应用Logistic回归模型分析甲状腺良恶性结节的超声特征
|
摘要
目的：以超声声像图特征及患者性别、年龄作为甲状腺结节良、恶性鉴别诊断的自变量，建立Logistic回归模型，比较超声声像图特征及患者性别、年龄等因素在甲状腺结节良恶性鉴别诊断中的价值。
材料与方法：收集经手术切除后病理证实的286例甲状腺结节，其中良性结节183例作为对照组，恶性结节103例作为病例组。收集两组患者的年龄、性别资料以及甲状腺结节的超声声像图特征，包括结节的数目、最大直径、形态、纵横比、边界、边缘特征、回声水平、内部质地、有无声晕、钙化情况、后方回声有无衰减和血流情况。两组之间年龄因素使用t检验，其余两组间参数采用两独立样本比较的χ2检验，比较两组的参数有无统计学差异。将有统计学差异的参数作为自变量，以甲状腺结节良恶性作为应变量，分别进行赋值，向前逐步法测定恶性结节的超声特征，最后建立Logistic回归模型，P＜0.05有统计学意义。
结果：两组病例之间年龄经t检验，其余变量经χ2检验。两组病例之间结节的数目无统计学差异（P=0.718），其余两组之间参数均有统计学差异。经过最大似然估计前进法逐步回归，筛选出边缘特征、钙化情况、年龄、有无侵犯包膜、回声水平这五个最有价值的参数，其中边缘毛刺（OR＝20.830，r＝2.970）、微钙化（OR＝14.540，r＝1.796）、年龄（OR＝16.359，r＝-0.074）、有侵犯包膜（OR＝6.890，r＝1.351）、极低回声（OR＝9.747，r＝2.553）作为自变量进入Logistic回归模型。建立模型为：Logit（P）=0.719+2.970×边缘（2）+1.796×钙化（3）－0.074×年龄+1.351×包膜（1）+2.553×回声（4）。该模型经似然比检验有统计学意义（χ2=170.571，P=0.000），以该模型预报286例甲状腺结节，如果P>0.5时预报为恶性结节，P≤0.5时预报为良性结节，预报正确率达85.3%。
结论：1.甲状腺结节的单、多发对良恶性的鉴别没有意义。2. Logistic回归模型筛选出5个对甲状腺结节恶性鉴别有意义的特征变量：患者的年龄、甲状腺结节的边缘特征、钙化情况、有无侵犯包膜、回声水平。3.患者的年龄与甲状腺结节的恶性呈负相关，年龄越小，其甲状腺结节的恶性可能性越大。4.边缘毛刺、微钙化、有侵犯包膜、极低回声与甲状腺结节的恶性呈正相关，这四个特征出现越多，其甲状腺结节的恶性可能性越大。5.进入方程的变量对方程重要程度：边缘毛刺＞年龄＞微钙化＞极低回声＞侵犯包膜。6.以超声声像图特征及患者的年龄等多个因素建立Logistic的回归模型有助于甲状腺结节的良、恶性鉴别。
Purpose: Sonographic features, patient's gender and age as the independent variablesto indentify the benign and malignant of thyroid nodule, establish a logistic regressionmodel, a benign thyroid nodule. Compare the values of sonographic characteristics, thepatient's gender, age and other factors in the differential diagnosis of benign and malignantthyroid nodulesthe.
Materials and methods: A retrospective analysis of two hundred and eighty six casesof thyroid nodules confirmed by pathology after operation excision,one hundred and eightythree nodules were benign as control group, one hundred and three nodules were malignantas case group. A retrospective collection of two groups of patients with age, the sexualdistinction and the ultrasonographic features of thyroid nodules, including nodule number,diameter, shape, boundary, internal echo level, edge feature, anteroposterior and transversediameter ratio, rear echo attenuation, halo, calcification and the blood flow. In addition,multiple logistic regression analysis with a forward stepwise method for selection ofsignificant variables was performed to determine independent ultrasound predictors formalignancy from the ultrasound characteristics that showed statistical significance(P<0.05). At last Logistic regression model was set up.
