多参数MRI在甲状腺良恶性结节诊断中的应用价值

目的:探讨甲状腺多参数MRI在甲状腺结节良恶性鉴别诊断的应用价值。方法:回顾性分析2018年12月至2020年5月中国医学科学院北京协和医学院肿瘤医院深圳医院经手术病理证实的78例共91枚甲状腺结节的MRI表现,观察结节的部位、大小、形态、边界、信号、是否伴囊变、增强程度、强化方式及周围结构侵犯,测量ADC值,绘制动态...     

甲状腺常见单发结节CT多征象联合鉴别诊断

目的 探讨甲状腺常见良、恶性单发结节的CT平扫及单期增强影像特征,应用多征象联合的方法提高鉴别诊断水平.方法 搜集甲状腺单发结节患者61例(其中结节性甲状腺肿27例,腺瘤7例,甲状腺癌27例),比较分析良、恶性结节的影像征象(包括是否囊变、增强后结节与甲状腺组织的边界、钙化、甲状腺边缘腺体的完整性、增强扫描结节实性成分密度是否均匀及颈部有无异常淋巴结),进行x2检验及Logistic回归区分主要征象及次要征象,使用主次多征象联合方法判断结节性质.结果 经x2检验良恶性甲状腺结节以上影像征象的差异均有统计学意义(P＜ 0.05);Logistic回归分析显示,无囊变、增强后结节与正常甲状腺组织边界不清晰及颈部异常淋巴结为甲状腺恶性结节的危险征象(OR值分别为10.672、27.188、94.000),上述3个征象作为鉴别甲状腺结节性质的主要征象,其他3个征象作为次要征象,以2个主要征象加1个次要征象或1个主要征象加3个次要征象作为诊断恶性结节的最低标准,诊断本组恶性结节敏感度为88.9％,特异度为88.2％,阳性预测值为85.7％,阴性预测值为90.9％,总体诊断符合率为88.5％.结论 CT平扫及单期增强检查对评估甲状腺常见单发结节性质具有重要价值,应用主次多征象联合判断的方法可获得较高的诊断准确率.     

基于CT影像特征的列线图对甲状腺良恶性结节鉴别诊断的价值

目的 探讨基于CT影像特征的列线图鉴别甲状腺良恶性结节的诊断价值。方法 回顾性分析经手术病理证实的262例甲状腺结节患者的临床和影像资料，其中良性组114例，恶性组148例，比较两组患者的临床资料及CT影像特征，包括结节的数目、位置、形态、边界、成分、钙化、包膜是否完整、纵横比(轴位及冠状位)、强化方式及平扫、动脉期、静脉期CT值，采用多因素Logistic回归分析筛选鉴别甲状腺良恶性结节的独立影响因素并构建列线图模型，采用受试者工作特征曲线(ROC)、校准曲线验证该模型的性能。结果 甲状腺良恶性结节均好发于女性，良性结节组占比略高于恶性结节组，差异无统计学意义(P>0.05);但良性结节组的平均年龄大于恶性结节组，且差异有统计学意义(P<0.05)。良性结节组多位于腺体内，形态较规则，边界清晰，包膜完整；恶性结节组多位于包膜下，形态不规则，边界模糊，包膜不完整。两组结节的位置、形态、边界、成分、钙化、包膜是否完整、轴位纵横比及动脉期CT值、静脉期CT值差异有统计学意义(P<0.05);两组结节的数目、强化方式、冠状位纵横比及平扫CT值差异无统计学意义(P>0....     

