超声弹性成像对Graves病与桥本甲状腺炎的鉴别意义
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摘要
目的探究超声弹性成像对弥漫性毒性甲状腺肿(Graves病)与桥本甲状腺炎(Hashimoto's thyroiditis,HT)的鉴别意义。方法选取2010年9月~2014年12月间在笔者医院初诊为Graves病和HT的患者共250例,分为Graves组(n=124)和HT组(n=126)。采用常规彩超观察并记录甲状腺体积、形态、回声特征、血流情况,采用弹性成像分析并记录甲状腺弹性评分、相对应变值平均值(average relative value,MEAN)和蓝色面积比例(area ration of lowstrain region,%AREA)。对比常规彩超与联合超声弹性成像的诊断准确率。结果两组甲状腺体积、回声分级和血流分级差异无统计学意义(P>0.05)。Graves组以散在低回声为主,HT组以弥漫性低回声为主,有网格样强回声;Graves组收缩期峰值流速(PSV)、舒张末期流速(EDV)均大于HT组,差异有统计学意义(P<0.05)。弹性成像分析显示,HT组弹性评分、%AREA均大于Graves组,但MEAN小于Graves组,差异有统计学意义(P<0.05)。彩超联合弹性成像对Graves病、HT鉴别诊断准确率高于常规彩超组,差异有统计学意义(P<0.05)。结论弹性成像能够提高超声诊断Graves病、HT的准确率。
Objective To investigate the value of ultrasound elastography in diagnosis of Graves disease and Hashimoto' s thyroiditis. Methods One hundred and twelve patients with Graves disease and 108 patients with Hashimoto's thyroiditis( HT) were included in this study between September 2010 and December 2014 in our hospital. Thyroid size,shape,echo characteristics,blood condition were observed and recorded by color Doppler ultrasound. In addition,Elastic score,the average value of the relative strain( MEAN) and the blue area ratio( % AREA) were gained by ultrasound elastography. The diagnosis accuracy of color Doppler ultrasound and ultrasound elastography were compared. Results No significant difference was detected in thyroid size,echo characteristics and blood flow classification( P > 0. 05). Graves group was mainly charactered with scattered hypoechoic echo- based distribution,and HT group was mainly charactered with diffuse hypoechoic echo- based distribution. PSV,EDV in Graves group were significantly higher than those in HT group( P < 0. 05). Elastic score and % AREA in HT group were significantly higher,but MEAN in HT group was significantly lower. The diagnosis accuracy of combined ultrasound was significantly higher than that of color Doppler ultrasound( P < 0. 05). Conclusion Color Doppler ultrasound combined with ultrasound elastography may play a role in the diagnosis of Graves disease and Hashimoto's thyroiditis.
Objective To investigate the value of ultrasound elastography in diagnosis of Graves disease and Hashimoto' s thyroiditis. Methods One hundred and twelve patients with Graves disease and 108 patients with Hashimoto's thyroiditis( HT) were included in this study between September 2010 and December 2014 in our hospital. Thyroid size,shape,echo characteristics,blood condition were observed and recorded by color Doppler ultrasound. In addition,Elastic score,the average value of the relative strain( MEAN) and the blue area ratio( % AREA) were gained by ultrasound elastography. The diagnosis accuracy of color Doppler ultrasound and ultrasound elastography were compared. Results No significant difference was detected in thyroid size,echo characteristics and blood flow classification( P > 0. 05). Graves group was mainly charactered with scattered hypoechoic echo- based distribution,and HT group was mainly charactered with diffuse hypoechoic echo- based distribution. PSV,EDV in Graves group were significantly higher than those in HT group( P < 0. 05). Elastic score and % AREA in HT group were significantly higher,but MEAN in HT group was significantly lower. The diagnosis accuracy of combined ultrasound was significantly higher than that of color Doppler ultrasound( P < 0. 05). Conclusion Color Doppler ultrasound combined with ultrasound elastography may play a role in the diagnosis of Graves disease and Hashimoto's thyroiditis.
引文
1 Visser R,De Mast Q,Netea-Maier RT,et al.Hashimoto's thyroiditis presenting as acute painful thyroiditis and as a manifestation of an immune reconstitution inflammatory syndrome in a human immunodeficiency virus-seropositive patient[J].Thyroid,2012,22(8):853-855
2郭汉涛,吴丽桑,周瑞莉,等.桥本甲状腺炎合并结节样病变超声诊断与病理结果分析[J].实用医学杂志,2012,28(24):4140-4142
