高频超声在甲状腺癌诊断和鉴别诊断中的应用

目的探讨高频超声在甲状腺癌诊断和鉴别诊断中的价值。方法选择2007年1月～2010年1月在我院经术后病理证实的甲状腺癌患者240例(观察组)及220例经术后病理证实的甲状腺瘤患者(对照组),对其术前高频超声检查结果进行回顾性分析。结果 240例甲状腺癌患者经高频超声检查诊断为甲状腺癌230例(95.83%),其中乳头状癌120例、滤泡状腺癌73例、未分化癌27例、髓样癌10例;误诊为甲状腺瘤7例、结节性甲状腺肿3例(4.17%)。观察组低回声者比例显著高于对照组,等回声者、高回声者比例均显著低于对照组(P<0.05),强回声者比例两组无显著差异;观察组2～3级血流者比例及阻力指数(RI)均显著高于对照组(P<0.05)。结论甲状腺癌的高频超声表现有一定特征性,如低回声、小钙化灶、高RI,此对甲状腺癌的诊断与鉴别诊断具有重要价值。     

甲状腺癌的高频彩超显像分析

目的探讨高频超声及彩色多普勒对甲状腺癌的诊断价值。方法通过对45例经手术病理证实为甲状腺癌的高频声像图及彩色多普勒血流显像进行回故性分析。结果 45例甲状腺癌肿,超声诊断甲状腺癌（包括提示甲状腺癌可能性大,不排除甲状腺癌等）37例,符合率82.12%。8例诊断不符合,其中7例诊断为结节性甲状腺肿或腺癌,1例诊断为甲状腺结核可能性大。结论高频彩超对甲状腺癌诊断具有重要的价值。     

甲状腺结节性疾病的超声诊断意义及超声特点分析

目的针对甲状腺结节性疾病采用高频超声以及彩色多普勒血流显像进行临床诊断,分析超声特点和诊断意义。方法选取我院2014年2月~2015年12月收治的结节性甲状腺患者95例作为研究对象,在术前进行高频超声和彩色多普勒血流显像检查,对比超声诊断和病理结果。结果甲状腺癌、甲状腺腺瘤以及结节性甲状腺肿的二维声像图查现各异,甲状腺癌的CDFI阳性率、Vm ax、RI与结节性甲状腺肿、甲状腺腺瘤对比,差异有统计学意义(P0.05);甲状腺癌、甲状腺腺瘤、结节性甲状腺肿诊断准确率分别为60.00%、62.50%、72.09%。结论应用彩色高频超声诊断在结节性甲状腺疾病中能够判别良性以及恶性的图像,不同性质的甲状腺结节超声查现各不相同,临床中应仔细对其加以区分,进而提升诊断的准确率。     

高频彩超在甲状腺癌诊断中的价值

目的探讨高频彩色多普勒超声对甲状腺癌的诊断价值。方法应用高频彩超诊断经病理学证实的30例甲状腺癌,观察肿块的大小、回声及形态、数目及彩色血流情况,测量收缩期最高流速（Vmax）、舒张期最低流速（Vmin）、阻力指数（RI）及颈部淋巴结有无肿大。结果30例甲状腺癌中,乳头状癌19例,滤泡状腺癌6例,髓样癌3例,未分化癌2例。肿瘤侧的Vmax、Vmin、RI均明显高于无瘤侧各指标,差异有统计学意义（P〈0．05）。结论高频彩超可以确定甲状腺癌肿块的数目、部位、大小以及有无淋巴结肿大,为甲状腺癌的诊断提供参考依据。     

高频彩超对甲状腺结节的诊断价值

目的 探讨运用高频彩超对甲状腺结节的诊断与鉴别诊断价值.方法 对2001-2007年间来我院就诊的80例患者高频彩超结果进行回顾性分析,全部病例均经手术及病理证实.结果 68例良性结节(59例甲状腺腺瘤、7例结节性甲状腺肿、2例甲状腺囊肿)及12例恶性结节(甲状腺癌)中二维超声表现不同,血流动力学差异较显著,其中高频彩超明确诊断的有69例,定性诊断正确率达86.2%.结论 高频彩超对甲状腺结节的诊断与鉴别具有重要价值.     