高频彩色多普勒超声对甲状腺结节诊断的临床意义

目的探讨高频彩色多普勒超声对甲状腺结节诊断的临床意义。方法分析200例经病理证实的甲状腺结节患者(261个结节)的声像特征。比较良性和恶性甲状腺结节的超声征象的差异。结果甲状腺良、恶性结节在性别及发病部位中的差异无统计学意义(P>0.05),在数目、形态、边界、声晕、微小钙化、血流分型及淋巴结转移方面的差异有显著统计学意义(均P<0.01)。良性甲状腺结节多为单发,形态规则,边界清晰,有声晕,血流分型多为Ⅰ或Ⅱ型,淋巴结转移率低;恶性甲状腺结节多为多发,形态不规则,边界不清晰,无声晕,血流分型多为Ⅲ型,淋巴结转移率高。结论高频彩色多普勒超声检测应主要从微小钙化、血流分型及淋巴结转移方面诊断与鉴别良性和恶性甲状腺结节。     

甲状腺良恶性结节的CT鉴别诊断

目的：分析甲状腺结节的CT表现,探讨CT扫描在甲状腺良恶性结节鉴别诊断中的价值。方法：对照回顾性分析108例（120个结节）甲状腺结节的CT表现,包括结节的边缘、密度、钙化、包膜、强化方式、强化程度等,比较良恶性结节之间的差异并与病理结果进行对比分析。结果：在结节边缘、微小钙化、包膜、结节数量等方面,良恶性结节之间差异有统计学意义（P〈0.05）,结节边缘不清、微小钙化、无包膜、病灶单发对恶性结节诊断的敏感度分别为45.5%、36.4%、100%、90.9%,特异度分别为83.7%、94.9%、22.4%、36.0%,准确度分别为83.6%、91.8%、36.7%、48.1%。结论：甲状腺良恶性结节的CT表现有一定特征性,边缘不清和微小钙化是甲状腺恶性结节的特征性征象,完整包膜和囊性结节是良性结节的特征性征象。     

小甲状腺癌的CT表现分析

目的 分析小甲状腺癌的CT表现,探讨其CT征象.方法 对40例CT平扫及增强扫描后经手术病理证实的直径在1.0～2.0 cm的小甲状腺癌的CT表现进行回顾性分析.结果 (1)38例为单发癌灶,2例为双侧双发癌灶;2例合并对侧结节性甲状腺肿,1例合并对侧甲状腺腺瘤;(2)边缘光整,包膜完整者8个病灶;边缘不光整,包膜不完整者34个病灶,但未见明显周围软组织及重要器官侵犯;(3)病灶平扫密度均匀或较均匀,未见明显出血或坏死囊变区;病灶内伴钙化者30个病灶,钙化形态各异,以砂粒状多见(20个病灶),也可见不规则结节状、蛋壳状或桑椹状钙化;(4)增强后41个病灶明显强化(强化幅度＞40 HU,CT值在90～140 HU之间),其中38个病灶均匀强化,3个病灶中央强化明显,边缘可见一环形低密度影,呈镶嵌征;(5)伴颈部淋巴结肿大者24例(60.0%),可呈实性、囊实性或囊性,增强后可呈均匀明显强化、不规则环形强化或壁结节样强化;8例淋巴结内可见砂粒状、结节状或蛋壳状钙化.结论 砂粒状钙化、甲状腺包膜不完整、强化明显的甲状腺实性结节及伴钙化、囊变、实性部分明显强化的颈部肿大淋巴结为小甲状腺癌较为特征性的CT表现.     

甲状腺囊实性结节良恶性的高频超声鉴别诊断价值

目的 探讨甲状腺囊实性结节良恶性的高频超声鉴别诊断价值.方法 回顾性选取2017年3月至2018年11月70例甲状腺囊实性结节患者的临床资料,以手术病理检查结果为金标准,所有患者均行高频超声检查,分析高频超声图像特征、检出率、灵敏度及特异度.结果 高频超声检查诊断甲状腺囊实性结节良恶性检出率为100％(98/98)、特...     