Results: The t test was used to evaluate the age of patient between the benign andmalignant nodules, the χ2test was used to evaluate the other parameters of two groups. Nosignificant difference between the two groups in the number of nodules (P=0.718), theother parameters of two groups were significant differences between theparameters(P<0.05). According to the output result of SPSS19.0, there were fiveindependent variable selected on the final step of Logistic regression analysis: calcification of nodules,the blood flow, age, capsular invasion,the echo level. There were the five of themore valuable parameter:spiculated margin (OR=20.830,r=2.970), calcification(OR=14.540, r=1.796), age (OR=16.359,r=-0.074), capsular invasion (OR=6.890, r=1.351), marked hypoechogenicity(OR=9.747,r=2.553). The model was: logit(P)=0.719+2.970edge(2)+1.796calcification(3)-0.074age+1.351capsularinvasion(1)+2.553theecho level(4). The likelihood ratio test was used to evaluate the fitting situation of thewhole model.It was statistically significant (χ2=170.571,P=0.000), the modle was used topredict the two hundred and eighty six thyroid nodules. The modle could distinguish thetwo kinds of nodules. When the regression value P was more than0.5, the prediction wasmalignant nodules. When the regression value P was less the or equal to0.5, the predictionwas benign nodules. The correct rate of prediction was85.3%.
Conclusion:①Thyroid nodules which were single or multiple can be helpless todifferential diagnosis of benign and malignant.②Five of fifteen independent variableswere selected by Logistic regression analysis: the age of patients, calcification, edgefeatures, capsular invasion, the echo level.③The age of patients was negatively correlatedwith malignant, the smaller the age, the more possibility of malignant thyroid nodules were.④Spiculated margin, microcalcification, capsular invasion and marked hypoechogenicityare positively correlated with malignant thyroid nodules, this four ultrasonic characteristicsmore appeared, the more possibility of malignant thyroid nodules were.⑤According theimportance of the model, arranged from high to low is: spiculated margin＞age＞microcalcification＞marked hypoechogenicity＞capsular invasion.⑥The binary Logisticregression model with the sonographic characteristics and the patients age can be helpful todifferentiation of benign and malignant thyroid nodules.
材料与方法：收集经手术切除后病理证实的286例甲状腺结节，其中良性结节183例作为对照组，恶性结节103例作为病例组。收集两组患者的年龄、性别资料以及甲状腺结节的超声声像图特征，包括结节的数目、最大直径、形态、纵横比、边界、边缘特征、回声水平、内部质地、有无声晕、钙化情况、后方回声有无衰减和血流情况。两组之间年龄因素使用t检验，其余两组间参数采用两独立样本比较的χ2检验，比较两组的参数有无统计学差异。将有统计学差异的参数作为自变量，以甲状腺结节良恶性作为应变量，分别进行赋值，向前逐步法测定恶性结节的超声特征，最后建立Logistic回归模型，P＜0.05有统计学意义。
结果：两组病例之间年龄经t检验，其余变量经χ2检验。两组病例之间结节的数目无统计学差异（P=0.718），其余两组之间参数均有统计学差异。经过最大似然估计前进法逐步回归，筛选出边缘特征、钙化情况、年龄、有无侵犯包膜、回声水平这五个最有价值的参数，其中边缘毛刺（OR＝20.830，r＝2.970）、微钙化（OR＝14.540，r＝1.796）、年龄（OR＝16.359，r＝-0.074）、有侵犯包膜（OR＝6.890，r＝1.351）、极低回声（OR＝9.747，r＝2.553）作为自变量进入Logistic回归模型。建立模型为：Logit（P）=0.719+2.970×边缘（2）+1.796×钙化（3）－0.074×年龄+1.351×包膜（1）+2.553×回声（4）。该模型经似然比检验有统计学意义（χ2=170.571，P=0.000），以该模型预报286例甲状腺结节，如果P>0.5时预报为恶性结节，P≤0.5时预报为良性结节，预报正确率达85.3%。
结论：1.甲状腺结节的单、多发对良恶性的鉴别没有意义。2. Logistic回归模型筛选出5个对甲状腺结节恶性鉴别有意义的特征变量：患者的年龄、甲状腺结节的边缘特征、钙化情况、有无侵犯包膜、回声水平。3.患者的年龄与甲状腺结节的恶性呈负相关，年龄越小，其甲状腺结节的恶性可能性越大。4.边缘毛刺、微钙化、有侵犯包膜、极低回声与甲状腺结节的恶性呈正相关，这四个特征出现越多，其甲状腺结节的恶性可能性越大。5.进入方程的变量对方程重要程度：边缘毛刺＞年龄＞微钙化＞极低回声＞侵犯包膜。6.以超声声像图特征及患者的年龄等多个因素建立Logistic的回归模型有助于甲状腺结节的良、恶性鉴别。
Purpose: Sonographic features, patient's gender and age as the independent variablesto indentify the benign and malignant of thyroid nodule, establish a logistic regressionmodel, a benign thyroid nodule. Compare the values of sonographic characteristics, thepatient's gender, age and other factors in the differential diagnosis of benign and malignantthyroid nodulesthe.
