Ethanol instillation of adenoma of the thyroid gland — a five-year experience

Summary

In a prospective study, 103 patients were treated with percutaneous ethanol injection (PEI). The study group consisted of 70 women and 33 men, with an average age of 64.5 years and an age-range of 31–92 years. 64 patients had a heterogeneous goitre with a struma multinodosa. 60 patients were suffering from toxic adenomas and 43 from pretoxic adenomas. 60 had a solitary adenoma and 33 had ≥ 2 autonomous areas. Multi-focal autonomy was present in 10 patients. The nodule volume was 1–91 ml, with an average of 10 ml. Colour Doppler sonography was able to differentiate uni-focal and oligo-focal tissue with hyperfunction from other nodules in 60 out of 64 patients. This had not been possible with any of these patients using B-image sonography. The increased vascularisation of the nodules correlated with the greater activity stimulation in the scintigram. During the course of PEI, colour-Doppler sonography was able to document a reduction of vascularisation in the adenomas of all patients. The number of sessions was 1–8 for each patient, with an average of four, using an average injection of 0.5 ml 96% alcohol per ml of nodule volume at each session. The observation period was 1–60 months (average of 12.8 months). In 50% of the patients with toxic adenomas, complete success was achieved, with elimination of the autonomous area and an increase in the thyroid stimulating hormone (TSH) basal levels. At least partial success was achieved in 88%, and euthyroidism was produced without further thyrostatic medication. Complete success was achieved in 70% of the cases of pretoxic adenoma. The final success of the therapy was dependent on the initial size and number of the adenomas. An average reduction of 47% in adenoma size was achieved at the conclusion of the therapy.     

Cold thyroid nodules: A new application of percutaneous ethanol injection treatment

Sonographically guided percutaneous ethanol injection (PEI) has been recently used with excellent results in the treatment of toxic and pretoxic thyroid adenoma. The aim of the present study was to assess the efficacy of PEI also in the treatment of “cold” thyroid nodules. Twenty patients, each with a single thyroid nodule, underwent PEI. In all cases the nodules were found to be cold by thyroid scintiscan. A total of 16.1 mL ± 3.1 mL of ethanol was injected once a week. No adverse effects were observed during therapy. A striking nodular shrinkage was obtained in all cases, ranging from 72.8% to 97.6% (mean 84.5%, p < 0.001 vs pretreatment volume). These preliminary results suggest that PEI is an effective and safe therapy that may be useful in the treatment of thyroid nodules as an alternative to other therapies (surgery, L-thyroxine). © 1994 John Wiley & Sons, Inc.     

结节性甲状腺肿的超声征象与病理对比分析

目的 探讨结节性甲状腺肿的声像图表现与病理的关系。方法 分析58例结节性甲状腺肿患者100个结节的二维及彩色多普勒声像图表现。结果 等回声或低回声结节14个,无回声结节45个,混合性回声结节41个。15个结节内可见稍增多的点线状血流信号,3个有声晕的结节在结节周边可见到血管信号。术后病理诊断为结节性甲状腺肿伴囊性变1个,出血囊性变13个,囊性变乳头状增生3个;结节性甲状腺肿伴钙化23个。结论 二维超声结合彩色多普勒超声能反映出结节性甲状腺肿的基本病理特征,可与腺瘤和甲状腺癌相鉴别。     

结节性甲状腺肿和甲状腺腺瘤的超声诊断及鉴别诊断

目的 分析结节性甲状腺肿和甲状腺腺瘤的声像图表现,探讨超声对二者的鉴别诊断价值.方法 分析32例甲状腺腺瘤和49例甲状腺结节患者的声像图特点,并与术后病理对照.结果 二维声像图示:结节性甲状腺肿表现为多结节分布,占68.7%(22/32),且周边少见晕环,腺体实质同声增粗;甲状腺腺瘤表现为单结节分布,占31.2%(10/32),且周边多见晕环,实质回声均匀.CDFI示:两者结节周边及内部血流信号有显著性差异(P＜0.05).结论 彩色多普勒超声可提高结节性甲状腺肿和甲状腺腺瘤的鉴别诊断水平,具有重要的临床意义.     

