摘要
目的总结桥本甲状腺炎(HT)合并甲状腺结节样病变超声与病理学特征。方法对89例超声显示HT合并甲状腺结节样病变患者的超声声像图表现与病理特征进行总结分析。结果89例HT合并甲状腺结节术前超声诊断良性结节78例(87.6%,78/89),恶性结节11例(12.4%,11/89)。其中78例良性结节最大径6.4 cm×4.6 cm,最小径0.4 cm×0.3 cm,超声表现:(1)甲状腺对称性弥漫性肿大,峡部肿大明显,腺体回声减低,可见细线状强回声交织呈网格状。(2)HT合并甲状腺结节形态多较规则(71.8%,56/78),边界清晰(73.1%,57/78),部分呈高回声(21.8%,17/78),多数结节(74.4%,58/78)内未见钙化,结节周围腺体分布不均匀(75.6%,59/78);少数结节(19.2%,15/78)内见环状或团状粗大钙化灶,结节周围腺体分布均匀(24.4%,19/78)。(3)彩色多普勒血流成像示结节内血流信号较丰富(30.8%,24/78),部分结节(25.6%,20/78)边缘血流绕行。11例恶性结节最大径3.8 cm×2.6 cm,最小径0.5 cm×0.4 cm,超声表现:(1)甲状腺回声增粗不均或无明显改变。(2)恶性结节多呈不规则形(54.5%,6/11),边界不清(81.8%,9/11),低回声为主(90.9%,10/11),内部见粗大钙化(36.4%,4/11)或微小钙化(45.5%,5/11);多数结节(72.7%,8/11)周围腺体分布不均匀,少数结节(27.3%,3/11)周围腺体分布均匀。(3)彩色多普勒血流成像示结节边缘血流信号不丰富(9.1%,1/11),4例(36.4%,4/11)见粗大穿支血流信号。89例HT合并甲状腺结节术前超声与病理相关特征:(1)局灶性HT无合并结节22例,病理镜下示甲状腺内局灶性淋巴细胞浸润无明显纤维间隔形成;(2)HT合并结节性甲状腺肿49例,合并甲状腺腺瘤7例,合并甲状腺癌11例,病理镜下示结节周围淋巴细胞浸润,甲状腺滤泡重度萎缩,周边见粗大纤维间隔,与不均匀或网格样结构的声像图表现相吻合;病理镜下显示甲状腺滤泡轻度萎缩,结节周围未见粗大纤维分隔,与声像图表现的腺体回声均匀的图像表现相吻合。与手术病理诊断对照显示:术前超声诊断甲状腺良性结节及恶性结节与病理诊断符合率分别为91.0%(71/78)及54.5%(6/11)。结论 HT合并甲状腺结节样病变因病理表现不同超声表现各异。腺体萎缩退化伴低回声结节内微小钙化或粗大钙化可能为HT合并甲状腺癌的特征性声像表现;腺体回声不均或出现网格状结构提示HT腺体严重萎缩,可能为HT合并甲状腺良性病变的特征性声像表现。
Objective To study the ultrasonographic features and pathyology of thyroid nodular lesions with Hashimoto′s thyroiditis（HT）. Methods Ultrasonographic characteristics of 89 patients confirmed by surgery and pathology findings were retrospectively analysed. Results Of all HT with nodular lesions 78 were benign nodules, 11 were malignant nodules, 71 cases were diagnosed as thyroid benign lesions by ultrasonography preoperatively, the maximum size was 6.4 cm×4.6 cm, the minimal was 0.4 cm×0.3 cm. Ultrasonographic features of benign lesions were：（1） Diffuse enlargement of the thyroid gland symmetrically, isthmus swelling, echo reduction of the gland, with hyperechoic linear echo.（2） Ultrasound showed 71.8%（56/78） benign nodules were oval shape, 73.1%（57/78） with clear boundary, some lesions were hyperechoic（21.8%, 17/78）, most lesions（74.3%, 58/78） were lack of calcification, and the echo of surrounding glands were uneven（75.6%, 59/78）. Ring or clustered calcifications were detected in few lesions, with with uniform glands surrounding the nodules（24.4%, 19/78）.（3） Color Doppler flow imaging： the blood flow signals were rich（30.8%, 24/78）, and some lesions with peripheral（25.6%, 20/78）. Six cases of malignant cases were diagnosed as preoperatively, the maximum size was 3.8 cm×2.6 cm, the minimal size was 0.5 cm×0.4 cm.（1） The echo pattern of enlarged thyroid was uneven or normal.（2） Ultrasound showed benign nodules were mostly irregular（54.5%, 6/11）, the boundary was unclear（81.8%, 9/11）, hypoechoic with micro-calcifications（45.5%, 5/11）, the echo of surrounding glands was heterogeneous（72.7%, 8/11）; peripheral blood flow signals were detected in few nodules（9.1%, 1/11）, 4 cases had blood flow signals within the nodule（36.4%, 4/11）, the surrounding glands were characterized by uniform echo（27.3%, 3/11）. Preoperative ultrasonography diagnosis of thyroid benign lesions, 6 cases with pathological diagnosis, the coincidence rate was 54.5%（6/11）. The coincidence rate of pathological diagnosis was 91.0%（71/78）.（3） Color Doppler flow imaging： no rich blood flow signal was detected in the nodules（9.1%, 1/11）, 4 cases（36.4%, 4/11） showed bulky blood flow signals inside the nodule. Preoperative sonographic findings of 89 HT cases were related to the pathological features：（1） Ultrasound showed focal HT in 22 cases, pathological examination showed nodular lesion without apparent lymphocyte infiltration fibrosis.（2） Ultrasound showed HT with nodular goiter（49 cases）, associated with thyroid adenoma, thyroid carcinoma（7 cases）, and nodules（11 cases） with peripheral lymphocytes infiltration, severe thyroid follicular atrophy, peripheral interstitial fibrosis fiand uneven echo pattern of the surrounding gland. Pathology revealed mild thyroid follicular atrophy, no bulky fibrotic separation were found around the nodule, and the ultrasonographic performance of the gland were uniform. Surgical pathology diagnosis showed that the coincidence rate of preoperative ultrasonography in the diagnosis of benign and malignant thyroid lesions and pathological diagnosis was 91.0%（71/78） and 54.5%（6/11）. Conclusions The sonographic findings of HT with thyroid nodular lesions are correlated to the different histological findings. Glands atrophy degeneration associated with hypoechoic nodules with microcalcification or coarse calcification may be characteristic for HT with thyroid cancer. Heterogeneous echo of the glands suggest serious glands atrophy, grid structure of HT with sonographic performance is characteristic of thyroid benign lesions.
出处
《中华医学超声杂志（电子版）》
2014年第8期46-51,共6页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
北京市西城区卫生局青年科技人才培养项目(2011JXX0305)