多层螺旋CT对甲状腺良恶性肿瘤的诊断及鉴别诊断价值

目的探讨多层螺旋CT在甲状腺结节良恶性鉴别与诊断中的临床应用价值。方法对68例经手术病理确诊的甲状腺结节患者的CT表现及病理结果进行对比分析。结果良恶性甲状腺肿瘤多层螺旋CT表现为:1密度:良性结节中有61.29%表现为不均匀,恶性结节中有60.00%表现为不均匀;2囊变程度:62个良性结节中48个(占77.42%)表现为囊实性、实性,而恶性结节均表现为囊实性、实性;3病变边缘:25个良性结节边缘规则,占40.32%;恶性结节中3个表现为规则,占15.00%;4砂粒样钙化:12个良性结节表现为砂粒样钙化,占19.35%,而恶性结节中50.00%表现为砂粒样钙化;5强化程度:55个良性结节的强化程度等于或高于甲状腺,18个恶性结节的强化程度低于甲状腺。经统计学分析发现恶性结节与良性结节在囊变程度、病变边缘、砂粒样钙化、强化程度等CT表现中存在明显差异,且差异具有统计学意义。良性结节在BF、MTT两个灌注参数方面与恶性结节比较存在显著差异,且差异具有统计学意义;而在BV、PS及TTP等方面比较则无显著差异。多层螺旋CT诊断甲状腺结节的敏感性为86.67%,特异性为90.57%,准确性为89.71%。结论多层螺旋CT对甲状腺结节的诊断可早发现,临床应用中方便快捷。     

甲状腺良恶性结节的超声鉴别诊断

目的探讨甲状腺良恶性结节声像图表现及鉴别诊断。方法对经手术病理证实的60例甲状腺良性结节和21例恶性结节的超声二维及彩色多普勒血流声像图（CDFI）表现进行对比分析。结果良恶性结甲在形态,边界,内部回声,彩色血流分布,阻力指数,颈部淋巴结肿大等指标有统计学显著性差异。结论形态不规整,边界不清,内部不均匀低回声,微钙化,内部血流丰富而周边少或无血流,RI〉0．7等可以作为恶性结节的主要指标;不清晰、不完整、宽窄不一的晕环及颈部淋巴结肿大高度提示恶性;囊性结节可作为排除恶性指标。微小乳头状癌结节及良恶性并发的多源性结节常常会被误诊。     

彩色多普勒超声诊断良恶性甲状腺结节的参考价值

目的分析良、恶性甲状腺结节的彩色多普勒超声表现,以提高超声诊断和鉴别诊断良、恶性甲状腺结节的价值。方法回顾性分析经手术、病理明确诊断的157个良、恶性甲状腺结节的彩色多普勒超声表现,良、恶性结节的形态、回声、钙化特点、彩色多普勒血流图血流信号分布等。结果157个甲状腺结节经病理诊断,其中 90个为良性结节,67个为恶性结节;本组病例彩色多普勒超声检查的特异性为92.2%,敏感性为80.6%,诊断符合率为87.2%;彩色多普勒超声图像显示甲状腺良、恶性结节的形态、边界、包膜、回声、血流信号分布、内部钙化情况、血流阻力指数值比较,差异比较均具有统计学意义（P<0.05）。结论彩色多普勒超声可诊断甲状腺病变,依据重要的参考指标,可评价甲状腺结节的良、恶性。     

Thyroid ultrasonography. Part 2: nodules

This article reviews common ultrasonographic patterns identified in both benign and malignant thyroid nodules. Categorizing nodules into benign and malignant patterns may be helpful to decide if ultrasound-guided fine-needle aspiration (FNA) should be performed. In addition, the FNA biopsy guidelines issued by major organizations are reviewed.     

2020 Imaging Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer: Korean Society of Thyroid Radiology

Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.     

Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers: Consensus Statement and Recommendations

Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology has developed recommendations for the optimal use of radiofrequency ablation for thyroid nodules. These recommendations are based on a comprehensive analysis of the current literature, the results of multicenter studies, and expert consensus.     

