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目的:探讨彩色多普勒超声用于甲状腺微小乳头状癌(PTMC)的诊断价值。方法:选择我院已取得病理结果的PTMC200例(恶性组)和甲状腺良性结节100例(良性组),分析两组结节的超声二维图像、内部及周边血流特征及血流动力学特点,以及在多结节、多种病理形态背景中PTMC的诊断情况。结果:恶性组病例均经病理切片确定为多种病理形态学(多源性)背景合并PTMC,其中病理形态为结节性甲状腺肿合并PTMC 99例(49.5%),甲状腺腺瘤合并PTMC 66例(33.0%),结节性甲状腺肿囊性变合并PTMC 35例(17.5%)。恶性组结节纵横比(A/T)≥1的例数为120例(60.0%),显著高于良性组的42例(42.0%),且在结节边界、形态、周边晕环、内部及后方回声、钙化等方面均与良性组存在显著差异(P<0.05);彩色多普勒血流显像(CDFI)检测示,良性组血流均为Ⅰ或Ⅱ级,而恶性组血流为Ⅲ级者占73.5%,差异非常显著(P<0.01);恶性组结节内血流平均阻力指数为0.73,显著高于良性组的0.60(P<0.05);频谱形态亦有显著差异,良性结节多为周边及内部血流信号,恶性结节则以边缘或内部丰富血流信号为主。结论:彩色多普勒超声对PTMC的诊断价值较高。
Objective: To investigate the diagnostic value of color Doppler ultrasound in the diagnosis of thyroid papillary carcinoma (PTMC). Methods: 200 cases of PTMC (malignant group) and 100 cases of benign thyroid nodules (benign group) were selected in our hospital. The two-dimensional images of the nodules in the two groups were analyzed. The internal and peripheral blood flow characteristics and hemodynamics Characteristics, and the diagnosis of PTMC in multiple nodules and various pathomorphological backgrounds. Results: The malignant group of patients were confirmed by pathological sections for a variety of pathomorphological (polygenic) background merger PTMC, of which pathological morphology of nodular goiter with PTMC in 99 cases (49.5%), thyroid adenoma with PTMC in 66 cases (33.0%), cystic nodular goiter and PTMC 35 cases (17.5%). Malignant group nodules with aspect ratio (A / T) ≥1 cases were 120 cases (60.0%), significantly higher than the 42 cases (42.0%) of the benign group, and in nodule boundaries, morphology, peripheral halo, internal (P <0.05). The color Doppler flow imaging (CDFI) showed that the benign group had grade Ⅰ or Ⅱ blood flow, while the malignant group showed no significant difference (P <0.01). The mean resistance index of blood flow in malignant group was 0.73, which was significantly higher than that in benign group (P <0.05). There was also significant difference in spectral shape between the two groups Benign nodules are mostly peripheral and internal blood flow signals, malignant nodules are mainly marginal or internal rich blood flow signals. Conclusion: The diagnostic value of color Doppler ultrasound in PTMC is high.