三维彩色血管能量成像在甲状腺良恶性结节中的诊断价值

目的观察甲状腺良恶性结节的三维彩色血管能量成像(3D-CPA)特点,探讨3D-CPA 在诊断甲状腺良恶性结节中的价值.资料与方法选择甲状腺结节患者46例,共67个结节,术前行3D-CPA 超声检查,依据术后病理结果将结节划分为结节性甲状腺肿、甲状腺腺瘤和甲状腺癌3组,分析良恶性结节的血流分布、走行规律及其周围腺体的血供情况.结果46例患者中,良性37例,包括结节性甲状腺肿33例共48个结节,甲状腺腺瘤4例共6个结节,恶性9例共13个结节.3D-CPA 显示良性结节血流分布以外周为主,走行自然,周围腺体血供相对不多,结节性甲状腺肿均未构成球形网状结构;甲状腺腺瘤瘤体血流灌注呈球形网状结构.恶性结节血管明显增粗,走行扭曲,且粗大杂乱,血运分布以内部为主.结论3D-CPA 可直观地显示甲状腺良恶性结节的立体形态、与周围组织的关系及血管的分布特点,有助于提高甲状腺良恶性结节的诊断水平,对其鉴别诊断具有一定价值.     

甲状腺结节性疾病的高频超声诊断价值

目的 :探讨高频超声对甲状腺结节良恶性的鉴别诊断价值。方法 :回顾性分析我院经手术病理及穿刺活检证实的120例甲状腺结节患者的超声图像,并进行对比,总结超声图像特点。结果 :术前超声诊断甲状腺良性结节82例,恶性结节38例;术后病理证实良性76例,恶性44例。结节形态规则或不规则,30例伴微小钙化,27例伴颈部淋巴结肿大,25例结节内见丰富血流信号。本组良性结节的血流RI≤0.7者68例(89.5%),恶性结节血流RI>0.7者40例(占90.9%)。结论:高频超声对甲状腺结节的良恶性诊断具有较高的敏感性,综合二维及彩色多普勒超声图像特点,可提高诊断准确率。     

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。     

甲状腺结节超声血流阻力指数与微血管密度相关性研究

目的:探讨甲状腺结节超声血流阻力指数(RI)与微血管密度(MVD)的相关性。方法:选择甲状腺良、恶性结节71例,术前应用彩色多普勒超声测定RI,术后采用免疫组织化学技术计算MVD,验证RI与MVD之间的相关性。结果:甲状腺良、恶性结节血流指数与微血管密度之间的相关系数为0.715,两者呈显著正相关(P<0.01);甲状腺恶性结节RI表现为高阻力,MVD亦呈高表达,与良性甲状腺结节差异显著(P<0.01);恶性结节中MVD的表达与淋巴结转移密切相关(P<0.05)。结论:RI及MVD联合检测对于判断甲状腺结节性质及其预后有重要参考价值。     

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。     

高频超声对甲状腺乳头状微癌的诊断价值

目的:探讨高频彩色多普勒超声对甲状腺乳头状微癌(papillary thyroid microcarcinoma,PTMC)的诊断价值。方法:回顾性分析经手术病理证实为PTMC的21例23个恶性结节的超声表现,包括结节的形状、边界、内部回声、钙化、纵横比、有无血流信号等情况;并与81个最大径≤1cm、有相似声像图表现的甲状腺良性结节进行比较。组间统计学分析采χ2检验。结果:统计学分析显示PTMC与良性结节在形状、边界、内部回声、微钙化、纵横比方面差异均有统计学意义(P<0.001)。PTMC组:43.5%形态欠规则或不规则,65.2%边界欠清或不清,91.3%为低回声,78.3%内部有微小钙化,60.9%纵横比≥1;而血流信号在2组中的显示率差异无统计学意义。结论:PTMC与良性结节的超声声像图表现具有一定的特征,超声能对手术前结节的良恶性作初步判断,为临床进一步处理提供有价值的信息。     