3 王深,孟召伟,贾强,等.MRI弥散加权成像、甲状腺摄碘率和血清指标测定鉴别Graves甲状腺功能亢进症和无痛性甲状腺炎的研究[J].国际放射医学核医学杂志,2014,38(6):392-397
4 郝轶,柳莉莎.超声弹性成像技术及其临床应用[J].医学综述,2010,16(3):453-455
5 俞清,徐智章,王文平,等.甲状腺占位性病变的实时超声弹性成像表现[J].中国医学影像技术,2011,23(11):1612-1614
6 丛淑珍,冯占武,甘科红,等.甲状腺良、恶性结节超声弹性成像特征分析[J].中国医学影像技术,2010,26(9):1682-1684
7 中华医学会内分泌学分会.中国甲状腺疾病诊治指南——甲状腺炎[J].中华内科杂志,2008,47(9):784-788
8 中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南——甲状腺功能亢进症[J].中华内科杂志,2007,46(10):876-882
9 傅先水,李志强,张华斌,等.局限性桥本氏甲状腺炎的超声影像学特征[J].中国医学科学院学报,2014,36(3):291-295
10 姜月茗茗,黄品同,苏楠,等.甲状腺微小实性结节超声诊断良恶性的Logistic回归分析[J].中华超声影像学杂志,2014,23(8):675-678
11 刘芳,肖萤.超声弹性成像鉴别良恶性甲状腺结节[J].中国医学影像技术,2010,26(6):1028-1030
12 任新平,詹维伟,周萍,等.实时超声弹性成像及灰阶超声检查在甲状腺占位性病变诊断的对比研究[J].中国超声医学杂志,2011,25(2):128-132
13 Nagayama Y,Nakahara M,Shimamura M,et al.Prophylactic and therapeutic efficacies of a selective inhibitor of the immunoproteasome for Hashimoto's thyroiditis,but not for Graves'hyperthyroidism,in mice[J].Clinical and Experimental Immunology,2012,168(3):268-273
14 AC L.Relapsing thrombocytopenia leading to the diagnosis of presymptomatic Hashimoto's thyroiditis[J].Annals of Hematology,2011,90(10):1245-1246
15 王建红,刘韶平,李萍,等.超声弹性应变率比值在桥本甲状腺炎合并甲状腺良恶性结节鉴别诊断中的应用[J].中国超声医学杂志,2012,28(7):595-598
16 Aversa T,Lombardo F,Corrias A,et al.In young patients with turner or down syndrome,graves'disease presentation is often preceded by hashimoto's thyroiditis[J].Thyroid,2014,24(4):744-747
17 Takeshima K,Inaba H,Furukawa Y,et al.Elevated serum immunoglobulin g4 levels in patients with graves'disease and their clinical implications[J].Thyroid,2014,24(4):736-743
18 王亚琼,李红.Graves眼病发病机制研究进展[J].国际眼科杂志,2012,12(1):65-68
19 詹想想,赵兵,杞灵斌.甲状腺疾病超声诊断的病理基础及临床价值[J].医学综述,2015,21(2):294-296
20 Bernecker C,Ostapczuk M,Vordenb S,et al.HLA-A2 phenotype may be protective against graves'disease but not against Hashimoto's thyroiditis in caucasians[J].Hormone and Metabolic Research,2013,45(1):74-77
2郭汉涛,吴丽桑,周瑞莉,等.桥本甲状腺炎合并结节样病变超声诊断与病理结果分析[J].实用医学杂志,2012,28(24):4140-4142
3 王深,孟召伟,贾强,等.MRI弥散加权成像、甲状腺摄碘率和血清指标测定鉴别Graves甲状腺功能亢进症和无痛性甲状腺炎的研究[J].国际放射医学核医学杂志,2014,38(6):392-397
4 郝轶,柳莉莎.超声弹性成像技术及其临床应用[J].医学综述,2010,16(3):453-455
5 俞清,徐智章,王文平,等.甲状腺占位性病变的实时超声弹性成像表现[J].中国医学影像技术,2011,23(11):1612-1614
6 丛淑珍,冯占武,甘科红,等.甲状腺良、恶性结节超声弹性成像特征分析[J].中国医学影像技术,2010,26(9):1682-1684
7 中华医学会内分泌学分会.中国甲状腺疾病诊治指南——甲状腺炎[J].中华内科杂志,2008,47(9):784-788
8 中华医学会内分泌学分会《中国甲状腺疾病诊治指南》编写组.中国甲状腺疾病诊治指南——甲状腺功能亢进症[J].中华内科杂志,2007,46(10):876-882
9 傅先水,李志强,张华斌,等.局限性桥本氏甲状腺炎的超声影像学特征[J].中国医学科学院学报,2014,36(3):291-295
10 姜月茗茗,黄品同,苏楠,等.甲状腺微小实性结节超声诊断良恶性的Logistic回归分析[J].中华超声影像学杂志,2014,23(8):675-678
11 刘芳,肖萤.超声弹性成像鉴别良恶性甲状腺结节[J].中国医学影像技术,2010,26(6):1028-1030
12 任新平,詹维伟,周萍,等.实时超声弹性成像及灰阶超声检查在甲状腺占位性病变诊断的对比研究[J].中国超声医学杂志,2011,25(2):128-132
13 Nagayama Y,Nakahara M,Shimamura M,et al.Prophylactic and therapeutic efficacies of a selective inhibitor of the immunoproteasome for Hashimoto's thyroiditis,but not for Graves'hyperthyroidism,in mice[J].Clinical and Experimental Immunology,2012,168(3):268-273
14 AC L.Relapsing thrombocytopenia leading to the diagnosis of presymptomatic Hashimoto's thyroiditis[J].Annals of Hematology,2011,90(10):1245-1246
15 王建红,刘韶平,李萍,等.超声弹性应变率比值在桥本甲状腺炎合并甲状腺良恶性结节鉴别诊断中的应用[J].中国超声医学杂志,2012,28(7):595-598
16 Aversa T,Lombardo F,Corrias A,et al.In young patients with turner or down syndrome,graves'disease presentation is often preceded by hashimoto's thyroiditis[J].Thyroid,2014,24(4):744-747
17 Takeshima K,Inaba H,Furukawa Y,et al.Elevated serum immunoglobulin g4 levels in patients with graves'disease and their clinical implications[J].Thyroid,2014,24(4):736-743
18 王亚琼,李红.Graves眼病发病机制研究进展[J].国际眼科杂志,2012,12(1):65-68
19 詹想想,赵兵,杞灵斌.甲状腺疾病超声诊断的病理基础及临床价值[J].医学综述,2015,21(2):294-296
20 Bernecker C,Ostapczuk M,Vordenb S,et al.HLA-A2 phenotype may be protective against graves'disease but not against Hashimoto's thyroiditis in caucasians[J].Hormone and Metabolic Research,2013,45(1):74-77