules, 24 (12.2%) were malignant. No significant differences in color mapping or strain ratio were observed between benign and malignant nodules. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 29.2% (95% confidence interval [CI]: 13.8%–49.4%), 77.5% (95% CI: 75.3%–80.3%), 15.2% (95% CI: 7.2%–25.8%), 88.7% (95% CI: 86.3%–92.0%), and 71.6% (95% CI: 67.8%–76.5%) for color mapping and 50.0% (95% CI: 30.%–69.5%), 57.2% (95% CI: 54.5%–59.9%), 14.0% (95% CI: 8.5%–18.4%), 89.2% (95% CI: 85.0%–93.4%) and 56.3% (95% CI: 51.6%–61.1%) for strain ratio measurement, respectively. USE with color mapping and strain ratio measurement has a limited ability to differentiate benign from malignant nodules for circumscribed solid thyroid nodules without definite malignant features categorized as indeterminate by B-mode US.     

Multimodal Evaluation of 2-D and 3-D Ultrasound,Computed Tomography and Magnetic Resonance Imaging in Measurements of the Thyroid Volume Using Universally Applicable Cross-Sectional Imaging Software: A Phantom Study

A precise estimate of thyroid volume is necessary for making adequate therapeutic decisions and planning, as well as for monitoring therapy response. The goal of this study was to compare the precision of different volumetry methods. Thyroid-shaped phantoms were subjected to volumetry via 2-D and 3-D ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). The 3-D US scans were performed using sensor navigation and mechanical sweeping methods. Volumetry calculation ensued with the conventional ellipsoid model and the manual tracing method. The study confirmed the superiority of manual tracing with CT and MRI volumetry of the thyroid, but extended this knowledge also to the superiority of the 3-D US method, regardless of whether sensor navigation or mechanical sweeping is used. A novel aspect was successful use of the same universally applicable cross-imaging software for all modalities.     

甲状腺结节超声图像特征

本文对５８７例经手术病理证实的各类甲状腺结节的超声图像特征、边界以及肿瘤内及肿瘤周边血供的观察进行综合评估，以建立超声诊断标准。超声诊断敏感性为９８．８％（５８０／５８７），甲状腺癌的诊断符合率为３７．３％（３１／８３）。腺瘤及结节以多发性为主（６２．９％，３０２／４８０），恶性则以单发为主。多源性肿块的存在，增加了诊断的难度。     

Logistic Regression Analysis of Contrast-Enhanced Ultrasound and Conventional Ultrasound Characteristics of Sub-centimeter Thyroid Nodules

The purpose of the study described here was to determine specific characteristics of thyroid microcarcinoma (TMC) and explore the value of contrast-enhanced ultrasound (CEUS) combined with conventional ultrasound (US) in the diagnosis of TMC. Characteristics of 63 patients with TMC and 39 with benign sub-centimeter thyroid nodules were retrospectively analyzed. Multivariate logistic regression analysis was performed to determine independent risk factors. Four variables were included in the logistic regression models: age, shape, blood flow distribution and enhancement pattern. The area under the receiver operating characteristic curve was 0.919. With 0.113 selected as the cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 90.5%, 82.1%, 89.1%, 84.2% and 87.3%, respectively. Independent risk factors for TMC determined with the combination of CEUS and conventional US were age, shape, blood flow distribution and enhancement pattern. Age was negatively correlated with malignancy, whereas shape, blood flow distribution and enhancement pattern were positively correlated. The logistic regression model involving CEUS and conventional US was found to be effective in the diagnosis of sub-centimeter thyroid nodules.     

超声显像和CT测量前列腺体积与重量的准确性比较

30例前列腺增生症病人，术前分别采用耻骨上超声显像及CT测量其体积和重量，并与术后标本重量对照，观察其准确性。结果表明两者均可较准确地测量前列腺体积和重量。但是耻骨上超声显像测量法的准确性优于CT测量法，经统计学处理前者相关系数r=0．9810（P＜0．001），后者相关数r=0．8311（P＜0.01），而且超声显像具有方法简便，易于推广，是一种可以信赖的方法。     

Abdominal Aortic Aneurysm Imaging with 3-D Ultrasound: 3-D-Based Maximum Diameter Measurement and Volume Quantification

The clinical reliability of 3-D ultrasound imaging (3-DUS) in quantification of abdominal aortic aneurysm (AAA) was evaluated. B-mode and 3-DUS images of AAAs were acquired for 42 patients. AAAs were segmented. A 3-D-based maximum diameter (Max3-D) and partial volume (Vol30) were defined and quantified. Comparisons between 2-D (Max2-D) and 3-D diameters and between orthogonal acquisitions were performed. Intra- and inter-observer reproducibility was evaluated. Intra- and inter-observer coefficients of repeatability (CRs) were less than 5.18 mm for Max3-D. Intra-observer and inter-observer CRs were respectively less than 6.16 and 8.71 mL for Vol30. The mean of normalized errors of Vol30 was around 7%. Correlation between Max2-D and Max3-D was 0.988 (p < 0.0001). Max3-D and Vol30 were not influenced by a probe rotation of 90°. Use of 3-DUS to quantify AAA is a new approach in clinical practice. The present study proposed and evaluated dedicated parameters. Their reproducibility makes the technique clinically reliable.