甲状腺结节CT灌注成像参数与微血管密度及血管内皮生长因子表达的相关性研究

目的 :分析甲状腺结节CT灌注参数与微血管密度(MVD)、血管内皮生长因子(VEGF)表达的相关性,探讨CT灌注成像在评价甲状腺结节血管生成中的应用价值。方法:选取经术后病理证实的甲状腺结节患者41例,均采用64排螺旋CT行常规CT平扫和灌注扫描,测得血流量(BF)、血容量(BV)、平均通过时间(MTT)及表面通透性(PS)值。术后标本行CD31、VEGF抗体免疫组织化学染色,分析甲状腺结节CT灌注成像参数与MVD及VEGF表达的相关性。结果:①恶性结节的BF明显高于良性结节,MTT较良性结节短,两者差异均有统计学意义(均P0.05),而两者BV、PS值差异均无统计学意义(均P 0.05)。②MVD在良恶性结节间差异无统计学意义(P 0.05),VEGF在良恶性结节间差异有统计学意义(P0.05)。③甲状腺结节MVD、VEGF与CT各灌注参数值间无明显相关性(均P 0.05)。结论:CT灌注成像在诊断甲状腺结节方面有一定的价值,但其术前无法反映甲状腺结节的MVD及VEGF。     

甲状腺乳头状癌的彩色多普勒超声血流特点

目的：探讨甲状腺乳头状癌的彩色多普勒超声（CDFI）血流表现的特点。方法：回顾性分析经术后病理证实的88例甲状腺乳头状癌患者的彩色多普勒超声图像,观察病灶内部回声,有无钙化,血流分布特点、血流形态,测量肿瘤内部血管阻力指数（RI）,收缩期峰值流速（Vmax）,并分析频谱的形态。结果：甲状腺乳头状癌结节内多为高血供（81．8％）,而微钙化与结节内部丰富血流同时出现具有特征性。甲状腺乳头状癌结节以结节内部血流为主（68．7％）,血流分布异常杂乱,结节内部更低回声区团块状异常丰富血流及无级别差异的分支血管的出现可提高对甲状腺乳头状癌的诊断。频谱多普勒峰值血流多出现于收缩期上升支的前1／3,RI〉0．7可作为甲状腺结节良恶性鉴别的指标。颈部转移淋巴结CDFI多为包膜下异常紊乱血流信号,并向内部分支,其血流丰富程度及血流形态与甲状腺内原发病灶相似。结论：甲状腺乳头状癌的彩色多普勒血流表现有一定的特点,将其与二维声像图结合可提高甲状腺乳头状癌的诊断率。     

软组织多形性透明变性血管扩张性肿瘤的临床病理学研究

目的：探讨软组织多形性透明变性血管扩张性肿瘤的临床病理学特征。方法：对软组织多形性透明变性血管扩张性肿瘤的临床资料、病理形态学、免疫组织化学染色进行观察，并结合相关文献加以分析。结果：肿瘤组织富含成簇分布的薄壁扩张血管，血管壁及血管周围有明显的透明样变性，血管之间为片状的多形性瘤细胞。罕见核分裂象，局部区域黏液变性，间质有肥大细胞等慢性炎细胞浸润。瘤细胞表达Vimentin，部分表达CD99，不表达CD34、S-100、SMA、bcl-2、EMA、CD68。结论：软组织多形性透明变性血管扩张性肿瘤是一种少见的低度恶性肿瘤，需要根治性切除和术后随访观察。鉴别诊断包括孤立性纤维性肿瘤、巨细胞血管纤维瘤、神经鞘瘤、恶性纤维组织细胞瘤以及肢端黏液样炎性纤维母细胞肉瘤等良恶性肿瘤。     

双源CT碘图与能谱曲线技术在甲状腺结节鉴别诊断中的应用

目的探讨双源CT碘图与能谱曲线技术在甲状腺结节鉴别诊断中的应用价值。方法回顾性分析58例经病理证实并行双能量模式(DECT)增强扫描的甲状腺结节患者的影像资料,利用"Liver VNC""Monoenergytic"软件处理得到碘图与能谱曲线,对甲状腺结节碘图和能谱曲线进行比较研究。结果良性结节的碘含量明显低于正常甲状腺组织高于恶性结节,甲状腺良恶性结节内实性成分之间的碘含量差异有统计学意义(P0.05);良性组所有结节单能谱成像病变实性成分呈下降型曲线,与正常甲状腺组织能谱走行一致,恶性组呈上升型曲线,少部分表现下降型曲线。良性组曲线斜率在三个期相均大于恶性组,在平扫和动脉期,两组间的曲线斜率两两比较差异均有统计学意义(P0.05);双能CT检查的灵敏度为88.5%,特异性为92.9%,准确率为96.2%。结论碘图定量分析和能谱曲线技术可提高甲状腺结节定性诊断的准确率,为甲状腺疾病临床诊疗提供新的影像学检查方法。     