分析结节性甲状腺肿合并甲状腺癌的超声和CT诊断效果

目的:分析结节性甲状腺肿合并甲状腺癌的超声和CT诊断效果.方法:回顾性选取我院接收的结节性甲状腺肿合并甲状腺癌患者80例作为实验对象,选取日期2018年7月-2019年7月,依据诊断方法不同分为2组,各40例.参照组接受超声诊断,实验组在参照组基础上接受CT诊断,对比80例患者的诊断符合率.结果:参照组符合数为38例,...     

低频超声联合高频超声对胆囊增生性疾病的诊断价值

目的探讨低频超声联合高频超声诊断胆囊良性病变的临床价值。方法回顾性分析2015年1月-2016年1月新疆图木舒克市人民医院门诊收治的经手术病理证实为胆囊良性病变患者110例。所有患者均先行常规低频超声检查并记录检查结果;然后联合高频超声进行检查并记录结果。对比分析常规低频超声检查和联合高频超声检查的病理诊断符合率。计数资料组间比较采用χ2检验。结果110例患者中,常规低频超声检查与病理诊断结果相符合的有83例;联合高频超声检查与病理诊断结果相符合有102例,其中胆囊息肉样病变70例(68.63%),胆囊腺肌增生症32例(31.37%),另有8例误诊,误诊率为7.3%;低频超声联合高频超声检查的病理诊断符合率(92.73%)明显高于低频超声检查(75.45%),差异有统计学意义(χ2=12.266,P=0.001)。结论低频超声联合高频超声检查,有利于提高胆囊良性病变的诊断准确率。     

“萤火虫”成像技术对甲状腺乳头状癌诊断的临床意义

目的对比分析＂萤火虫＂成像技术和二维高频超声显示甲状腺内细砂粒样钙化对甲状腺乳头状癌诊断的临床意义。方法选取我院甲状腺外科2010年1月～2010年7月128例甲状腺结节手术患者（共计160个结节）,良性结节96个,恶性结节64个,其中甲状腺乳头状癌结节63个,甲状腺髓样癌结节1个。术前患者均进行甲状腺二维高频超声及＂萤火虫＂成像技术检查,重点观察甲状腺结节内有无细砂粒样钙化,诊断甲状腺乳头状癌,并与术后病理结果对照分析。结果二维高频超声检出甲状腺内细砂粒样钙化诊断甲状腺乳头状癌的敏感性54.0%（34/63）、特异性78.4%（76/97）、精确度68.8%（110/160）;＂萤火虫＂成像技术诊断甲状腺癌的敏感性81.0%（51/63）、特异性81.4%（80/97）、精确度81.3%（130/160）。两者对比有显著差异性（P〈0.05）。结论 ＂萤火虫＂成像技术在检出细砂粒样钙化诊断甲状腺乳头状癌的敏感性、特异性、精确度均高于二维高频超声。     

高频超声检查微小钙化对甲状腺癌的诊断价值

超声是评价甲状腺疾病和筛查甲状腺癌的主要影像学检测手段之一.在超声表现中,可有各种各样钙化灶,其中砂粒样钙化可高度提示恶性.作者就高频超声检查微小钙化对甲状腺癌的诊断价值进行了观察.     

隐匿性甲状腺癌的淋巴结及血行转移：附41例报告

对４１例伴有淋巴结或血行转移的隐匿性甲状腺癌进行回顾性临床分析。颈淋巴结转移３８例，血行转移３例。转移与病理类型有关，与原发灶大小无关。认为隐匿 性甲状腺癌生物学性与其同类甲状腺癌相符合，应遵循同类型甲状腺癌的治疗原则。     