Hepatocellular carcinoma: therapeutic experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with the contrast agent Levovist.

OBJECTIVE: To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion. METHODS: Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean +/- SD, 2.7 +/- 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis. RESULTS: After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography. CONCLUSIONS: Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.     

甲状腺腺瘤和结节性甲状腺肿的彩色多普勒超声诊断

目的探讨彩色多普勒超声对甲状腺腺瘤和结节性甲状腺肿的鉴别诊断价值。方法回顾性分析经手术或细针抽吸活检病理证实的58例甲状腺腺瘤患者和47例结节性甲状腺肿患者的声像图资料,对这两组的二维声图像与彩色多普勒血流(CDFI)图像特点进行比较分析,并将声像图诊断与病理结果相对照。结果上述两组疾病在甲状腺大小,结节数目、大小、内部回声、周边包膜及结节内部血流参数等方面,均无显著性差异(P>0.05);在结节边缘晕环、结节内部血流信号、结节周边血流信号及其血流参数等方面,差异均有显著性(P<0.05)。结论彩色多普勒超声可对甲状腺腺瘤和结节性甲状腺肿做出较准确的诊断。     

Color Doppler sonography: Anatomic and physiologic assessment of the thyroid

The purpose of this study was to assess the potential application of color Doppler sonography in thyroid imaging. Thyroid nodules and other thyroid pathology detected by color Doppler ultrasound and nuclear scintigraphy were compared in 115 patients. The majority of “cold” nodules demonstrated a peripheral rim of color flow and no internal color flow with color Doppler sonography. A large number of “hot” nodules demonstrated internal color flow. Color Doppler sonography was helpful in delineating nodules in otherwise inhomogeneous glands. We determined that color Doppler cannot reliably distinguish benign from malignant thyroid nodules; fine-needle aspiration biopsy remains the most accurate method in differentiating benign and malignant lesions. We suggest that color Doppler sonography plays only a limited role in the evaluation of nodular thyroid disease at this time. The color Doppler appearance of other thyroid disorders (including toxic multinodular goiter, Graves' disease, and thyroiditis) is discussed. © 1995 John Wiley & Sons, Inc.     

Color Doppler sonography for evaluating response to transcatheter arterial embolization and percutaneous ethanol injection therapy and for detecting recurrence of hepatocellular carcinoma.

Eighty-six patients (mean age, 63 years) with 92 hepatocellular carcinomas (2.0 cm or greater in diameter; mean +/- SD, 3.5 +/- 1.6 cm) underwent color Doppler sonography before and after transcatheter arterial embolization and after subsequent percutaneous ethanol injection for (1) identification of pulsatile flow in the residual tumor area after transcatheter arterial embolization, (2) evaluation of therapeutic effectiveness of combined transcatheter arterial embolization and percutaneous ethanol injection, and (3) detection of recurrence during follow-up evaluation. Before and 2 weeks after transcatheter arterial embolization, color Doppler sonography revealed pulsatile flow in 76 (82.6%) and 43 (46.7%)lesions, respectively. After percutaneous ethanol injection, tumor stains in these lesions completely disappeared on digital subtraction angiography (gold standard). During follow-up study (3 to 45 months), digital subtraction angiography revealed recurrence in 73 patients (38 local recurrences and 19 new lesions [2.0 cm or greater]), whereas color Doppler sonography revealed pulsatile flow in 76.3% (local) and 63.2% (new) (not significant). Color Doppler sonography was useful for complying with our three objectives, especially for detecting local recurrence during follow-up evaluation.     

High-resolution and color doppler sonography in the evaluation of skin metastases.

