董應(yīng)梅等

[摘要] 目的 探討在甲狀腺良惡性結(jié)節(jié)診斷中采用高頻彩色多普勒超聲檢查的臨床價值。 方法 對185例甲狀腺結(jié)節(jié)患者（共369個結(jié)節(jié)）采用高頻彩色多普勒超聲檢查，分析其影像學(xué)特點及對比良惡性結(jié)節(jié)征象。 結(jié)果 采用高頻彩色多普勒超聲檢查甲狀腺結(jié)節(jié)，靈敏度為97.01%，特異度為95.59%，陽性預(yù)測值為98.98%，陰性預(yù)測值為87.84%；超聲檢查發(fā)現(xiàn)，良性結(jié)節(jié)形態(tài)多規(guī)則，邊界清晰，伴有或不伴有聲暈，橫向生長，內(nèi)部回聲多為中等回聲、高回聲、囊性無回聲，多數(shù)不伴有鈣化，同惡性結(jié)節(jié)相比較，差異具有統(tǒng)計學(xué)意義（P<0.05）；對血流進行分析，301個良性結(jié)節(jié)中Ⅰ型血流134例，Ⅱ型血流123例，Ⅲ型血流35例，Ⅳ型血流9例，68個惡性結(jié)節(jié)中Ⅰ型血流11例，Ⅱ型血流9例，Ⅲ型血流32例，Ⅳ型血流16例，組間對比差異具有統(tǒng)計學(xué)意義（P<0.05）。 結(jié)論 甲狀腺良惡性結(jié)節(jié)聲像之間有明顯的差異，也存在交叉的共同表現(xiàn)，結(jié)節(jié)邊緣成角、內(nèi)部微鈣化形成和頸部異常淋巴結(jié)腫大有助于甲狀腺乳頭狀癌的診斷；甲狀腺腺瘤和甲狀腺濾泡狀癌在聲像上很相似，鑒別時需謹慎。對甲狀腺結(jié)節(jié)二維及彩色多普勒血流顯像進行全面綜合分析，可提高結(jié)節(jié)良惡性診斷率。高頻彩色多普勒超聲檢查在甲狀腺良惡性結(jié)節(jié)鑒別診斷中具有重要價值，可作為臨床首選的影像檢查。

[關(guān)鍵詞] 高頻彩色多普勒超聲；甲狀腺良性結(jié)節(jié)；甲狀腺惡性結(jié)節(jié)；鑒別診斷

[中圖分類號] R445.1 [文獻標(biāo)識碼] B [文章編號] 2095-0616（2015）13-182-05

[Abstract] Objective To explore the clinical value of the high frequency color doppler ultrasound in the diagnosis of benign and malignant thyroid nodules. Methods 185 patients with thyroid nodules （369 nodules） were received high frequency color doppler ultrasound. Imaging features were analyzed and the signs of benign thyroid nodules and malignant thyroid nodules were compared. Results The sensitivity， specificity， positive predictive value， negative predictive value of the high frequency color doppler ultrasound in the examination of benign and malignant thyroid nodules were respectively 97.01%， 95.59%， 98.98% and 87.84%. Ultrasound examination found that benign nodules usually laterally grew with regular contour and clear boundary accompanied by internal echoes mostly including media echo， high echo and no echo and most benign nodules were non-calcified. The differences between benign thyroid nodules and malignant thyroid nodules were statistically significant （P<0.05）. Blood flow was compared. The number of type Ⅰ blood flow， type Ⅱ blood flow， type Ⅲ blood flow， type Ⅳ blood flow were respectively 134， 123， 35 and 9 in the 301 cases of benign nodules. While the number of type Ⅰ blood flow， type Ⅱ blood flow， type Ⅲ blood flow， type Ⅳ blood flow were respectively 11， 9， 32 and 16 in 68 cases of malignant nodules. The difference was statistically significant （P<0.05）. Conclusion There are obvious differences in the acoustic images of benign thyroid nodules and malignant thyroid nodules as well as some crossed common features. Angulated edge and internal micro calcification of nodules and abnormal lymphadenopathy of the neck is helpful in the diagnosis of papillary thyroid carcinoma. Acoustic images of thyroid adenoma and thyroid follicular cancer are extremely similar which needs to be cautious when differentiating. A comprehensive and synthetic analysis of Two-dimensional imaging and color Doppler flow imaging can improve the diagnostic rate of benign and malignant thyroid nodules. High frequency color doppler ultrasound has important value in the differential diagnosis of benign and malignant thyroid nodules which can be the preferred imaging examination in clinical practice.endprint