Hyperthyroidism and thyroid carcinoma

Twenty-two of 251 patients with differentiated thyroid carcinoma suffered from or had a history of hyperthyroidism. They were hyperthyroid with a diffuse goitre (N = 4), a diffuse goitre with a cold nodule (N = 10), a multinodular goitre (N = 6), and an autonomous adenoma (N = 2). Among the 22 patients, more than one fourth had an occult thyroid carcinoma with a diameter of 1 cm or less, those with the papillary tumour types, less frequently had lymph node metastases than the total group of patients with papillary carcinomas (13.3 vs 35.6%). The clinical courses of the 22 patients resembled those of the other thyroid carcinoma patients whose age and initial findings were comparable. In 643 patients who underwent surgery for hyperthyroidism the incidence of thyroid carcinoma was 2.3%. The increase in coincidence of hyperthyroidism and thyroid carcinoma repeatedly reported in recent years is probably ascribable primarily to extensive and improved diagnostics and not to a direct connection between hyperthyroidism and development of thyroid carcinoma. On the other hand, our findings do confirm that, even in the presence of hyperthyroidism, all thyroid nodules require careful diagnostics for exclusion of malignancy.     

Detection of pelvic vein thrombosis by magnetic resonance angiography in patients with acute pulmonary embolism and normal lower limb compression ultrasonography

STUDY OBJECTIVE: In patients with proven acute pulmonary embolism (PE), a systematic search for "residual" deep vein thrombosis (DVT) using venography or compression duplex ultrasonography (CDUS) of the lower limbs is negative in 20 to 50% of patients. We hypothesized that undetectable pelvic vein thrombosis (from the external iliac vein to the inferior vena cava) could account for a substantial proportion of patients with negative CDUS findings. Using a noninvasive test, magnetic resonance angiography (MRA), the objective of the study was to assess the prevalence of pelvic DVT in patients with acute PEs and normal findings on lower limb CDUS. DESIGN: Prospective study. SETTING: A 35-bed respiratory unit in a 680-bed Parisian teaching hospital. PATIENTS: From June 1995 to October 1996, 24 patients (mean age, 49 years; age range, 18 to 83 years) with acute PEs and normal findings on lower limb CDUS underwent pelvic MRA. MEASUREMENTS AND RESULTS: MRA disclosed pelvic DVT in seven patients (29%). The common iliac vein was involved in five patients. Internal iliac vein (hypogastric) thrombosis was imaged in two patients, but no patients had DVT limited to this vein. Three patients underwent subsequent venography studies that confirmed the MRA findings. In three other patients, a new MRA at the end of anticoagulant therapy showed the resolution of the DVT. CONCLUSIONS: Our data support the view that, among patients with negative findings on CDUS, a substantial proportion of the DVTs that are responsible for PE originates in the pelvic veins. This study provides additional arguments to suggest that MRA might become the reference test for the exploration of pelvic DVT.     

磁共振成像与彩色多普勒超声诊断胆道结石临床价值比较

目的 比较磁共振成像(MRI)与彩色多普勒超声(CDUS)在诊断胆道结石方面的临床应用价值。方法 2016年11月～2018年11月我院诊治的136例患者,均接受MRI和CDUS检查,以内镜下逆行胰胆管造影术( ERCP)检查为“金标准”,比较MRI和CDUS检查的诊断效能。结果 在136例患者中,经ERCP术后证实存在胆道结石115例,其中单发结石65例,多发结石50例,MRI的检出率分别为89.2%和100.0%,显著高于CDUS(分别为76.9%和56.0%,P<0.05);ERCP诊断大于1.0 cm、0.5～1.0 cm和<0.5 cm分别为49例、57例和9例,MRI的检出率分别为100.0%、91.2%和77.8%,显著高于CDUS的79.6%、63.2%和33.3%(P<0.05);MRI检查出胆囊、肝外胆管、肝内胆管和胆总管结石21例、30例、20例和37例,而CDUS只分别检出了18例(85.7%)、 18例(60.0%)、17例(65.4%)和25例(65.8%);本组MRI总体检出率为93.9%,显著高于CDUS的67.8%(P<0.05),MRI的误诊率为4.9%,而CDUS为10.3%。结论 尽管MRI检查诊断胆道结石的总体效能高于CDUS检查,但MRI和CDUS临床应用的价值可能与结石的位置和大小密切相关,临床应根据实际工作需要灵活选择应用。     

