超声检查桥本甲状腺炎合并甲状腺乳头状癌颈部淋巴结转移的价值

目的探讨桥本甲状腺炎合并甲状腺乳头状癌颈部淋巴结转移超声检查的价值。方法选择2014年4月～2017年6月本院就诊的桥本甲状腺炎合并甲状腺乳头状癌患者100例,均经穿刺病理或手术确诊,术前均经超声检查,比较桥本甲状腺炎合并甲状腺癌颈部淋巴结转移的超声检查纵横比、内回声、边界、钙化、血流信号特征。结果超声诊断桥本甲状腺炎合并甲状腺癌颈部淋巴结转移纵横比低于2者50例(92. 5%),纵横比超过2者20例(43. 5%),内部回声不均匀60例(88. 2%),内部回声均匀10例(31. 3%),边界欠规则48例(88. 9%),边界规则22例(47. 8%),钙化45例(90. 0%),无钙化者25例(50. 0%),有血流信号50例(96. 2%),无血流信号20例(41. 7%),差异有统计学意义(P0. 05);桥本甲状腺炎合并甲状腺癌颈部淋巴结转移的超声检查纵横比、内部回声、边界、钙化、血流信号特征与病理检查结果比较,差异无统计学意义(P 0. 05)。结论桥本甲状腺炎合并甲状腺乳头状癌、颈部淋巴结转移进行超声诊断具有一定的特征,少数微小癌仍需要术后病理确诊或在超声监测下穿刺活检。     

原发性甲状腺淋巴瘤与甲状腺乳头状癌的超声特征比较

目的 探讨原发性甲状腺淋巴瘤(PTL)与甲状腺乳头状癌(PTC)的临床及超声特征，以提高超声医师对两者的早期诊断率。方法 选取经病理确诊的50例PTL患者及141例结节>2cm的PTC患者，定量数据采用t检验比较；二分类数据采用χ²检验及Fisher确切概率法，单因素分析有统计学意义的因素纳入Logistic回归进行多因素分析。结果两组患者在年龄、结节大小、伴甲状腺非对称性肿大、合并桥本方面差异有统计学意义(P<0.001),PTL在内部回声极低、内部条索样回声、后方回声增强、富血供、缺乏钙化方面比例高于PTC，差异有统计学意义(P<0.05)，多因素Logistic回归分析显示：年龄、后方回声增强、缺乏钙化、内部条索样回声为独立预测因素(P<0.05)。结论 内部回声极低、内部条索样回声、后方回声增强、缺乏钙化等超声特征有助于PTL与PTC的鉴别。     

术前超声与血液学检查诊断桥本甲状腺炎合并甲状腺肿瘤临床价值

目的探讨术前超声联合血液学检查诊断桥本甲状腺炎合并甲状腺肿瘤的价值。方法回顾性分析自2014年1月至2018年10月辽宁省肿瘤医院收治的936例病理确诊为桥本甲状腺炎合并甲状腺肿瘤患者的临床资料。以病理学检查为"金标准",比较不同超声征象(钙化、结节性质)诊断的准确度、灵敏度、特异度,比较甲状腺炎合并甲状腺肿瘤恶性组、良性组的血液学指标[淋巴细胞比值(NLR)、血小板和淋巴细胞绝对值的比值(PLR)、游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)、促甲状腺激素(TSH)]水平,并绘制血液学指标诊断桥本甲状腺炎合并甲状腺癌的受试者工作特征(ROC)曲线。结果术后病理诊断恶性249例,良性687例。超声钙化、超声结节性质、钙化+结节性质诊断HT合并甲状腺癌的准确度分别为70.3%、73.9%、65.0%,灵敏度分别为82.3%、97.1%、98.4%,特异度分别为65.9%、65.5%、53.0%。超声钙化、结节性质诊断的准确度均高于钙化+结节性质,诊断的灵敏度均低于钙化+结节性质,诊断的特异度均高于钙化+结节性质,差异均有统计学意义(P<0.05)。血液学指标中,桥本甲状腺炎合并甲状腺肿瘤恶性组PLR、TSH高于良性组,差异有统计学意义(P<0.05)。5项血液学指标中,TSH的ROC曲线下面积最大为0.659(95%可信区间0.610～0.708),TSH的灵敏度和特异度最高,分别为81.1%、54.2%。结论钙化、结节性质、TSH可协助提高对桥本甲状腺炎合并甲状腺癌的诊断效能。     