Materials and methods: A retrospective analysis of two hundred and eighty six casesof thyroid nodules confirmed by pathology after operation excision,one hundred and eightythree nodules were benign as control group, one hundred and three nodules were malignantas case group. A retrospective collection of two groups of patients with age, the sexualdistinction and the ultrasonographic features of thyroid nodules, including nodule number,diameter, shape, boundary, internal echo level, edge feature, anteroposterior and transversediameter ratio, rear echo attenuation, halo, calcification and the blood flow. In addition,multiple logistic regression analysis with a forward stepwise method for selection ofsignificant variables was performed to determine independent ultrasound predictors formalignancy from the ultrasound characteristics that showed statistical significance(P<0.05). At last Logistic regression model was set up.
Results: The t test was used to evaluate the age of patient between the benign andmalignant nodules, the χ2test was used to evaluate the other parameters of two groups. Nosignificant difference between the two groups in the number of nodules (P=0.718), theother parameters of two groups were significant differences between theparameters(P<0.05). According to the output result of SPSS19.0, there were fiveindependent variable selected on the final step of Logistic regression analysis: calcification of nodules,the blood flow, age, capsular invasion,the echo level. There were the five of themore valuable parameter:spiculated margin (OR=20.830,r=2.970), calcification(OR=14.540, r=1.796), age (OR=16.359,r=-0.074), capsular invasion (OR=6.890, r=1.351), marked hypoechogenicity(OR=9.747,r=2.553). The model was: logit(P)=0.719+2.970edge(2)+1.796calcification(3)-0.074age+1.351capsularinvasion(1)+2.553theecho level(4). The likelihood ratio test was used to evaluate the fitting situation of thewhole model.It was statistically significant (χ2=170.571,P=0.000), the modle was used topredict the two hundred and eighty six thyroid nodules. The modle could distinguish thetwo kinds of nodules. When the regression value P was more than0.5, the prediction wasmalignant nodules. When the regression value P was less the or equal to0.5, the predictionwas benign nodules. The correct rate of prediction was85.3%.
Conclusion:①Thyroid nodules which were single or multiple can be helpless todifferential diagnosis of benign and malignant.②Five of fifteen independent variableswere selected by Logistic regression analysis: the age of patients, calcification, edgefeatures, capsular invasion, the echo level.③The age of patients was negatively correlatedwith malignant, the smaller the age, the more possibility of malignant thyroid nodules were.④Spiculated margin, microcalcification, capsular invasion and marked hypoechogenicityare positively correlated with malignant thyroid nodules, this four ultrasonic characteristicsmore appeared, the more possibility of malignant thyroid nodules were.⑤According theimportance of the model, arranged from high to low is: spiculated margin＞age＞microcalcification＞marked hypoechogenicity＞capsular invasion.⑥The binary Logisticregression model with the sonographic characteristics and the patients age can be helpful todifferentiation of benign and malignant thyroid nodules.
引文
[1]孙永宇,郑笑娟,史小龙,等.高频彩色多普勒对甲状腺肿瘤的诊断价值[J].现代中西医结合杂志,2008,17(28):4416-4417.
[2] Mortensen JD,Woolnerlb LB,Bennett WA.Gross and microscopic findings in clinicallynormal thyroid glands[J]. J Clin Endocrinol Metab,1955,15(10):1270-1280.
[3] Hoang JK,Lee WK,Lee M,et al.US Features of thyroid malignancy:pearis andpitfalls[J].Radiographics,2007,27(3):847-860.
[4]张缙熙.新编超声诊断问答[M].北京:科学技术文献出版社,2008:239.
[5] Hegedüs L. Clinical practice.The thyroid nodule[J]. N Engl J Med,2004,351(17):1764-1771.
