2019 年第 3 期 第 14 卷

二维及彩色多普勒超声联合弹性成像技术对诊断甲状腺微小乳头状癌的临床意义

Clinical value of two-dimensional and color Doppler ultrasound combined with elastography in diagnosis of papillary thyroid microcarcinoma

作者：贺梅婷李春梅邢媛媛

英文作者：

单位：100029首都医科大学附属北京安贞医院综合超声科

英文单位：

关键词：甲状腺微小乳头状癌；彩色多普勒超声；弹性成像技术

英文关键词：

• 摘要：

• 【摘要】目的    探讨二维及彩色多普勒超声联合弹性成像技术对诊断甲状腺微小乳头状癌的临床意义。方法    回顾性分析2014年1月至2016年12月于首都医科大学附属北京安贞医院手术并经病理证实为甲状腺微小乳头状癌的41例患者的病历资料，共发现恶性结节56个。将41例患者按检查方法不同分为观察组和对照组。观察组（21例）采用二维及彩色多普勒超声联合弹性成像技术检查，共发现28个结节，对照组（20例）采用二维及彩色多普勒超声检查，共发现28个结节。观察56个结节具体情况，比较2组诊断正确率。结果    56个恶性结节中单侧单发结节34个（60.7%），双侧单发及多发结节22个（39.3%），最小结节为2.0 mm×2.0 mm×3.0 mm，最大结节为9.0 mm×9.0 mm×10.0 mm。56个结节中极低回声2个（3.6%）、低回声50个（89.3%）、囊实性回声3个（5.4%）、等回声1个（1.8%）；边界清楚6个（10.7%）、不清楚50个（89.3%）；形态规则9个（16.1%）、不规则47个（83.9%）；纵横比≥1共53个（94.6%）、＜1共3个（5.4%）；粗大钙化3个（5.4%）、微钙化53个（94.6%）。观察组诊断正确率明显高于对照组［96.4%(27/28)比75.0%(21/28)］，差异有统计学意义（P=0.002）。结论    二维及彩色多普勒超声联合弹性成像技术诊断甲状腺微小乳头状癌的正确率优于仅用二维及彩色多普勒超声检查。低回声结节，形态不规则，呈现边界模糊、边界成角、微小分叶和毛刺状边界，伴有多发点状、针尖状、砂砾样的微钙化，纵横比≥1，弹性成像评分4～5分是甲状腺微小乳头状癌的特征性改变。

• 【Abstract】Objective    To analyze the clinical value of two-dimensional and color Doppler ultrasound combined with elastography in diagnosis of papillary thyroid microcarcinoma. Methods    Clinical data of 41 cases of papillary thyroid microcarcinoma with 56 malignant nodules confirmed by post-surgery pathological examination from January 2014 to December 2016 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. The patients were divided into observation group and control group according to different ultrasonic examination methods. In observation group(21 cases), 28 nodules were detected by elastography, two-dimensional and color Doppler ultrasound; the control group (20 cases) had two-dimensional and color Doppler ultrasound and 28 nodules were found. Diagnostic accuracy for thyroid malignant nodules was compared between groups. Results    There were 34 unilateral single nodules(60.7%) and 22 bilateral single or multiple nodules(39.3%). The smallest nodule was 2.0 mm×2.0 mm×3.0 mm and the largest one was 9.0 mm×9.0 mm×10.0 mm. Among the 56 nodules, 2 nodules(3.6%) showed very low echo, 50 nodules(89.3%) showed low echo, 3 nodules(5.4%) showed solid-cystic echo and 1 nodule(1.8%) was iso-echo; 6 nodules(10.7%) had clear boundaries and 50 nodules(89.3%) were unclear; 9 nodules(16.1%) presented regular morphology and 47 nodules(83.9%) were irregular; 53 nodules(94.6%) had aspect ratio≥1 and 3 nodules(5.4%) had aspect ratio＜1; 3 nodules(5.4%) had coarse calcification and 53 nodules(94.6%) had micro-calcification. Diagnostic accuracy in observation group was significantly higher than that in control group［96.4%(27/28) vs 75.0%(21/28)］（P=0.002）. Conclusions    Elastography can help to improve the diagnostic accuracy of papillary thyroid microcarcinoma in combination with two-dimensional and color Doppler ultrasound. Hypoechoic nodules with irregular shape, blurred border, angular border, lobulate and speculate border, multiple punctate and gravel-like microcalcification, aspect ratio≥1, elastography score 4-5 are characteristic changes of papillary thyroid microcarcinoma.