甲状腺髓样癌的超声成像特征分析及诊断价值评价

目的:分析甲状腺髓样癌（medullary thyroid carcinoma，MTC）的超声特征，研究并探讨超声成像对甲状腺髓样癌的诊断价值。方法:选取来我院就诊的49例甲状腺髓样癌（MTC）患者的68枚结节，与同期随机选取的60例甲状腺乳头状癌（papillary thyroid carcinoma，PTC）的82枚结节做对比，分析两者的二维超声特点、剪切波弹性成像(shear wave elastography，SWE)的各参数及颈部淋巴结转移情况，病灶均有手术及病理评估。结果:MTC声像图表现为低回声（73.5%），边界清楚（50.0%），纵横比＜1（89.7%），结节内伴钙化（60.2%），结节内存在血流（58.8%），合并颈部淋巴结转移（55.1%）；与PTC相比，MTC多表现为结节较大，边界清楚，纵横比＜1，结节内存在血流，结节内钙化多为粗大钙化，易发生淋巴结转移（P<0.05）。MTC的SWE各参数为Emax(48.4±19.1)kPa，Emean(32.3±14.5）kPa。淋巴结超声检查，MTC可疑淋巴结22例，诊断准确率为81.5%。结论:MTC既具有恶性结节的一般特点，又有相对特异的超声表现，超声成像对MTC的早期诊断及手术治疗有较大的参考依据。

Ultrasonic imaging features analysis and diagnostic evaluation of medullary thyroid carcinoma

Objective:To analyze the ultrasonographic features of medullary thyroid carcinoma (MTC) and to study and discuss the diagnostic value of ultrasonic imaging in medullary thyroid carcinoma.Methods:Sixty-eight nodules from 49 patients with medullary thyroid carcinoma(MTC) who were compared with eighty-two nodules of 60 patients with papillary thyroid carcinoma(PTC) rand-omly selected during the same period.Conventional ultrasound features and SWE elasticity imaging characteristics and lymph node metastasis were recorded.The lesions were evaluated by surgical operation and pathology.Results:Conventional ultrasound findings for MTC were hypoechogenicity（73.5%），smooth margins（50.0%），wider-than-tall（89.7%），calcification（60.2%），intranodular blood flow（58.8%），lymph node metastasis（55.1%）.Compared with PTC，MTC tended to show large nodules，smooth margin，wider-than-tall，intranodular blood flow，more macro-calcifications，more lymph node metastasis（P<0.05）.THE SWE imaging paremeters of MTC were Emax(48.4±19.1）kPa and Emean(32.3±14.5）kPa.Through lymph node ultrasonography，MTC suspicious lymph nodes in 22 cases，the diagnostic accuracy was 81.5%.Conclusion:The sonographic findings of MTC are similar to the other thyroid malignancy and have their own characteristics.Ultrasonography can provide valuable information for early diagnosis and surgical treatment of these patients.