超声造影对甲状腺良恶性结节的鉴别诊断价值

Value of contrast-enhanced ultrasound in differential diagnosis of benign and malignant thyroid nodules

摘要:

目的：探讨超声造影（contrast-enhanced ultrasound，CEUS）增强模式对甲状腺结节良恶性的鉴别诊断价值。方法：回顾性动态观察184个甲状腺良恶性结节的CEUS灌注过程，分析CEUS各指标包括造影剂进入结节的快慢、方式、增强强度、达峰时间、造影剂分布是否均匀、边界是否清晰、有否周边环状增强以及结节内造影剂消退快慢。结果：甲状腺良恶性结节增强模式间差异具有显著性意义（P<0.001），甲状腺良性结节多表现为同步等增强或高增强及周边环状增强；而恶性结节多表现为慢进快退、向心性、不均匀低增强，其中快退对于诊断甲状腺恶性结节的灵敏度最高（92.2%），向心性、慢进及低增强等造影指标的特异度均较高。结论：CEUS增强模式分析对甲状腺结节的良恶性鉴别诊断具有重要的价值。造影剂慢进快退、向心性、不均匀低增强有助于甲状腺恶性结节的诊断，而环状增强有助于良性结节的诊断。

Abstract:

Objective：To investigate value of contrast-enhanced ultrasound（CEUS） in differential diagnosis of benign and malignant thyroid nodules. Methods：Dynamic contrast infusion process of 184 thyroid nodules was retrospectively observed in comparison with adjacent thyroid parenchyma. Evaluation criterions were as follows：the time and the pattern of contrast up-take，contrast intensity，time of peak，contrast-enhancement distribution（homogeneous or inhomogeneous），well-defined or not，ring enhancement or not，contrast wash-out early or not. Results：There were statistically significant differences in enhancement patterns between benign and malignant nodules（P<0.001）. Most benign thyroid nodules in CEUS showed synchronal，homogeneous isoenhancement or hyperenhancement and ring enhancement. While most malignant ones showed centripetal and heterogeneous hypoenhancement，contrast up-take latter but earlier diffusion mode. Among all evaluation criterions，early diffusion had the highest sensitivity（92.2%），and up-take latter，cen－tripetal，hypoenhancement had high specificity. Conclusions：Analysis of enhancement patterns is valuable in differential diagnosis of benign and malignant thyroid nodules. Contrast up-take latter，centripetal enhancement，heterogeneous hypoenhancement and earlier diffusion help the diagnosis of malignant thyroid nodules while ring enhancement helps the diagnosis of benign ones.