超声造影在甲状腺微小癌血流灌注方面的初步研究

目的 应用超声造影动态观察常规超声TI-RADS 3级及3级以上的甲状腺小结节的血流灌注特点,定量分析TIC曲线,探讨甲状腺微小癌超声造影的特征性表现.方法 选取在笔者医院就诊常规超声诊断为TI-RADS 3级及3级以上的、结节直径＜ 1cm患者67例,共72个甲状腺结节行超声造影,所有结节均经手术切除并获得病理诊断.超声造影观察甲状腺结节增强模式和增强强度,分析良、恶性结节的超声造影增强规律.应用Contrast Dynamic定量分析软件分别在甲状腺结节及周边正常甲状腺腺体感兴趣区取样,获取TIC曲线及TIC曲线定量参数（峰值强度、达峰时间、曲线下面积及平均通过时间）,比较良、恶性小结节与周边正常腺体,良、恶性小结节间上述参数差异,探讨甲状腺微小癌的超声造影特征.结果 甲状腺良、恶性小结节的增强规律存在统计学差异,良性小结节以环状增强（25/36）、等增强（28/36）较常见;微小癌以不均匀（33/36）、低（36/36）增强多见;甲状腺微小癌Peak及AUC均小于周围正常组织、AUC小于良性小结节,其差异均具统计学意义（P＜0.05）;而达峰时间和平均通过时间三者间差异无统计学意义（P＞0.05）.结论 甲状腺微小癌的超声造影多表现为不均匀、低增强.微小癌的Peak及AUC均小于周围正常组织,微小癌的AUC小于良性小结节.超声造影能更好地显示甲状腺微小癌的血流灌注情况,对甲状腺微小癌的诊断有一定的意义.

Prelimiary Study on the Characteristics of Blood Perfusion of Thyroid Microcarcinoma with Contrast-Enhanced Ultrasound

Objective To explore the features of contrast-enhanced ultrasound（CEUS） in the thyroid microcarcinoma by observing the characteristics of blood perfusion and enhancement pattern of TIRADS Ⅲ and Ⅲ above thyroid nodules with dynamic CEUS,quantifying analysis of TIC curve.Methods Totally 67 patients with 72 thyroid nodules confirmed by pathology were enrolled in this study.All the nodules showed TIRADS 3 and 3 above and less than 1 cm on conventional ultrasound.The enhanced appearance of thyroid benign and malignant nodules was investigated by observing enhancement patterns and intensity of nodules.Contrast Dynamic Quantitative Analysis Software was used to acquire quantitative parameters of time-intensity curve（TIC,including peak intensity （Peak）,peak time（PT）,area under curve（AUC） and mean transit time（MTT） through acquiring region of interests（ROI） of nodules and surrounding normal gland tissue respectively.The contrast enhancement features of thyroid microcarcinoma was explored by comparing the differences of above parameters among benign,malignant nodules and surrounding normal gland tissue,and differences between benign and malignant nodules.Results There was a significant difference between benign and malignant nodules in the enhancement pattern.Benign nodules mainly manifested ring-enhancement（25/36）,and iso-enhancement（28/36） ;and malignant nodules （microcarcinoma） mainly heterogeneous -enhancement（33/36） and hypo-enhancement（36/36）.The results of TIC analysis revealed that both PT and AUC of malignant microcarcinoma were less than those of surrounding normal gland tissue respectively,and there was significant difference in PT and AUC （P 〈 0.05）.AUC of benign nodules was more than that of malignant,and there was significant difference （P 〈 0.05）.There was no significant difference in Peak and MTT among them.（P 〉 0.05）.Conclusion Thyroid microcarcinoma mainly presented as heterogeneous -and hypo-enhancement,and both PT and AUC of microcarcin