Studies on small thyroid carcinoma in dialysis patients with hyperparathyroidism

For twenty long-term hemodialysis patients with medically uncontrolled hyperparathyroidism, subtotal parathyroidectomy (PTX) was performed and histological examination was done for 17 out of them, suspected of thyroid disease from operative findings. Thyroid carcinomas were found in 5 out of 17 patients by biopsied specimens of thyroids. Histological findings of carcinomas were follicular (2 cases) and papillary types (3 cases). In all cases, carcinomas were in occult state and the sizes of carcinomas of 4 cases were small being a diameter less than 10 mm. Among others, findings of follicular adenoma (2 cases) and chronic thyroiditis (1 case) were obtained. The incidence rate of thyroid carcinoma in this report seemed to be rather high as the incidence diagnosed from biopsied specimen at operation. Several factors such as immunological incompetence accompanied by renal failure, metabolic abnormalities of cells induced by parathyroid dysfunction and accelerated aging are considered to be involved as a cause of increased incidence of thyroid carcinoma in hemodialysis patients with hyperparathyroidism.     

The value of contrast-enhanced color Doppler ultrasound in the detection of vascularization of finger joints in patients with rheumatoid arthritis

OBJECTIVE: A prospective study was performed to assess the usefulness of contrast-enhanced color Doppler ultrasound (CDUS) in the evaluation of intraarticular vascularization of finger joints in patients with rheumatoid arthritis (RA). METHODS: We investigated 198 finger joints in 46 patients with RA, and 80 finger joints in 10 healthy volunteers. Joints with varying levels of clinical activity of inflammation were classified as being active, moderately active, or inactive. CDUS was performed with a high-frequency multi-D linear array transducer. A microbubble-based ultrasound (US) contrast agent (Levovist; Schering, Berlin, Germany) was intravenously infused. Doppler findings were rated on the basis of both unenhanced and contrast-enhanced CDUS images. RESULTS: Healthy joints showed no intraarticular vascularization on either unenhanced or contrast-enhanced CDUS. Unenhanced CDUS detected intraarticular vascularization in 7 (8%) of 83 inactive joints, in 31 (52%) of 60 moderately active joints, and in 32 (58%) of 55 active joints. Contrast-enhanced CDUS detected intraarticular vascularization in 41 (49%) of 83 joints with inactive RA, in 59 (98%) of 60 joints with moderately active RA, and in all 55 joints with active RA. Detection of intraarticular vascularization was improved by administration of the microbubble-based US contrast agent (P < 0.001). Contrast-enhanced CDUS demonstrated differences in intraarticular vascularization between joints with inactive RA and those with active RA (P < 0.001), between joints with inactive RA and those with moderately active RA (P < 0.001), and between joints with moderately active RA and those with active RA (P < 0.001). CONCLUSION: The use of a microbubble-based US contrast agent significantly improved the detection of intraarticular vascularization in the finger joints of patients with RA. This technique seems to be a useful adjunct in the assessment of disease activity.     

Prevalence of sporadic medullary thyroid carcinoma: the importance of routine measurement of serum calcitonin in the diagnostic evaluation of thyroid nodules