Multi-slice CT of thyroid nodules: comparison with ultrasonography

PURPOSE: To evaluate the usefulness of multi-slice computed tomography (MSCT) in comparison with ultrasonography (US) for the differentiation of benign from malignant thyroid nodules and the evaluation of tumor extension. MATERIALS AND METHODS: Thirty patients with thyroid nodules (14 malignant, 16 benign) who underwent both MSCT and US participated in the present study. MSCT with contrast enhancement was performed, and 3D shaded volume rendering (SVR) and multiplanar reconstruction (MPR) were employed to differentiate benign from malignant nodules and to evaluate tumor extension. US images were obtained using a 7.5 MHz annular array probe. A three-point rating scale was used for image interpretation, and the kappa statistic was employed to evaluate agreement between MSCT and US. RESULTS: Sensitivity in differentiating benign from malignant nodules was found to be 85.7% for US and 78.6% for MSCT. Disagreement between MSCT and US occurred in assessing the homogeneity of the solid component and the presence of fibrous capsule. In two of seven T4 cases, MPR provided a more accurate diagnosis than US examination in detecting extracapsular invasion. CONCLUSION: For differential diagnosis of thyroid nodules, US was found to be better than MSCT. However, MSCT could be useful for the evaluation of advanced cases with suspicion of extracapsular extension.     

Differentiation between Benign and Malignant Solid Thyroid Nodules Using an US Classification System

Objective

To evaluate the diagnostic accuracy of a new ultrasound (US) classification system for differentiating between benign and malignant solid thyroid nodules.

Materials and Methods

In this study, we enrolled 191 consecutive patients who received real-time US and subsequent US diagnoses for solid thyroid nodules, and underwent US-guided fine-needle aspiration. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories by real-time US: "malignant," "suspicious for malignancy," "borderline," "probably benign," and "benign". We evaluated the diagnostic accuracy of thyroid US and the cut-off US criteria by comparing the US diagnoses of thyroid nodules with cytopathologic results.

Results

Of the 191 solid nodules, 103 were subjected to thyroid surgery. US categories for these 191 nodules were malignant (n = 52), suspicious for malignancy (n = 16), borderline (n = 23), probably benign (n = 18), and benign (n = 82). A receiver-operating characteristic curve analysis revealed that the US diagnosis for solid thyroid nodules using the 5-category US classification system was very good. The sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86%, 95%, 91%, 92%, and 92%, respectively, when benign, probably benign, and borderline categories were collectively classified as benign (negative).

Conclusion

The diagnostic accuracy of thyroid US for solid thyroid nodules is high when the above-mentioned US classification system is applied.     

甲状腺实性结节动静脉比例鉴别结节良恶性的价值研究

目的利用彩色多普勒血流显像技术观测甲状腺实性结节内血流的动静脉比例,探讨动静脉比例在甲状腺结节良恶性鉴别的价值。方法对66例患者的81个甲状腺实性结节进行彩色多普勒检查。计算并对比良恶性结节的动静脉比例有无差异,对比不同观察者测量的动静脉比例的差异,评价动静脉比例对甲状腺实性结节良恶性鉴别的价值。结果甲状腺恶性结节动静脉比例以动脉型为主,良性结节以静脉型或混合型为主。两种结节的动静脉比例差异有统计学意义（P〈O．05）。不同观察者测量的良性结节及恶性结节中混合型的动静脉比例数值具有统计学差异（P〈0．05）,但是不影响对结节良恶性的判断。以结节内动脉型动静脉血流比例作为诊断标准,预测甲状腺恶性结节的灵敏度为76．00％、特异度为89．83％、阳性预测值为88．89％、阴性预测值为94．64％。结论彩色多普勒血流显像技术检测甲状腺结节的动静脉血流比例对结节良恶性的鉴别诊断具有一定价值。     