OBJECTIVE: To evaluate high-resolution sonography in differentiating cutaneous metastases from other benign dermatologic diseases with the final objective of proposing high-resolution sonography in the diagnostic protocol for asymptomatic patients and those with neoplasms who have 1 or more rapidly growing skin nodules. METHODS: We selected 57 patients (24 women and 33 men; mean age +/- SD, 53 +/- 25 years) who underwent high-resolution and color Doppler sonography because they recently noticed 1 or more superficial nodules. Patients were mostly asymptomatic, but 15 had previously diagnosed malignancies. Each nodule was classified by measurement of fundamental sonographic parameters (major diameter, shape, borders, echo texture, and homogeneity) and by assessment of vascularity (presence or absence of flow and vascular pattern) with color Doppler sonography. All nodules were ablated and histologically examined. RESULTS: Of 68 nodules, 23 were malignant (21 metastases and 2 B-cell lymphomas), and 45 were benign (22 sebaceous cysts, 18 granulomas of different origins, 3 fibromas, and 2 neurofibromas). The nodules were all localized in the subcutaneous space, had clearly demarcated borders, and were hypoechoic; a circular or oval shape was predominant, but 7 metastases had an irregular, polycyclic shape. On color Doppler sonography, none of the benign nodules or B-cell lymphomas showed signs of vascularity, whereas the metastatic nodules were all vascularized, with 1 or more peripheral poles (21 of 21 nodules) and internal vessels (11 of 21 nodules). CONCLUSIONS: A polycyclic shape and hypervascularity, with multiple peripheral poles and, eventually, internal vessels, should be considered the most indicative signs of metastasis.     

Analysis of color Doppler signal intensity variation after levovist injection: a new approach to the diagnosis of thyroid nodules.

The objective of this study was to evaluate the usefulness of a galactose-based ultrasonographic contrast agent, Levovist (Schering AG, Berlin, Germany), in differentiating benign from malignant thyroid nodules by analysis of the time-intensity curves correlating the variation of the intensity signal value during the contrast transit time. Fifty-four patients scheduled for surgical removal of a nodule or the thyroid gland or both after cytologic examination were enrolled in this study; all of the nodules underwent a baseline color and power Doppler evaluation and then to a color Doppler examination after an intravenous bolus injection of Levovist. The time-intensity curves were analyzed with respect to the histologic results. Carcinomas showed a significantly earlier arrival time of Levovist than nodular hyperplastic benign nodules and adenomas (8.1 +/- 1.41 versus 19.6 +/- 2.2 and 16.1 +/- 2.8 seconds; P < .0001), although no significant difference occurred between hyperplastic benign nodules and adenomas; carcinomas and adenomas showed an earlier time to peak than hyperplastic benign nodules (14.6 +/- 1.2 and 23.1 +/- 3.8 versus 33.0 +/- 3.0 seconds; P < .0001). No significant difference was found in baseline, peak, final intensity signal, and percent variation of intensity signal among hyperplastic benign nodules, adenomas, and carcinomas. Although cytologic examination still remains the standard of reference for the presurgical diagnosis of thyroid nodules, the preliminary data of this pilot study demonstrate that the analysis of time-intensity curves after Levovist injection might provide useful, complementary, and quantitative information to differentiate benign from malignant thyroid nodules.     

甲状腺结节超声误诊原因的分析——大宗病例临床报告

目的通过大宗病例的临床报告,分析甲状腺结节超声误诊的常见原因。方法对2006-2009年间行手术治疗并经病理确诊的1933名患者共201 1个甲状腺结节的超声图像及术前诊断进行回顾性分析。结果超声诊断正确1575个(78.3%)、误诊436个(21.7%)。其中恶性病变误诊为良性病变133个,良性病变误诊为恶性病变37个,良性病变间相互误诊266个。结论误诊的主要原因包括对结节性甲状腺肿的高发病率及腺瘤在甲状腺结节病变中的相对低比例认识不足、对结节性甲状腺肿声像图的多样性及对甲状腺腺瘤和甲状腺癌的声像特点掌握不够。基础疾病的存在及多源性结节的并存也是不可忽略的重要因素。     

结节性甲状腺肿和甲状腺腺瘤的超声鉴别诊断

目的评价二维及彩色多普勒超声对结节性甲状腺肿及甲状腺腺瘤的鉴别诊断价值。方法对98例甲状腺疾病患者进行二维及彩色多普勒超声检查,将声像图表现与术后病理结果对照分析。结果结节性甲状腺肿的囊性变发生率明显高于甲状腺腺瘤(P<0.05),二者间钙化发生率差异无统计学意义(P>0.05)。结论超声检查可作为诊断甲状腺疾病首选的影像学检查方法,术前对结节性甲状腺肿与腺瘤进行超声鉴别诊断具有重要意义。     