[6] Camargo RY,Tomimori EK.Usefulness of ultrasound in the diagnosis and managementof well-differentiated thyroid carcinoma[J].Arq Bras EndocrinolMetabol,2007,51(5):783-792.
[7] Okamoto T,Yamashita T,Harasawa A,et al.Test performances of three diagnosticprocedures in evaluating thyroid nodules:physical examination,ultrasonography andfine needle as piration cytology[J]. Endocr J,1994,41(3):243-247.
[8]丛淑珍,李康,吴丽桑,等.超声复合成像技术在甲状腺癌诊断中的实用价值[J].中国医学影像技术,2006,22(8):1183-1184.
[9] Shapiro RS.Management of thyroid nodules detected at sonography:Society ofRadiologists in Ultrasound Consensus Conference Statement[J].Thyroid,2006,16(3):209-210.
[10] Khati N,Adamson T,Johnson KS,et al.Ultrasound of the thyroid and parathyroidglands[J].Ultrasound Q,2003,19(4):162-176.
[11] Chan BK,Desser TS,McDougall IR,et al.Common and uncommon sonographicfeatures of papillary thyroid carcinoma[J].J Ultrasound Med,2003,22(10):1083-1090.
[12] Frates MC,Benson CB,Charboneau JW,et al.Management of thyroid nodules detectedat US:Society of Radiologists in Ultrasound consensus conferencestatement[J].Radiology,2005,237(3):794-800.
[13]吕珂,姜玉新,张缙熙,等.甲状腺结节的超声诊断研究[J].中华超声影像学杂志,2003,12(5):285-288.
[14] Butros R,Boyvat F,Ozyer U,et al.Management of infracentimetric thyroidnodules withrespect to ultrasonographic features[J].Eur Radiol,2007,17(5):1358-1364.
[15] Tae HJ,Lim DJ,Baek KH,et al.Diagnostic value of ultrasonography to distinguishbetween benign and malignant lesions in the management of thyroid nodules[J].Thyroid,2007,17(5):461-466.
[16]韩治宇,梁萍,李欣,等.超声诊断甲状腺结节证实偏倚校正的临床研究[J].中国医学影像技术,2008,24(1):48-50.
[17]方积乾.医学统计学与电脑实验[M].上海科学技术出版社,2001:484-498.
[18]李河,麦劲壮,肖敏,等.哑变量在Logistic回归模型中的应用[J].循证医学,2008,8(1):42-45.
[19] Raab SS,Silverman JF,Elsheikh TM,et al.Pediatric thyroid nodules:disease demo-graphics and clinical management as determined by fine needle aspirationbiopsy[J].Pediatrics,1995,95(1):46-49.
[20]陈孝平.外科学[M].北京:人民卫生出版社.2005:425-428.
[21]方国恩,李莉.甲状腺结节的诊断和处理[J].中国实用外科杂志,2003,23(3):135-137.
[22]陈文,张武,苗立英.甲状腺恶性肿瘤的二维及彩色多谱勒超声征象及其临床意义[J].中国超声医学杂志,2000,16(7):495-497.
[23] Frates MC,Benson CB,Doubilet PM,et al.Prevalence and distribution of carcinoma inpatients with solitary and multiple thyroid nodule sonsonography[J].J Clin endocrinolMetab,2006,91(9):3411-3417．
[24] Lang W, Borrusch H,Bauer L.Occult carcinomas of the thyroid:evaluation of1,020sequential autopsies[J].Am J Clin Pathol,1988,90(1):72-76.
[25] Yoon DY,Lee JW,Chang SK,et al.Peripheral calcification in thyroid nodules:ultrasonographic features and prediction of malignancy[J]. Ultrasound Med,2007,26(10):1349-1357.
[26] Cappelli C,Castellano M,Pirola I,et al.Thyroid nodule shape suggests malignancy[J].Eur J Endocrinol,2006,155(1):27-31.
[27] Papini E,Guglielmi R,Bianchini A,et al.Risk of malignancy in nonpalpable thyroidnodules: predictive value of ultrasound and color-Doppler features[J].J ClinEndocrinol Metab,2002,87(5):1941-1946.
[28] Stavros AT,Thickman D,Rapp CL,et al.Solid breast nodules:use of sonography todistinguish between benign and malignant lesions[J].Radiology,1995,196(1):123-134.