Usefulness of a 201Tl dynamic study of thyroid tumors

A thallium 201 dynamic study was performed on 39 patients with thyroid tumor by use of a digital gamma-camera, which was connected to the computer data system. They consisted of 12 patients with a benign lesion and 27 patients with a malignant lesion. Regions of interest (ROIs) were assigned for tumor, normal thyroid, and background. Time activity curves (TACs) were generated from these ROIs. The following six parameters were created from the TACs and compared between benign and malignant tumors: 1) Tmax, 2) T3/4max, 3) distribution index (DI) = peak count determined for a tumor divided by that for the normal thyroid, 4) mean transit time (MTT), 5) relative MTT (r-MTT) = MTT for a tumor divided by that for the normal thyroid, and 6) perfusion curve (PC) = TAC that is drawn on the basis of the quotients obtained by dividing A by B (A = counts in the individual frames determined for a tumor; B = those for the normal thyroid). Among the first five parameters, DI, T3/4max, and r-MTT were significantly different between the two sorts of lesions. To be more precise, DI was significantly lower (p less than 0.01) and T3/4max and r-MTT were higher (p less than 0.05) in the malignant group. PC was classified into three types: decreased type, parallel type, and increased type. In the benign group the PCs were decreased or parallel type in all cases except two. In the malignant group the PCs were parallel or increased type in all cases. In conclusion, the present observations suggest that thallium 201 accumulates in a malignant lesion at nearly the same rate as in the normal thyroid in an early phase, or otherwise its washout from the lesion is prolonged, and further that early-phase accumulation in a benign lesion is high and washout from the lesion is rapid compared with the normal thyroid. Functional images (peak count, MTT), which were obtained through computer analysis, facilitated visual diagnostic evaluation of thyroid tumor.     

双能量 CT 碘图及标准化碘浓度对甲状腺癌的诊断价值

目的：探讨双能量CT碘图形态学与碘浓度测定对甲状腺癌的诊断价值。方法回顾性分析行双能量CT增强扫描且经手术病理证实的甲状腺结节患者,分别测量动、静脉期颈内动脉C T值,筛选C T值同时满足动脉期110～250 H U、静脉期70～110 HU共90例（恶性60例,良性30例）。测量正常甲状腺组织,良、恶性结节碘浓度,得出NICnod值（normalized iodine concen‐tration ,标准化碘浓度）,比较良、恶性及正常组间甲状腺结节的差异。对结节形态学分析,分别观察：形态是否规则、沙砾样钙化、结节强化环不完整呈“强化残圈征”、结节突破甲状腺包膜呈“节段缺损征”在诊断恶性结节中的灵敏度、特异性及准确度,比较在碘图及普通图像上的差异。结果①甲状腺癌碘图上,形态不规则、结节强化环不完整呈“强化残圈征”、结节突破甲状腺包膜呈“节段缺损征”诊断为甲状腺癌的灵敏度、特异度及准确度均较普通 CT图像高（P均＜0．05）,沙砾样钙化在碘图与普通图像上无差异（P＞0．05）。②正常与恶性组、正常与良性组及恶性与良性组 NICnod静脉期差异均有统计学意义（Z值分别为－3．092、－3．187、－2．660, P均＜0．05）,动脉期良、恶性组差异无统计学意义。静脉期最佳 NICnod为0．76,小于该值诊断为恶性,受试者工作特征曲线（ROC）的曲线下面积（AUC）值为0．91,敏感度和特异度分别为74．61％、75．60％。③碘图形态学结合结节NICnod诊断甲状腺癌的灵敏度、特异度及准确度分别为：91．67％、86．67％、94．44％。结论双能量C T碘图形态学及碘浓度测量对甲状腺癌的定性诊断有价值。     

Thallium-201 scintigraphy in the evaluation of thyroid nodules A retrospective study of 246 cases

