超声新技术在甲状腺微小癌中的研究现状
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摘要
超声诊断技术的不断更新使甲状腺微小癌(TMC)的诊断准确率逐年提高,为疾病的治疗和预后做出贡献。超声造影通过造影剂血管显像,可清晰显示肿瘤的血流灌注情况,且超声造影定量参数能反映TMC的微血管密度与微血管面积。弹性成像可准确、客观地获取组织的硬度信息,有助于准确诊断并在多个病灶中发现TMC,提高TMC的检出率,降低漏诊误诊率。超微血管成像可很好地显示微血管及低速血流。三维超声可通过重建技术清晰地展示病灶的空间三维结构,展示结节内部情况及结节与周边组织的关系,提供立体血管树三维图像。
A number of new ultrasound techniques have been developed year by year,which have improved the diagnostic accuracy of thyroid microcarcinoma( TMC) and contributed to the treatment and prognosis of the disease. Blood perfusion of the tumor can be clearly show when using contrast-enhanced ultrasound. And its quantitative parameter can provide us the density and area of microvascular of TMC. Elastography can accurately diagnose TMC by obtaining the tissue hardness information accurately and objectively,and it can recognize the malignant one in multiple nodules,helping to increase the rate of detection and reduce the rate of misdiagnosis. Superb microvascular imaging can show the micro-vessels and low-velocity blood flow well. Three-dimensional ultrasound can give us a clear impression about the three-dimensional spatial structure of the lesion,the internal conditions of the nodules,the relationship between the nodules and the surrounding tissue,and give us a 3 D image of the vascular tree.
A number of new ultrasound techniques have been developed year by year,which have improved the diagnostic accuracy of thyroid microcarcinoma( TMC) and contributed to the treatment and prognosis of the disease. Blood perfusion of the tumor can be clearly show when using contrast-enhanced ultrasound. And its quantitative parameter can provide us the density and area of microvascular of TMC. Elastography can accurately diagnose TMC by obtaining the tissue hardness information accurately and objectively,and it can recognize the malignant one in multiple nodules,helping to increase the rate of detection and reduce the rate of misdiagnosis. Superb microvascular imaging can show the micro-vessels and low-velocity blood flow well. Three-dimensional ultrasound can give us a clear impression about the three-dimensional spatial structure of the lesion,the internal conditions of the nodules,the relationship between the nodules and the surrounding tissue,and give us a 3 D image of the vascular tree.
引文
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[2] Costamagna D,Pagano L,Caputo M,et al. Incidental cancer in patients surgically treated for benign thyroid disease. Our experience at a single institution[J]. G Chir,2013,34(1/2):21-26.
[3] Kutlutürk K,Otan E,Yaˇgc? MA,et al. Thyroid pathologies accompanying primary hyperparathyroidism:A high rate of papillary thyroid microcarcinoma[J]. Ulus Cerrahi Derg,2014,30(3):125-128.
[4] Leboulleux S,Tuttle RM,Pacini F,et al. Papillary thyroid microcarcinoma:Time to shift from surgery to active surveillance[J].Lancet Diabetes Endocrinol,2016,4(11):933-942.
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[6]陈霰,徐丽伟,华娟,等.超声造影在甲状腺微小乳头状癌诊断中的应用价值[J].中国超声医学杂志,2015,31(4):375-378.
[7] Li F,Zhang J,Wang Y,et al. Clinical value of elasticity imaging and contrast-enhanced ultrasound in the diagnosis of papillary thyroid microcarcinoma[J]. Oncol Lett,2015,10(3):1371-1377.
[8]吕颖钺,栗翠英,巩海燕,等.高分辨率超声、超声弹性成像及超声造影在甲状腺结节良恶性病变诊断中的比较研究[J].中华内分泌代谢杂志,2014,30(4):297-301.
[9]张雯,余铖,项飞翔,等.甲状腺微小乳头状癌高频超声及超声造影表现[J].中国医师杂志,2017,19(5):716-720.
[10]张隽,陈辽,胡伟,等.超声造影参数成像在TI-RADS3~4级甲状腺微小癌鉴别诊断中的应用价值[J].中华超声影像学杂志,2017,26(10):855-860.
[11]种静,孙咏梅,宁春平,等.甲状腺乳头状癌超声造影特征与微血管密度及微血管面积的相关性研究[J/CD].中华医学超声杂志(电子版),2017,14(4):274-279.
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[13] Ophir J,Céspedes I,Ponnekanti H,et al. Elastography:A quantitative method for imaging the elasticity of biological tissues[J].Ultrason Imaging,1991,13(2):111-134.