高频超声对无钙化型甲状腺癌的诊断价值

目的探讨高频超声在无钙化型甲状腺癌结节中的诊断价值。方法回顾性分析35例经病理证实的无钙化型甲状腺癌的超声声像图特点,选取37例经病理证实的甲状腺良性无钙化结节为对照组,对比分析两组病例的超声特点。结果病例组较对照组结节小(P>0.05);病例组结节:纵横比>1,彩色多普勒结节血供的类型,边界模糊,低回声或极低回声后方伴衰减,III^VII区淋巴结肿大钙化、液化,差异具有统计学意义(均P<0.05)。病例组:纵横比>1的敏感性和特异性分别为91.4%和97.3%;极低回声伴衰减的敏感性和特异性分别为34.2%和100.0%;淋巴结肿大钙化、液化的敏感性和特异性分别为11.4%和91.9%;中心血供的敏感性和特异性分别为42.9%和81.1%。结论纵横比>1、极低回声伴衰减、中心血供以及周围淋巴结肿大钙化,有助于无钙化型甲状腺癌的诊断。     

超声弹性应变率比值在TI-RADS(4-6)类合并钙化的甲状腺结节中的价值

目的探讨超声弹性应变率比值在鉴别诊断甲状腺TI-RADS(4-6)类合并钙化结节中的应用价值。方法常规超声观察303例患者(共324个结节)甲状腺结节的边界、内部回声、是否合并钙化、纵横比、内部及周边血流情况等,依据甲状腺影像数据评分与报告系统(TI-RADS)对相应的甲状腺结节进行分类,同时进行超声弹性成像记录弹性应变率比值,绘制ROC曲线,获得弹性应变率比值鉴别诊断甲状腺良恶性结节的最佳界值。其中TI-RADS 4-6类患者137例(137个结节)分钙化组(Ⅰ组)和无钙化组(Ⅱ组),钙化组又以钙化大小分为微钙化组(≤2mm)和粗钙化组。以病理结果为金标准,绘制ROC曲线,评价弹性应变率比值在Ⅰ、Ⅱ组病变中的应用价值。结果弹性应变率界值为0.55。微钙化组和Ⅱ组的敏感性、特异性、准确性、阳性预测值分别为88.9%、71.4%、86.5%、95.2%和82.4%、78.9%、81.1%、87.5%,ROC曲线下面积(AUC)分别为0.808、0.831;粗钙化组ROC曲线AUC为0.655。结论应用TI-RADS分类标准联合弹性应变率比值可提高鉴别诊断Ⅱ组和微钙化组甲状腺结节良恶性的敏感性、特异性和准确性,指导临床对甲状腺合并钙化结节采取正确的处理,达到早期诊断,早期治疗的效果。     

超声多因素Logistic回归分析鉴别甲状腺良恶性结节的价值

目的探讨多因素Logistic鉴别诊断甲状腺结节的价值。方法经超声引导下穿刺活检或手术后病理证实的甲状腺恶性结节32例,良性结节50例,灰阶超声观察结节的位置、大小、形态、边界、回声及血流分布等超声特征;超声造影观察结节增强模式。单因素分析以上特征,将有差异的指标作多因素logistic回归分析。结果单因素分析显示极低回声、边界不清、边缘毛刺、纵横比、微钙化、内部血流丰富、不均性增强鉴别甲状腺良恶性结节差异有统计学意义(P0.01)。多因素分析显示极低回声、不均匀增强模式及微钙化与甲状腺癌相关(P=0.001,0.012,0.030)。多因素分析诊断甲状腺癌的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为89.0%(73/82)、84.4%(27/32)、92.0%(46/50)、90.2%(46/51)和87.1%(27/31)。结论多因素logistics回归分析能有效提高甲状腺癌诊断的准确性,可以作为综合判断甲状腺结节良恶性的可靠手段。     

桥本甲状腺炎超声诊断与误诊分析

目的 通过对桥本甲状腺炎的超声二维图象及彩色多普勒血流显像(CDFI)分析,提高诊断符合率。方法应用二维超声观察甲状腺及病灶的大小,形态,边界,内部回声,CDFI观察腺体内及病灶区的血流分布。结果 超声显示26例桥本甲状腺炎均有甲状腺肿大,回声不均,19例检出有结节,且结节形态不规则,边界不清,无包膜,内部多为均匀低回声,CDFI显示腺内血流无明显改变,结节周边血流低或无。超声诊断符合率为69.2％。结论 利用高频探头和彩色多普勒技术,可提高对桥本甲状腺炎超声诊断的敏感性,减少误诊。     