Ultrasonography and the Ultrasound-Based Management of Thyroid Nodules: Consensus Statement and Recommendations

The detection of thyroid nodules has become more common with the widespread use of ultrasonography (US). US is the mainstay for detecting and making the differential diagnosis of thyroid nodules as well as for providing guidance for a biopsy. The Task Force on Thyroid Nodules of the Korean Society of Thyroid Radiology has developed recommendations for the US diagnosis and US-based management of thyroid nodules. The review and recommendations in this report have been based on a comprehensive analysis of the current literature, the results of multicenter studies and from the consensus of experts.     

Reproducibility of whole-body <Superscript>131</Superscript>I scan and serum thyrotropin and stimulated thyroglobulin values in patients studied twice after injection of recombinant human thyrotropin

Purpose Recombinant human TSH (rhTSH) is used to increase radioiodine uptake during imaging of thyroid cancer, obviating the need to render the patient hypothyroid. We assessed the reproducibility of radioiodine uptake, serum thyrotropin (TSH), and stimulated serum thyroglobulin (Tg) levels after rhTSH administration. Methods A retrospective review was performed of patients at Stanford who underwent whole-body ¹³¹I scanning for surveillance of thyroid cancer twice after thyroidectomy and ¹³¹I ablation, with rhTSH prior to each scan. Forty-eight hour radioiodine uptake, peak serum TSH, and stimulated serum Tg levels for each study were recorded. Paired t tests and correlation analysis were used to assess interexamination repeatability. Results Twenty-three patients underwent two scintiscans with rhTSH, for a total of 46 exams. There was no significant difference between percent uptake at 48 h in the paired exams (p=0.40). Serum TSH level was measured in 45 of 46 exams; TSH exceeded 50 mIU/l in all cases, and there was no significant difference between paired TSH levels (p=0.93). All patients had stimulated serum Tg levels measured, with no significant difference between paired Tg levels (p=0.40); after excluding one patient whose Tg changed from 15.8 ng/ml to undetectable between scans without interval treatment, the p value rose to 0.95. There was a strong correlation among paired uptake values (r=0.85, p<0.0001), peak serum TSH (r=0.69, p=0.0003), and stimulated Tg levels (r=0.81, p<0.0001). No discordant scan interpretations were reported. Conclusion Forty-eight hour radioiodine uptake, peak serum TSH, and stimulated serum Tg levels after administration of rhTSH are repeatable between studies, demonstrating reproducibility of diagnostic results without rendering patients hypothyroid.     

对甲状腺良性结节高频超声误诊原因的初步探讨

目的:探讨各不同病理类型良性甲状腺结节的超声声像图表现;探讨超声在甲状腺结节良、恶性鉴别诊断中,出现假阳性的主要原因及可行的避免误诊的方法。方法:经手术病理证实的172例甲状腺良性结节,42例甲状腺微灶癌和26例甲状腺乳头状癌。对比分析超声误诊的43例良性结节、42例甲状腺微灶癌和26例甲状腺乳头状癌的声像图表现、对甲状腺结节的钙化模式进行分型,探讨超声误诊的主要原因。结果:甲状腺恶性结节内伴发钙化的比例明显高于甲状腺良性结节。甲状腺结节不伴发钙化组的诊断准确性明显高于伴发钙化组。结论:结节内伴发的钙化灶已成为影响高频超声良恶性鉴别诊断准确性,尤其是特异性的主要原因。严格定义III型钙化的诊断标准,可以减少部分的假阳性的发生。     

Utilidad de la biopsia con aguja gruesa ecoguiada en nódulos tiroideos con punción aspirativa con aguja fina no diagnóstica