OBJECTIVE The prevalence of sporadic forms of medullary thyroid carcinoma (MTC) has been studied In patients living in an area of moderate iodine deficiency. Such forms of MTC are usually diagnosed after surgery and have little chance of definitive cure. Using the measurement of basal serum calcitonin (CT) levels in a large series of patients with both thyroid disease and normal 24-hour urinary Iodine excretion, we assessed the prevalence of MTC and, in patients affected with the disease, we also evaluated the stage of the disease according to surgical findings and post surgical plasma CT levels. PATIENTS A prospective study of 657 patients with thyroid disease (469 with nodular and 188 with non-nodular thyroid disease). As controls, 40 normal subjects were also studied. MEASUREMENTS In all patients: (1) measurement of basal serum CT, free T4, total T3, TSH levels and serum TSH-receptor, peroxidase and thyroglobulin (Tg) antibody concentrations, (2) thyroid ultrasonography, (3) fine needle aspiration cytology (FNAC). In patients with Increased basal CT levels: (1) measurement of serum CT levels during pentagastrin test prior to surgery, (2) histological examination and immunostaining with both anti-CT and anti-Tg antibodies of all the nodular thyroid tissue surgically removed, (3) measurement of basal and pentagastrin stimulated serum CT values after surgery. RESULTS All the patients with non-nodular thyroid disease had normal basal CT levels. Four patients (0.84%) with nodular thyroid disease (2 with uninodular and 2 with multinodular goitre) had both elevated basal and pentagastrin stimulated CT levels. In the two patients with uninodular goitre, FNAC was suggestive of MTC in 1 (nodular diameter 8.0 cm) and of follicular carcinoma In 1 (nodular diameter 2.5 cm). Histological examination of the nodules confirmed these histotypes. Immunostaining with anti-CT antibodies was positive In the former patient but also In the latter. FNAC was suggestive of benign adenomatous tissues in the two patients with multinodular goitre. Histological examination of all the thyroid nodules confirmed the cytological findings. However, serial sections through the gland in each of these two patients showed an occult follicular carcinoma which had, however, positive staining with anti-CT antibodies. Furthermore, immunostaining with anti-Tg antibodies was negative In the patient with MTC but positive in the 3 patients with follicular carcinoma. Finally, both basal and pentagastrin stimulated CT levels remained elevated after total thyroidectomy only in the patient with FNAC suggesting MTC. CONCLUSIONS This study demonstrates a surprisingly high prevalence of sporadic forms of medullary thyroid carcinoma in patients with nodular thyroid disease. Such forms of medullary thyroid carcinoma seem to be unrelated to iodine intake and may be pure or mixed with a follicular carcinoma. In these mixed thyroid carcinomas, only the neoplastic follicular pattern was seen on both cytological and histological examination. Routine measurements of serum calcitonin levels should therefore be considered an integral part of the diagnostic evaluation of thyroid nodules. Indeed, increasing the accuracy of diagnosis of medullary thyroid carcinoma encourages the surgeon to perform more radical treatment, thus achieving more frequent normalization of post-operative serum calcitonin levels.     

Adult Perithyroid and Cervical Thymus-Parathyroid Unit: Case Reports of a Rare Entity

The thymus-parathyroid unit (TPU) occurring in adults is rare.The main symptoms and important clinical findings are as follows: 2 patients presented with neomercazole-resistant Basedow–Graves disease. A third patient presented with thyroid nodules and a fourth patient with a neck mass after thyroid resection for medullary thyroid carcinoma.The main diagnoses were those of thyroid nodules (either in the context of goiter, or not). In the fourth case the diagnosis was of thyroid medullary carcinoma recurrence in the neck.Thyroidectomy was performed in the 2 cases of Basedow–Graves disease and in the third case (wherein selective neck dissection was also performed). In the fourth case, a neck dissection was performed for a possible medullary carcinoma recurrence.A TPU was microscopically detected in 2 cases with perithyroid location, on thyroidectomies for Basedow–Graves disease and in the 2 other cases with neck soft tissue location (associated with thyroid papillary carcinoma and thyroid medullary carcinoma extension). Postsurgical hypocalcemia requiring treatment occurred in both patients with Basedow–Graves disease and in the fourth patient.The presence of TPU should be acknowledged because such lesions can be misdiagnosed as suspect lymph nodes during thyroid surgery for malignant tumors.     

Long‐term follow‐up of patients with bone metastases from differentiated thyroid carcinoma – surgery or conventional therapy?