超声对桥本甲状腺炎良恶结节的鉴别诊断价值

目的探讨灰阶超声在桥本甲状腺炎背景下鉴别诊断甲状腺良恶性结节的价值。方法超声检查结合病理（包括穿刺活检及术后病理）检查结果回顾性分析我院2010年1月-2013年6月桥本甲状腺炎伴发良性结节患者（56例）和伴发恶性结节（16例）共72个结节（每例患者重点评估1个结节）的超声表现特征。结果桥本甲状腺炎背景下72个甲状腺结节中：77.8%为良性（56/72）,22.2%为恶性（12/72）,恶性结节均为甲状腺乳头状癌,多表现为单发,低回声,不规则形,边界不清,内部回声分布不均,更易发现点状钙化及后方回声衰减;良性结节易多发、部分为高回声,具有低回声晕,多无钙化。良恶性结节发生的甲状腺实质背景类型构成比间有统计学差异（P〈0.05）。在彩色多普勒特征分析中,多数良恶性结节均表现为少许血流信号,两者差异无统计学意义。结论灰阶超声对桥本甲状腺炎背景下甲状腺良恶性结节具有良好的鉴别诊断价值。     

桥本甲状腺炎超声诊断与误诊分析

目的 通过对桥本甲状腺炎的超声二维图象及彩色多普勒血流显像（CDFI）分析。提高诊断符合率。方法 应用二维超声观察甲状腺及病灶的大小,形态、边界,内部回声,CDFI观察腺体内及病灶区的血流分布。结果 超声显示26例桥本甲状腺炎均有甲状腺肿大,回声不均,19例检出有结节,且结节形态不规则,边界不清,无包膜,内部多为均匀低回声,CDFI显示腺内血流无明显改变,结节周边血液低或无,超声诊断符合率为69.2%。结论 利用高频探头和彩色多商业区协技术,可提高对桥本甲状腺炎超声诊断的敏感性,减少误诊。     

桥本氏甲状腺炎合并甲状腺乳头状癌超声分析

目的:探讨桥本甲状腺炎(HT)合并的甲状腺乳头状癌(PTC)超声表现特征.方法:回顾性分析35例HT伴PTC(HT组)和57例PTC(非HT组)共92例单发癌结节患者超声图像特征,采用SPSS 16.0软件统计分析超声图像特征的差异.结果:HT组的癌结节内粗钙化比例为45.71％,明显高于非HT组的17.54％[x2=8.488,P=0.004,OR=3.958(95％CI:1.526-10.264)].非HT组中癌结节多表现为低回声伴微小钙化.非HT组的癌结节内微钙化的比例为63.16％,明显高于HT组的34.29％[x2 =7.244,P=0.007.OR=1.784(95 ％CI:1.177-2.703)];且非HT组的癌结节低回声的比例为86.96％,明显高于HT组的54.28％[x2=ll.286.P=0.001.OR=3.257(95％CI:1.559-6.806)].两组癌结节在大小、形态、边界及CDFI特征方面差异无统计学意义(P＞0.05).结论:分析HT合并癌结节的超声表现,有助于提高HT背景下的甲状腺癌检出率.     

桥本甲状腺炎伴甲状腺乳头状癌32例声像图分析

目的探讨二维超声及彩色多普勒超声对桥本甲状腺炎基础上伴发甲状腺乳头状癌的诊断价值。方法回顾分析经病理检查确诊的32例(36个病灶)桥本甲状腺炎基础上伴发甲状腺乳头状癌患者,根据二维超声及彩色多普勒血流观察直径>1 cm的肿瘤及直径<1 cm的肿瘤。结果 32例(36个病灶)桥本甲状腺炎伴发甲状腺乳头状癌患者中,36个病灶均为实性,肿瘤周边未见声晕,内部血流分布为主。肿瘤直径>1 cm的27个病灶中内部可见砂砾体样微钙化者15例,低回声者27例,边界模糊者22例;肿瘤直径<1 cm的9个病灶中,内部可见砂砾体样微钙化者4例,低回声者9例,边界模糊者4例。结论二维超声及彩色多普勒超声可以对桥本甲状腺炎伴发甲状腺乳头状癌作出诊断。     

基于二维超声图像的纹理分析在桥本甲状腺炎背景下甲状腺结节良、恶性鉴别中的价值

目的:探讨基于二维超声图像的纹理分析对桥本甲状腺炎背景下甲状腺结节良、恶性的鉴别诊断价值.方法:回顾性分析2018年2月-8月在本院经病理证实的合并桥本甲状腺炎的甲状腺结节的二维超声图像.根据病理结果将甲状腺结节分为良性组和恶性组.采用ITK-SNAPE软件在甲状腺结节的二维超声图像上手工勾画兴趣区,通过python的...     