超声监视下无水酒精治疗甲状腺结节的临床研究

在超声监视下对62例甲状腺结节进行无水酒精硬化治疗,其中囊性结节47例,实性结节15例,每例病人均行囊液或细针穿刺抽吸细胞学检查,除外了恶性肿瘤。结果:总治愈率74.2％,有效率96.8％。研究表明本方法是一种治疗甲状腺结节的安全、简便、有效的方法,可作为传统的外科手术、放射性碘治疗及口服药物疗法的替代或补充。     

超声引导^32P胶体注射治疗甲状腺良性囊性结节

目的探讨超声引导^32P胶体注射治疗甲状腺良性囊性结节的疗效及临床价值。方法采用超声引导经皮注射^32P胶体治疗甲状腺良性囊性结节120例,其中甲状腺囊肿46例,甲状腺腺瘤囊性变74例。结果①甲状腺良性囊性结节在多次治疗后,总有效率为95％,总治愈率为82．5％。其中甲状腺囊肿总有效率为97．8％,总治愈率为84．8％;甲状腺腺瘤囊性变总有效率为93．2％,总治愈率为81．1％。两种囊性结节总有效率和总治愈率差异无统计学意义;②不同大小结节在多次治疗后总有效率和总治愈率差异无统计学意义;③所有病例均未出现明显不良反应。结论超声引导^32P胶体注射治疗甲状腺良性囊性结节是安全有效的微创治疗方法,易于被患者接受,具有重要的临床实用价值。     

Gray-scale and power doppler sonographic appearances of acute inflammatory diseases of the scrotum

PURPOSE: We describe the spectrum of gray-scale and power Doppler sonographic appearances in inflammatory scrotal diseases. METHODS: Twenty-five patients ranging in age from 3 to 69 years underwent gray-scale and power Doppler sonography with multifrequency transducers of 7-9 MHz or 10-13 MHz. In addition, color Doppler and power Doppler findings were compared in 7 cases. RESULTS: In all 5 prepubertal patients, power Doppler imaging demonstrated hyperemia associated with epididymitis and, in some cases, orchitis. Among the 20 pubertal and adult patients, power Doppler imaging revealed increased vascularity associated with spermatic cord involvement, epididymitis, orchiepididymitis, or orchitis. Enlargement and heterogeneity of the epididymis and/or testis were seen in 11 patients, with vas efferens ectasia in 3 patients. Abscess formation and testicular infarction were easily depicted by power Doppler imaging. In 5 cases total, hyperemia was the only sonographic finding of inflammation. In the comparison between color and power Doppler imaging, a subjective increase in the number and length of vessels was seen with power Doppler imaging. CONCLUSIONS: Power Doppler imaging is an easy and fast Doppler modality for evaluating inflammatory conditions of the scrotum and proved especially useful in cases with no gray-scale sonographic anomalies, in prepubertal patients, and in patients with abscesses or ischemic lesions.     

孤立性甲状腺结节介入治疗的初步评价

目的评价超声引导介入治疗单发的非功能性甲状腺结节的疗效。方法18例单发的非功能性甲状腺结节，实性3例，囊性变6例，囊内出血4例，纯囊性病变5例。在高频超声引导下穿刺抽出囊内液后注入无水酒精4～10ml(抽出的液体量或实性结节体积的1／4)。结果无效4例(22．2％)，好转9例(50．0％)，痊愈5例(27．8％)，总有效率(77．8％)。主要并发症为声嘶(1例)。结论甲状腺单发结节硬化治疗的效果取决于肿块的物理性质，而与结节大小无明显相关。     

Relapsing neoplastic seeding after percutaneous ethanol injection for hepatocellular carcinoma. Clinical and ultrasonographic findings in a cirrhotic patient

