彩超诊断甲状腺恶性肿瘤的特征性表现和误诊分析

目的通过高频超声和彩色多普勒超声检查,分析甲状腺癌超声声像图特征,降低超声误诊或漏诊率。方法通过对经手术后病理诊断为甲状腺癌60例的病例,进行高频声像图和彩色多普勒血流显像（CDFI）的回顾性分析,对超声漏诊和误诊原因进行归纳和总结。结果在高频二维声像图中癌病灶呈低回声和内部有细粒状钙化灶是特征性较高的甲状腺癌的超声表现,而多源性结节或者微小癌常使甲状腺癌缺乏特征性声像图表现而容易误诊。CDFI表现：甲状腺癌比较甲状腺良性病灶,内部血流更丰富,血流阻力指数（RI）和收缩期最高流速峰值（Vmax）增高,二者有显著差异（P〈0.05）。甲状腺癌的超声诊断的符合率91.6%（55/60）,其中误诊4例（4/60）,漏诊1例（1/60）。结论大多数甲状腺癌都具有特征性超声表现,结合彩色多普勒超声更有助于提高甲状腺癌诊断的准确性,以减少漏诊和误诊。

Characteristics of thyroid malignant tumors with color Doppler ultrasound:analysis of misdiagnosis

Objective To investigate the characteristics of thyroid malignant tumors on high-frequency ultrasonography in order to reduce the misdiagnostic rate.Methods The gray scale and color Doppler flow imaging of 60 cases with thyroid malignant tumors confirmed pathologically were reviewed retrospectively and the reasons of misdiagnosis were analyzed and summarized.Results The characteristics of thyroid carcinomas were hypoechogenic with tiny calcification on gray scale ultrasonogrphy.Diversified nodules and microcarcinoma were easily misdiagnosed due to its uncharacteristics.Thyroid carcinomas showed more abundant blood flow signals than thyroid benign nodules on color Doppler flow imaging.The resistance index（RI） and peak systolic velocity in thyroid carcinomas were higher than those in benign nodules（P0.05）.The accuracy of ultrasonography in the diagnosis of thyroid carcinomas was 91.6%（55/60）.There were 4 cases misdiagnosed and 1 case missed by ultrasonography.Conclusion Most thyroid carcinomas present characteristic on ultrasonography.Combination of gray scale ultrasonography and color Doppler flow imaging will be helpful in improving the diagnostic accuracy for thyroid carcinomas.