淋巴细胞性甲状腺炎合并甲状腺乳头状癌18例分析

目的探讨淋巴细胞性甲状腺炎(HT)合并甲状腺乳头状癌(PTC)患者的病因、病理相关性及诊断与治疗。方法回顾性分析我科自2006年2月—2011年2月收治的18例HT合并PTC患者的临床资料。结果 18例患者术前彩超均发现甲状腺低回声团块,发现伴钙化灶7例,提示恶性者2例。术前甲状腺球蛋白抗体(TG-Ab)升高7例,甲状腺过氧化物酶抗体(TPO-Ab)升高4例,两者均升高3例。1例行细针穿刺活检(FNA)确诊为乳头状癌。所有患者均行手术治疗。结论 HT与PTC病因、病理上呈明显的相关性,术前结合TG-Ab、TPO-Ab、超声检查、FNA综合分析有助于HT合并PTC的诊断,手术治疗是针对HT合并PTC的有效治疗方法,我们应打破传统HT内科治疗,高度警惕HT合并PTC。     

MR imaging of the thyroid: correlation between apparent diffusion coefficient and thyroid gland scintigraphy

PURPOSE: To evaluate the usefulness of echo-planar MR imaging for assessing the thyroid function and confirm the clinical use of MR imaging for thyroid diseases. MATERIALS AND METHODS: Thirty-four patients with a variety of thyroid disorders (24 Graves disease; five subacute thyroiditis; five Hashimoto thyroiditis) were examined using T1-, T2-, and diffusion-weighted magnetic resonance (MR) imaging and thyroid scintigraphy with Tc-99m pertechnetate. RESULTS: The ADC values obtained from the diffusion-weighted images of the patients with Graves disease were significantly higher than those of patients with subacute hyroiditis and Hashimoto thyroiditis, though no difference among those disorders was observed on T1- and T2-weighted images. Based on the ADC value, anisotropy was not observed in the thyroid gland. An ADC value of 1.82 x 10(-3) mm(2)/second or higher indicated the presence of Graves disease (sensitivity 75%, specificity 80%). CONCLUSION: Diffusion-weighted MR images may be of value for the diagnosis of thyroid diseases and could be clinically important in the evaluation of thyroid function.     

桥本甲状腺炎合并甲状腺乳头状癌的研究进展

桥本甲状腺炎（HT）合并甲状腺乳头状癌（PTC）的发病率呈逐年上升的趋势,但两种疾病之间的关系一直存在较大争议。笔者就近年来有关HT合并PTC的流行病学及发病机制、标志性抗体、分子特征、临床病理学特征、影像学诊断和治疗等方面的研究进展进行综述。     

Echography of non-suppurative thyroiditis

The echographic results of 14 cases of thyroiditis (7 of chronic lymphocytic thyroiditis (CLT), 5 of De Quervain subacute thyroiditis, 1 of lignous thyroiditis, 1 of Riedel's fibrous thyroiditis) were extracted from a consecutive series of 900 thyroid echograms and analysed retrospectively. Homogeneous hypoechogenicity, similar to that of surrounding muscles, was found in 12 cases. This hypoechogenicity affected all of the thyroid parenchyma diffusely in the 6 cases of CLT where it was present, and by contrast localised to a unilateral lateral or, more often, 2 bilateral lateral plaques, progressively blending with the residual parenchyma in SAT and lignous thyroiditis. Riedel's thyroiditis took the form of a large unilateral hypoechogenic but heterogeneous mass. Echography would seem overall to make a significant contribution in the diagnosis of thyroiditis: a diffuse hypoechogenic goitre is very common, though not an absolutely constant feature, in TCL. Bilateral lateral plaques of homogeneous hypoechogenicity are highly suggestive of a diagnosis of SAT.     

Thyroid nodules associated with Hashimoto thyroiditis: assessment with US.