A case of neoplastic implant after percutaneous ethanol injection (PEI) therapy for hepatocellular carcinoma (HCC) occurring in two steps is described. A 74-year-old male cirrhotic patient underwent PEI for a 5-cm HCC nodule. To obtain complete tumoral necrosis, 80 ml were injected under sonographic guidance in four sessions. Ten months after the completion of PEI a subcutaneous nodule was palpated in the abdominal wall within the area of needle punctures. Histologic examination of the excised nodule confirmed the sonographic and Power Doppler diagnosis of metastatic HCC. At the US exam scheduled three months later a non-palpable subcutaneous nodule of 16 mm was appreciated near the surgical wound. Once again metastatic HCC was demonstrated at pathological examination.     

Echo-enhanced Doppler sonography of focal nodular hyperplasia of the liver.

Lesions of focal nodular hyperplasia are hypervascular, benign focal liver lesions whose differentiation from other focal liver lesions is of significant clinical relevance. The purpose of this study was to investigate the echo-enhancing agent SHU 508A (Levovist) in the evaluation of focal nodular hyperplasia with Doppler sonography. We examined 49 patients with 71 lesions of focal nodular hyperplasia in the liver with gray scale and power Doppler sonography. In all patients Levovist was administered intravenously in a concentration of 300 to 400 mg galactose per milliliter. Visualization of the feeding vessels and the vascularity of the lesions were evaluated, and the resistive indices in the feeders and the hepatic arteries were assessed. In comparison with unenhanced power Doppler sonography, echo-enhanced power Doppler sonography yields a higher sensitivity in the detection of the feeding artery (97% versus 82%) in focal nodular hyperplasia and in the depiction of the radial vascular architecture in such lesions, especially those located in the left lobe of the liver. Lesions less than 3 cm in diameter do not consistently show a characteristic vascular architecture with echo-enhanced Doppler sonography. The resistive index of the tumor-feeding artery (mean, 0.51 +/- 0.09) is significantly (P < 0.0001) lower than that of the hepatic artery (mean, 0.65 +/- 0.06) and decreases as the size of the focal nodular hyperplasia increases. The administration of Levovist may improve the signal-to-noise ratio and thus visualization of the vascular architecture in focal nodular hyperplasia. Lesions located in the left lobe of the liver, which commonly are subject to disturbing motion artifacts in color Doppler sonography, will significantly benefit from the administration of Levovist. Echo-enhanced power Doppler sonography, however, is not capable of depicting a characteristic vascular pattern in small (< or = 3 cm) lesions of focal nodular hyperplasia that would guarantee a specific diagnosis.     

桥本氏甲状腺炎的超声诊断与鉴别诊断

目的探讨桥本氏甲状腺炎(HT)的二维及彩色多普勒超声表现及鉴别要点。方法60例HT患者及82例甲状腺其他疾病患者应用常规超声检查,分析其声像图表现及超声鉴别要点。结果按回声分类,HT可分为四型:局灶性回声减低型、弥漫性回声减低型、单发结节型及多发结节型。与甲状腺其他疾病比较,各型HT特征性的变化有峡部增厚,双侧叶对称性肿,不规则强回声带,结节呈实性、斑点状钙化,结节外血流信号丰富及双侧甲状腺上动脉PSV值对称性升高。结论二维及彩色多普勒超声对HT的诊断及鉴别诊断有重要价值。     

结节性甲状腺肿超声误诊分析

目的 探讨非毒性结节性甲状腺肿超声误诊原因,提高诊断符合率.方法 对超声检查误诊的63例结节性甲状腺肿声像图进行回顾性分析.结果 单发结节类35例可分三型:7例为类似囊肿型、10例为类似腺瘤型、18例为腺瘤囊性变型;多发结节类28例可分两型:8例为多发实性结节型、20例囊实结节混合型.全组63例结节以外的腺体回声无异常,结节内仅4例有钙化.结论 对结节性甲状腺肿的高发病率及其在甲状腺结节病变中的高比例和对该病病理的复杂性及其图像的多样性认识不足, 对甲状腺囊肿、腺瘤的声像特点掌握不够是误诊的主要原因.