There is controversy at present concerning the value of Tl-201 scintigraphy in the diagnosis of malignant thyroid nodules. The usefulness of Tl-201 scintigraphy in differentiating benign from malignant nodules was evaluated retrospectively. Tl-201 scintigraphy was performed in 101 patients with malignant thyroid nodules and in 145 with benign nodules. Early and late images were examined to compare Tl-201 uptake in nodules and normal thyroid tissue. The visual method resulted in 74 % of sensitivity and 58 % of specificity for the detection of malignant nodules including incidental cancers. Excluding incidental cancers, 87 % sensitivity and 58 % specificity were achieved. Small cancers, including incidental cancers less than 1.5 cm in diameter and small number of viable tumor cells in a large tumor also gave negative Tl-201 scintigraphic results. Forty-two percent of the benign lesions gave false positive Tl-201 scintigraphic results. It is concluded that Tl-201 scintigraphy is a sensitive and useful method to use in diagnosing malignant thyroid nodules, but is not a specific method even with late scan, for the detection of malignant thyroid nodules.     

多因素Logistic回归分析评价MSCT鉴别甲状腺良恶性结节的价值

目的:探讨多因素Logistic回归分析评价MSCT鉴别甲状腺结节良恶性的价值.方法:选取87例经超声引导下细针穿刺活检或术后病理确诊的甲状腺结节,其中良性组44例,恶性组43例.以病理结果作为金标准评价MSCT诊断甲状腺结节良恶性的效能,并对良性组与恶性组结节的CT征象行Logistic回归分析.结果:单因素分析显示...     

双源CT双能量技术鉴别甲状腺良恶性结节的临床应用研究

目的 探讨双源CT能量成像在鉴别甲状腺良恶性结节中的临床应用价值.方法 收集91例经双源CT双能量扫描的甲状腺结节患者,获得单能量40~190 keV图像及碘图,计算线性融合图像与各单能量图像对比噪声比(CNR),测量动静脉期良恶性结节各单能量图像CT值、碘图正常甲状腺、结节、同层面颈动脉碘浓度值,绘制良恶性结节CT值衰减趋势图,计算曲线斜率、正常甲状腺与甲状腺结节内碘浓度差异(ICD)、碘浓度差异比(ICDNR)、标准化碘浓度比(NIC),采用配对样本t检验并绘制受试者工作特征(ROC)曲线比较上述定量参数值诊断恶性结节效能.结果 动、静脉期甲状腺结节在不同能量水平下CNR均有统计学差异(P<0.0001),动脉期最佳CNR在70 keV为11.61±1.71,静脉期最佳CNR在60 keV为10.55±1.09;良恶性结节动脉期单能谱曲线斜率(λ)分别为1.66±0.48,3.31±1.33,ICD分别为(2.83±1.23)mg/mL,(2.10±0.98)mg/mL,ICDNR分别为0.50±0.23,0.38±0.27,差异均有统计学意义(F=-89.43,4.036,2.791,P均<0.05),λ恶性结节大于良性,ICD及ICDNR良性结节大于恶性;静脉期曲线斜率分别为3.85±2.47,1.24±1.26,NIC分别为0.57±0.32,0.39±0.13,差异有统计学意义(F=8.651,4.893,P均<0.05),均良性结节大于恶性;动脉期ICDNR曲线下面积(AUC)最大为0.913,诊断敏感度为100%,特异度为87.5%.结论 动、静脉期分别采用70 keV及60 keV单能量图像可提高甲状腺结节检出率,能量相关定量参数值对良恶性结节鉴别诊断有较大临床应用价值.     

Diagnosis of thyroid nodules by Doppler ultrasonography: a comparison between color Doppler and power Doppler ultrasonography

The purpose of this study was to assess the usefulness of color and power Doppler imaging in thyroid nodules. The following 4 items were compared between malignant thyroid nodules (34 cases) and benign nodules (51 cases): 1) vascularity; 2) distribution of tumor vessels (none, marginal, peripheral, central); 3) nature of tumor vessels (tortuosity, interruption); and 4) FFT analysis. The distribution of tumor vessels on color Doppler images, nature of tumor vessels on power Doppler images, and the indices of PI, RI, and ATI in FFT analysis were useful in making the differential diagnosis between malignant and benign nodules. In terms of vascularity, including the distribution of tumor vessels on power Doppler images and nature of tumor vessels on color Doppler images, no statistically significant differences were found between malignant and benign nodules. Power Doppler images depicted tumor vessels in more detail than color Doppler images and were considered to extend the application of FFT analysis.