[14]张桦.超声弹性成像与造影联合应用诊断甲状腺结节的临床价值[J].医学影像学杂志,2017,27(6):1060-1062.
[15]崔秋丽,严昆,杨薇,等.超声弹性分级与应变率比值鉴别诊断甲状腺微小结节[J].中国医学影像技术,2013,29(5):714-717.
[16] Bamber J,Cosgrove D,Dietrich CF,et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastograpy. Part1:Basic principles an d technology[J]. Ultraschall Med,2013,34(2):169-184.
[17]于萍,张万蕾,于蕾,等.超声弹性成像在甲状腺微小病变诊断中的价值[J].中国超声医学杂志,2014,30(7):584-587.
[18] Kim SY,Kim EK,Moon HJ,et al. Application of Texture Analysis in the Differential Diagnosis of Benign and Malignant Thyroid Nodules:Comparison With Gray-Scale Ultrasound and Elastography[J]. AJR Am J Roentgenol,2015,205(3):W343-351.
[19] Faruk T,Islam MK,Arefin S,et al. The Journey of Elastography:Background,Current Status,and Future Possibilities in Breast Cancer Diagnosis[J]. Clin Breast Cancer,2015,15(5):313-324.
[20]邹霞,李泉水,李清山,等.声脉冲辐射力弹性成像VTQ在鉴别诊断甲状腺良恶性结节中的应用价值[J].中国超声医学杂志,2014,30(7):588-591.
[21]谢晓玮,王兴田,王荣.声脉冲辐射力弹性成像对甲状腺微小癌的诊断价值[J].中国肿瘤外科杂志,2016,8(2):104-107.
[22] Zhan J,Jin JM,Diao XH,et al. Acoustic radiation force impulse imaging(ARFI)for differentiation of benign and malignant thyroid nodules-A meta-analysis[J]. Eur J Radiol,2015,84(11):2181-2186.
[23]郝菲,陈武,刘晓芳,等.实时剪切波弹性成像诊断甲状腺微小癌的临床应用价值[J/CD].中华临床医师杂志(电子版),2017,11(8):1269-1273.
[24] Samir AE,Dhyani M,Anvari A,et al. Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid:Diagnostic Accuracy and Optimal Measurement Plane[J]. Radiology,2015,277(2):565-573.
[25] Cantisani V,Grazhdani H,Drakonaki E,et al. Strain US Elastography for the Characterization of Thyroid Nodules:Advantages and Limitation[J]. Int J Endocrinol,2015,2015:908575.
[26]贾红靖,徐晓红.声脉冲辐射力弹性成像诊断甲状腺结节的研究进展[J].医学综述,2014,20(3):515-517.
[27]李怡,张玉英.新型超声弹性成像技术在对甲状腺结节性质判断中的应用进展[J].山东医药,2016,56(28):111-113.
[28] Lu R,Meng Y,Zhang Y,et al. Superb microvascular imaging(SMI)compared with conventional ultrasound for evaluating thyroid nodules[J]. BMC Med Imaging,2017,17(1):65.
[29] DemenéC,Tiran E,Sieu LA,et al. 4D microvascular imaging based on ultrafast Doppler tomography[J]. Neuroimage,2016,127:472-483.
[30] Kong J,Li JC,Wang HY,et al. Role of Superb Micro-Vascular Imaging in the Preoperative Evaluation of Thyroid Nodules:Comparison With Power Doppler Flow Imaging[J]. J Ultrasound Med,2017,36(7):1329-1337.
[31]刁雪红,詹嘉,陈林,等.超级微血管成像技术在甲状腺实性结节良恶性鉴别诊断中的应用价值[J/CD].中华医学超声杂志(电子版),2016,13(8):622-626.
[32]陈红燕,朱慧,朱丽,等.微血流成像对甲状腺微小癌诊断价值的初步探索[J].中国超声医学杂志,2016,32(2):101-103.
[33]陈红燕,陈悦,朱慧,等.超微血流显像与超声造影鉴别诊断甲状腺微小结节的对比研究[J].中华超声影像学杂志,2016,25(1):44-47.
[34]欧阳伽保,初银珠,邱前义,等.微血管成像与超声造影在鉴别甲状腺结节良恶性的价值研究[J].中国超声医学杂志,2017(4):293-296.
[35]魏巍.超声造影与微血管成像在甲状腺结节鉴别诊断中的应用价值对照研究[J].当代医学,2018,24(1):63-65.