Sonographic findings in 109 thyroid nodules in 104 patients with Hashimoto thyroiditis were retrospectively analyzed. Sixty patients underwent ultrasound (US)--guided fine-needle aspiration (FNA) biopsy (65 nodules, 24 palpable, 27 surgically confirmed), 14 of whom also underwent palpation-guided FNA (14 nodules, all palpable, all surgically confirmed). Forty-four patients (44 nodules, 25 palpable) underwent diagnostic US followed up with surgery. US-guided FNA helped differentiate between benign (n = 11) and malignant (n = 16) diseases (sensitivity, 100%). Two papillary carcinomas were falsely diagnosed as Hashimoto thyroiditis with palpation-guided FNA. Eight malignancies were not palpable, and correct diagnosis was obtained with US-guided FNA. Hyperechoic nodules were usually benign, and isoechoic nodules had a low frequency (13%) of malignancy. Most carcinomas were found in hypoechoic masses, and almost all lymphomas were found in markedly hypoechoic masses. Lymphoma was indistinguishable from pseudotumor in Hashimoto thyroiditis or adenomatous hyperplasia at US. US-guided FNA is helpful in making the histologic diagnosis in thyroid nodules associated with Hashimoto thyroiditis. US-guided FNA is clinically beneficial because it can help select patients who need surgery, avoiding unnecessary surgery for patients with nonneoplastic disorders.     

Role of combined grey scale US and US tissue elastography in differentiating solid thyroid nodules

Background

Ultrasonographic (US) examination is an accurate method for detecting thyroid nodules, but its use in differentiating between benign and malignant thyroid nodules is relatively low. US elastography has been applied to study the hardness/elasticity of nodules to differentiate malignant from benign lesions thus deviating a significant group of patients from unnecessary FNAB.

Objectives

The aim of the study is to evaluate the validity of combined grey scale US and tissue elastography in differentiating benign form malignant solid thyroid nodules.

Methods

The study included 46 selected patients with solid thyroid nodules according to our inclusion and exclusion criteria. The patients underwent surgery for compressive symptoms or suspicion of malignancy on FNA cytology. US features and tissue elastography were scored according to the Rago criteria (1).

Results

On US elastography: all the 31 cases with a final diagnosis of benign nodule had a score of 1–3, while 14 of 15 (94.1%) with a final diagnosis of carcinoma had a score of 4–5, with a sensitivity of 93.3%, a specificity of 100% and an accuracy of 97.8%. Combined US and elastography reveals that hypoechogenicity/score 4–5 was most predictive of malignancy with sensitivity 80% and specificity 100%; and accuracy 93.4%.

Conclusions

US elastography seems to have great potential as a new tool for differentiating solid thyroid nodules and for recommending FNAC. Combined grey scale US features and US elastography added no significant value when compared with US elastography alone. Further prospective studies are needed.     

甲状腺疾病的CT评价(附48例报告)

目的：探讨ＣＴ对甲状腺病变的诊断价值。材料与方法：分析经手术病理或临床生化证实的４８例甲状腺病变的ＣＴ表现其中甲头腺腺交谈２０例,腺癌１２例,Ｇｒａｖｅｓ病３例,桥本氏甲朱炎２例,多结节性甲状腺肿１１例。全部病例行ＣＴ扫,４５例增强。结果：全部病例均显示低密谋灶,最小病灶为６ｍｍ,ＣＴ术前定性诊断准确率为８３．３％。３例胸内甲状腺全部由ＣＴ首先检出,钙化以多结节性甲状腺肿多见,占５４．６％。１２例     

The sonographic appearances in postpartum thyroiditis.

During the postpartum period about 50% of women with circulating thyroid autoantibodies develop a transient autoimmune thyroiditis. To determine the sonographic appearances in postpartum thyroiditis (PPT), serial ultrasound (US) scans of the thyroid were performed in 135 postpartum women who were divided into three clinical groups: Group 1, 37 antibody positive subjects who developed PPT; Group 2, 28 antibody positive subjects in whom thyroid function remained normal; Group 3, 70 antibody negative controls. Thyroid hypoechogenicity was observed in 14/31 patients (45%) who were scanned between 4 and 8 weeks postpartum and who subsequently developed PPT (Group 1) compared with 4/24 patients (17%) in Group 2 (P less than 0.05) and 1/65 patients (1.5%) in Group 3 (P less than 0.001). In antibody positive patients, the positive predictive value of an abnormal scan during this period was 78%. Between 15 and 25 weeks postpartum thyroid hypoechogenicity was present in 32/37 patients (86%) in Group 1 compared with 11/28 patients (39%) in Group 2 (P less than 0.001) and 2/70 patients (3%) in Group 3 (P less than 0.001). Sonographic abnormality persisted beyond 32 weeks postpartum in 36/41 antibody positive patients (87%) who had exhibited thyroid hypoechogenicity earlier during the study and who had late scans. The characteristic US appearance in PPT is thyroid hypoechogenicity. The role of sonography in the prediction, diagnosis and follow up of patients with PPT is discussed.