彩色多普勒超声在诊断甲状腺癌中的应用

目的探讨甲状腺癌的灰阶及彩色多普勒超声表现,寻求鉴别甲状腺良恶性结节的可靠影像学检查方法。方法经术后病理证实甲状腺癌和良性结节各60例,重点分析甲状腺结节的内部回声、边界、血流分布、频谱形态以及收缩期峰值血流速度(PSV)、阻力指数(RI)。结果超声诊断甲状腺癌的准确度、敏感度及特异度分别为89.2%、86.7%及91.7%。低回声、无包膜、内部微钙化作为鉴别甲状腺良恶性结节差异有显著统计学意义(P<0.005)。内部血流较丰富、频谱多普勒舒张期无血流或出现反向血流、高阻力型动脉血流频谱是甲状腺癌较特异的征象。以RI>0.7鉴别甲状腺良恶性结节,差异有统计学意义(P<0.005),其诊断甲状腺癌的准确度、敏感度和特异度分别为65.8%、63.3%和68.3%。术前超声对颈部淋巴结转移诊断的符合率为78.8%(41/52),对阳性淋巴结病例诊断的符合率为75.0%(12/16)。结论高频彩色超声对鉴别甲状腺良恶性结节具有重要临床价值。

Application for diagnosis of thyroid carcinoma by color Doppler ultrasound

Objective To explore the gray-scale and color Doppler ultrasonic features of thyroid carcinoma, and to identify the reliable indicator for differential diagnosis of benign and malignant thyroid tumor. Methods Sixty patients with thyroid carcinoma and 60 patients with benign thyroid tumors were enrolled. The thyroid internal echo, border, blood flow distribution, the spectrum shape and the resistance index were analyzed. Results The accuracy, sensitivity and specificity by ultrasound diagnosis were 89.2% , 86.7% and 91.7%, respectively. Hypoechoic, without envelope, internal micro-calcification as identifica- tion of benign and malignant thyroid nodules had statistically significant difference （ P 〈 0. 005 ）. The rich in- ternal blood flow or no flow or reverse flow in diastolic period, high resistance index had more specific signs of thyroid cancer. RI 〉 0.7 was used to identify benign and malignant thyroid tumors with statistical significance （P 〈0.005）. The accuracy, sensitivity and specificity were 65.8%, 63.3% and 68.3% , respectively. Preoperative ultrasonography in the diagnosis of cervical lymph node metastases and positive eases of lymph node were 78.8% （41/52） and 75.0% （12/16）. Conclusion High frequency ultrasonography has great value for diagnosis of thyroid carcinoma.