[36]赵永锋,周平,伍晓敏,等.超微血管成像评价甲状腺结节激光消融疗效[J].中国医学影像技术,2016,32(9):1357-1360.
[37]袁南兵.三维超声体积测量研究进展[J].四川医学,2015,36(11):1602-1604.
[38]韩露,赵海,宫术娟.二维超声与三维超声在甲状腺结节诊断中的应用[J].黑龙江医学,2015,39(10):1149-1150.
[39]闫岩,王志远,石卫东.三维超声对正常甲状腺血流的定量评价[J].中国社区医师,2014,30(19):115-116.
[40]鲁玉婷,宋涛,赵琴,等.三维能量多普勒血管成像及其定量参数在甲状腺结节诊断中的应用[J].中国超声医学杂志,2014,30(9):769-771.
[41]马振,刘雪玲,雷蓓,等.三维能量多普勒超声对良恶性甲状腺肿瘤的鉴别诊断[J].西部医学,2015,27(4):574-576.
[2] Costamagna D,Pagano L,Caputo M,et al. Incidental cancer in patients surgically treated for benign thyroid disease. Our experience at a single institution[J]. G Chir,2013,34(1/2):21-26.
[3] Kutlutürk K,Otan E,Yaˇgc? MA,et al. Thyroid pathologies accompanying primary hyperparathyroidism:A high rate of papillary thyroid microcarcinoma[J]. Ulus Cerrahi Derg,2014,30(3):125-128.
[4] Leboulleux S,Tuttle RM,Pacini F,et al. Papillary thyroid microcarcinoma:Time to shift from surgery to active surveillance[J].Lancet Diabetes Endocrinol,2016,4(11):933-942.
[5] Miyauchi A. Clinical Trials of Active Surveillance of Papillary Microcarcinoma of the Thyroid[J]. World J Surg,2016,40(3):516-522.
[6]陈霰,徐丽伟,华娟,等.超声造影在甲状腺微小乳头状癌诊断中的应用价值[J].中国超声医学杂志,2015,31(4):375-378.
[7] Li F,Zhang J,Wang Y,et al. Clinical value of elasticity imaging and contrast-enhanced ultrasound in the diagnosis of papillary thyroid microcarcinoma[J]. Oncol Lett,2015,10(3):1371-1377.
[8]吕颖钺,栗翠英,巩海燕,等.高分辨率超声、超声弹性成像及超声造影在甲状腺结节良恶性病变诊断中的比较研究[J].中华内分泌代谢杂志,2014,30(4):297-301.
[9]张雯,余铖,项飞翔,等.甲状腺微小乳头状癌高频超声及超声造影表现[J].中国医师杂志,2017,19(5):716-720.
[10]张隽,陈辽,胡伟,等.超声造影参数成像在TI-RADS3~4级甲状腺微小癌鉴别诊断中的应用价值[J].中华超声影像学杂志,2017,26(10):855-860.
[11]种静,孙咏梅,宁春平,等.甲状腺乳头状癌超声造影特征与微血管密度及微血管面积的相关性研究[J/CD].中华医学超声杂志(电子版),2017,14(4):274-279.
[12] Yuan Z,Quan J,Yunxiao Z,et al. Contrast-enhanced ultrasound in the diagnosis of solitary thyroid nodules[J]. J Cancer Res Ther,2015,11(1):41-45.
[13] Ophir J,Céspedes I,Ponnekanti H,et al. Elastography:A quantitative method for imaging the elasticity of biological tissues[J].Ultrason Imaging,1991,13(2):111-134.
[14]张桦.超声弹性成像与造影联合应用诊断甲状腺结节的临床价值[J].医学影像学杂志,2017,27(6):1060-1062.
[15]崔秋丽,严昆,杨薇,等.超声弹性分级与应变率比值鉴别诊断甲状腺微小结节[J].中国医学影像技术,2013,29(5):714-717.
[16] Bamber J,Cosgrove D,Dietrich CF,et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastograpy. Part1:Basic principles an d technology[J]. Ultraschall Med,2013,34(2):169-184.
[17]于萍,张万蕾,于蕾,等.超声弹性成像在甲状腺微小病变诊断中的价值[J].中国超声医学杂志,2014,30(7):584-587.
[18] Kim SY,Kim EK,Moon HJ,et al. Application of Texture Analysis in the Differential Diagnosis of Benign and Malignant Thyroid Nodules:Comparison With Gray-Scale Ultrasound and Elastography[J]. AJR Am J Roentgenol,2015,205(3):W343-351.