ObjectivesTo determine the diagnostic performance of ultrasound-guided core-needle biopsy in thyroid nodules after two inconclusive fine-needle aspiration biopsies. To assess the complications of core-needle biopsy. To analyze the reliability of diagnoses obtained with core-needle biopsy. To measure the economic impact of avoiding lobectomies in patients with benign core-needle biopsy findings.Material and methodsThis retrospective study reviewed 195 core-needle biopsies in 178 patients. To determine the reliability of the core-needle biopsy findings, we compared the diagnosis from the core-needle specimen versus the histologic findings in the surgical specimens when core-needle biopsy findings indicated malignancy or follicular proliferation and versus the stability of the nodule on ultrasound follow-up for one year when core-biopsy findings indicated benignity.ResultsCore-needle biopsy yielded a diagnosis for 179 (91.7%) nodules, of which 122 (62.5%) were classified as benign, 50 (25.6%) as follicular proliferation, and 7 (3.6%) as malignant. The findings were inconclusive for 16 (8.3%) nodules. Minor complications were observed in 4 (2%) patients; no major complications were observed. The sensitivity of core-needle biopsy for the diagnosis of thyroid cancer was low (42.8%) because the technique was unable to detect capsular or vascular invasion, although the specificity and positive predictive value (PPV) were 100%. However, when we considered histologic findings of malignancy and follicular proliferation positive because both require surgical resection, the sensitivity increased to 97.5% and the PPV decreased to 83.3%. There were 79 nodules with ultrasound follow-up for at least one year; 76 (96.2%) had negative core-needle biopsy findings, and 74 (97.3%) of these remained stable. The negative predictive value (NPV) for malignancy of the benign nodules was 98.6%, although no malignant transformation was observed. Nevertheless, the results of the statistical analysis do not allow us to recommend forgoing ultrasound follow-up in patients with benign core-biopsy findings. The cost savings of avoiding lobectomy in patients with benign nodules and stability of the nodule on ultrasound follow-up for at least one year was about 90%.ConclusionsCore-needle biopsy of thyroid nodules is effective because it diagnoses more than 90% of nodules with inconclusive findings after fine-needle aspiration biopsy. It is safe if done by experienced professionals. It is reliable because it yields 100% specificity and 100% PPV for malignant nodule, 97.5% sensitivity for the detection of nodules that require surgery, and 98.6% NPV for benign nodules. It is efficient because it reduces the costs of diagnosis compared to lobectomy in benign nodules.     

超声积分在甲状腺良恶性结节的鉴别诊断中的应用

目的：探讨超声积分在甲状腺良恶性结节的鉴别诊断中的应用,提高诊断符合率。方法：对经病理诊断的41例甲状腺癌患者和187例甲状腺良性疾病患者的超声二维图像进行分析,并给予评分。计算每个结节的总分值,比较甲状腺良恶性结节在超声图像上有无明显差异,比较甲状腺良恶性结节的超声积分。结果：甲状腺良恶性结节在超声图像上有明显差异;恶性结节的得分高于良性结节,总分值大于5.5分为临界线,其敏感度为93.9%,特异度94.7%。结论：超声在甲状腺良恶性结节的鉴别诊断中具有较高的临床价值,采用超声积分对甲状腺结节进行量化分析,提高甲状腺癌的诊断符合率。     

Thyroid dysgenesis in monozygotic twins: Variants identified by scintigraphy

The unusual occurrence of neonatal hypothyroidism in monozygotic twins is reported. Scintigraphy demonstrated that permanent hypothyroidism in one resulted from an ectopic suprahyoid thyroid, while in the other, the transient hypothyroid state was associated with thyroid hemiagenesis. These findings suggest that the anomalies represent variants of the same developmental aberration.     

超声对甲状腺乳头状腺瘤与甲状腺癌的诊断分析

目的:分析超声对甲状腺乳头状腺瘤与甲状腺癌的诊断及鉴别诊断。方法:对13例甲状腺乳头状腺瘤患者与21例甲状腺癌患者的声像图进行分析,所用病例经手术、病理证实。结果:超声显示甲状腺乳头状腺瘤包膜完整,无回声内可见乳头状突起,其内及周边有丰富低速血流信号;甲状腺癌肿块无完整包膜,边界模糊,有的呈“蟹足样”改变,内可见细小成簇钙化点,有的肿块内可伴液化,瘤体内及周边见条状高速血流信号。结论:超声检查尤其是彩色及频谱多普勒对甲状腺乳头状腺瘤及甲状腺癌的诊断及鉴别诊断具有重要价值。