OBJECTIVE: Surgery of bone metastases from differentiated thyroid carcinoma seems indicated in individual patients. This study was performed (1) to analyse retrospectively patients with bone metastases from differentiated thyroid carcinoma and (2) to evaluate the impact of surgery of bone metastases on survival. PATIENTS AND DESIGN: We analysed 41 consecutive patients with bone metastases from differentiated thyroid carcinoma who had undergone thyroid surgery at Vienna University Hospital since 1966. The median follow-up time was 12 years. There were 24 females and 17 males with a mean age of 60 +/- 12 years. Primary tumour histology was follicular in 35 and papillary in six patients. Radioiodine treatment was performed in 32 with a mean administered activity of 27 +/- 24 GBq 131I. Metastases restricted to the skeleton were found in 22 whereas in 19 individuals additional extraskeletal distant metastases were seen. Twenty-seven patients had multiple bone metastases. In 21 individuals, up to five bone metastases were surgically removed with the intention of cure. RESULTS: Univariate analysis identified total thyroidectomy (P = 0.003), lymph node surgery (P = 0.001), radioiodine therapy (P = 0.036), and the absence of extraskeletal distant metastases (P = 0.017) as significant predictors of survival. Multivariate analysis failed to identify significant prognostic factors. In the subgroup of patients with distant metastases limited to the bones, univariate analysis identified, in addition to thyroid and lymph node surgery, the surgical extirpation of the bone metastases as a significant prognostic factor associated with improved survival (P = 0.025). CONCLUSIONS: These findings indicate that in patients without additional extraskeletal distant metastases, the radical surgical extirpation of bone metastases from differentiated thyroid carcinoma might be associated with improved survival.     

Carotid duplex ultrasonography: importance of standardisation. Asymptomatic Carotid Surgery Trial Collaborators and Vascular Laboratories.

BACKGROUND: Carotid duplex ultrasonography (CDUS) is an established non-invasive tool for assessing patients with suspected carotid bifurcation disease. Current trends show an increased dependence on CDUS in recommending patients for stroke prevention surgery. The aim of the study was to evaluate routine practice in vascular laboratories across 26 countries participating in The Asymptomatic Carotid Surgery Trial (ACST), and to determine the areas which are in need of future standardisation if CDUS is to be the primary tool in recommending patients for CEA. METHODS: Retrospective. Information was gathered from questionnaires, and 22 on-site visits of vascular laboratories between August 1996 to September 1997. SETTING: Clinical vascular laboratory practice. PARTICIPANTS: Eligible participants were vascular laboratories of ACST collaborators. MEASURES: Laboratories were compared in 7 categories: ultrasound equipment, operators, experience, protocols, stenosis evaluation, interpretation criteria, and reporting. RESULTS: Information on 117 respondents showed that (i) experience: at least one operator in each laboratory had more than 3 years experience; (ii) equipment: 88% (103/117) had colour duplex capability; (iii) operators: 54% of laboratories had exams performed by technologists, 33% vascular surgeons, 28% radiologists, and 35% other. The most significant findings were in (iv) stenosis evaluation: only 29% (33/117) were using a standardised Doppler angle (this single factor may greatly alter exam results); and (v) interpretation criteria; with >41 different criteria reported. These specific laboratory variations can affect those patients considered appropriate for CEA. CONCLUSIONS: This study highlights the most significant areas for future standardisation to be Doppler angle and interpretation criteria, if CDUS is to be a primary tool in recommending patients for CEA, when indicated by clinical trial results.     

Remitting seronegative symmetrical synovitis with pitting edema of the hands: ultrasound, color doppler ultrasound, and magnetic resonance imaging findings

OBJECTIVE: To assess the value of gray-scale ultrasound (US), color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and magnetic resonance imaging (MRI) in the diagnostic evaluation of the hands in patients with remitting seronegative symmetrical synovitis with pitting edema (RS3PE). METHODS: Eight patients (5 men, 3 women; mean +/- SD age 69.3 +/- 7.2 years) with clinical diagnosis of RS3PE syndrome underwent US, CDUS, contrast-enhanced CDUS, and MRI. US was performed with a linear array transducer operating at 12 MHz. The US contrast agent (SHU 508; Levovist, Schering, Germany) was intravenously infused in a concentration of 300 mg/ml at a rate of 1 ml/minute. RESULTS: All patients showed symmetric subcutaneous edema and synovitis of tendons and finger joints on both US and MRI. Vascularity was detected subcutaneously in tendon sheaths and in the joint synovia on CDUS and MRI. Detection of increased vascularity was improved after contrast administration compared with unenhanced CDUS (P < 0.01). CONCLUSION: Ultrasound, CDUS, contrast-enhanced CDUS, and MRI are valuable tools in the diagnostic evaluation of involved anatomic structures in patients with RS3PE. Contrast-enhanced CDUS is superior to CDUS in assessment of inflammatory edema, effusion, and synovitis.