[19] Faruk T,Islam MK,Arefin S,et al. The Journey of Elastography:Background,Current Status,and Future Possibilities in Breast Cancer Diagnosis[J]. Clin Breast Cancer,2015,15(5):313-324.
[20]邹霞,李泉水,李清山,等.声脉冲辐射力弹性成像VTQ在鉴别诊断甲状腺良恶性结节中的应用价值[J].中国超声医学杂志,2014,30(7):588-591.
[21]谢晓玮,王兴田,王荣.声脉冲辐射力弹性成像对甲状腺微小癌的诊断价值[J].中国肿瘤外科杂志,2016,8(2):104-107.
[22] Zhan J,Jin JM,Diao XH,et al. Acoustic radiation force impulse imaging(ARFI)for differentiation of benign and malignant thyroid nodules-A meta-analysis[J]. Eur J Radiol,2015,84(11):2181-2186.
[23]郝菲,陈武,刘晓芳,等.实时剪切波弹性成像诊断甲状腺微小癌的临床应用价值[J/CD].中华临床医师杂志(电子版),2017,11(8):1269-1273.
[24] Samir AE,Dhyani M,Anvari A,et al. Shear-Wave Elastography for the Preoperative Risk Stratification of Follicular-patterned Lesions of the Thyroid:Diagnostic Accuracy and Optimal Measurement Plane[J]. Radiology,2015,277(2):565-573.
[25] Cantisani V,Grazhdani H,Drakonaki E,et al. Strain US Elastography for the Characterization of Thyroid Nodules:Advantages and Limitation[J]. Int J Endocrinol,2015,2015:908575.
[26]贾红靖,徐晓红.声脉冲辐射力弹性成像诊断甲状腺结节的研究进展[J].医学综述,2014,20(3):515-517.
[27]李怡,张玉英.新型超声弹性成像技术在对甲状腺结节性质判断中的应用进展[J].山东医药,2016,56(28):111-113.
[28] Lu R,Meng Y,Zhang Y,et al. Superb microvascular imaging(SMI)compared with conventional ultrasound for evaluating thyroid nodules[J]. BMC Med Imaging,2017,17(1):65.
[29] DemenéC,Tiran E,Sieu LA,et al. 4D microvascular imaging based on ultrafast Doppler tomography[J]. Neuroimage,2016,127:472-483.
[30] Kong J,Li JC,Wang HY,et al. Role of Superb Micro-Vascular Imaging in the Preoperative Evaluation of Thyroid Nodules:Comparison With Power Doppler Flow Imaging[J]. J Ultrasound Med,2017,36(7):1329-1337.
[31]刁雪红,詹嘉,陈林,等.超级微血管成像技术在甲状腺实性结节良恶性鉴别诊断中的应用价值[J/CD].中华医学超声杂志(电子版),2016,13(8):622-626.
[32]陈红燕,朱慧,朱丽,等.微血流成像对甲状腺微小癌诊断价值的初步探索[J].中国超声医学杂志,2016,32(2):101-103.
[33]陈红燕,陈悦,朱慧,等.超微血流显像与超声造影鉴别诊断甲状腺微小结节的对比研究[J].中华超声影像学杂志,2016,25(1):44-47.
[34]欧阳伽保,初银珠,邱前义,等.微血管成像与超声造影在鉴别甲状腺结节良恶性的价值研究[J].中国超声医学杂志,2017(4):293-296.
[35]魏巍.超声造影与微血管成像在甲状腺结节鉴别诊断中的应用价值对照研究[J].当代医学,2018,24(1):63-65.
[36]赵永锋,周平,伍晓敏,等.超微血管成像评价甲状腺结节激光消融疗效[J].中国医学影像技术,2016,32(9):1357-1360.
[37]袁南兵.三维超声体积测量研究进展[J].四川医学,2015,36(11):1602-1604.
[38]韩露,赵海,宫术娟.二维超声与三维超声在甲状腺结节诊断中的应用[J].黑龙江医学,2015,39(10):1149-1150.
[39]闫岩,王志远,石卫东.三维超声对正常甲状腺血流的定量评价[J].中国社区医师,2014,30(19):115-116.
[40]鲁玉婷,宋涛,赵琴,等.三维能量多普勒血管成像及其定量参数在甲状腺结节诊断中的应用[J].中国超声医学杂志,2014,30(9):769-771.
[41]马振,刘雪玲,雷蓓,等.三维能量多普勒超声对良恶性甲状腺肿瘤的鉴别诊断[J].西部医学,2015,27(4):574-576.