[29] Shimura H,Haraguchi K,Hiejima Y,et al.Distinct diagnostic criteria forultrasonogaphic examination of papillary thyroid carcinoma:a multicenter study[J].Thyroid,2005,15(3):251-258.
[30]温伟,金科,胡祥,等.甲状腺乳头状癌与结节性甲状腺肿CT成像特点的对比分析[J].实用放射学杂志,2008,24(9):1168-1711.
[31]曾金凤,胡文彬,陈毅馨.结节性甲状腺肿的超声征象与病理对比分析[J].临床超声医学杂志,2006,8(9):536-537.
[32] Frates MC,Benson CB,Doubilet PM,et al.Can color Doppler sonography aid in theprediction of malignancy of thyroid nodules?[J].J Ultrasound Med,2003,33(2):127-131.
[33] Nam-Goong IS,Kim HY,Gong G,et al.Ultrasonography-guided fine-needle aspirationof thyroid incidentaloma:correlation with pathological findings[J].Clin Endocrinol,2004,60(1):21-28.
[34] Fukunari N,Nagahama M,Sugino K,et al.Clinical Evaluation of color Doppler imagingfor the differential diagnosis of thyroid follicular lesions[J].World J Surg,2004,28(12):1261-1265.
[35] Kim DL,Song KH,Kim SK.High prevalence of carcinoma in ultrasonography-guidedfine needle aspiration cytology of thyroid nodules[J].Endocrine Journal,2008,55(1):135-142.
[36] Kovacevic DO,Skurla MS.Sonographic diagnosis of thyroid nodules: Correlation with theresults of sonographically guided fine-needle aspiration biopsy [J]. Journal Of ClinicalUltrasound,2007,35(2):63-67.
[37] McIvor NP,Freeman JL,Salem S.Ultrasonography of the thyroid and parathyroidglands [J].ORL J Otorhinolaryngol Relat Spec,1993,55(5):303-308.
[38] Solbiati L,Volterrani L,Rizzatto G,et al.The thyroid gland with low uptake lesions:evaluation by ultrasound [J].Radiology,1985,155(1):187-191.
[39] Ahuja AT. Practical head and neck ultrasound[M].London:Greenwich Medical MediaLimited,2000:35-63．
[40]路光中,何之彦,金宇飚,等.552例乳腺疾病的钙化分析[J].中华今日医学杂志,2003,3(16):3-5.
[41] Bassett LW,Jackson VP,Jahan R,et al.Diagnosis of the breast[M]. Philadelphia:WBSaunders Co,1997:113.
[42] Iannuccilli JD,Cronan JJ,Monchik JM.Risk for malignancy of thyroid nodules asassessed by sonographic criteria:the need forbiopsy[J].J Ultrasound Med,2004,23(11):1455-1464.
[43] Das DK,Mallik MK,Haji BE.Psammoma body and its precursors in papillary thyroidcarcinoma:a study by fine-needle as piration cytology[J].Diagn Cytopathol,2004,31(6):380-386.
[44]牛丽鹃,郝玉芝,周纯武.超声诊断甲状腺占位性病变的价值[J].中华耳鼻咽喉头颈外科杂志,2006,41(6):415-418.
[45] Cheng SP,Lee JJ,Lin J,et al. Eggshell calcification in follicular thyroid carcinoma[J].Eur Radiol,2005,15(8):1773-1774.
[46]丛淑珍,徐辉雄,吴丽桑,等.超声探测甲状腺结节内钙化的临床意义[J].中国超声医学杂志,2004,20(4):254-255.
[47] Moon WJ,Lung SL,Lee JH,et al.Benign and malignant thyroid nodules:USdiffertiation--muticenter retropective study[J].Radiology,2008,247(3):762-770.
[48] Vincenzo T,Edoardo G,Brunella L,et al.Microcalcifications and psammoma bodies inthyroid tumors[J].Thyroid,2008,18(9):1017-1018.
[49]刘洪枫,唐伟松,杨志英.甲状腺钙化性病症与甲状腺癌[J].中国医学科学院学报.2006,9(4):950-951.
[50]杨天高,张东辉,王志伟,等.乳腺浸润性微乳头状癌的病理与临床[J].航天航天医药,2010,28(10):1846-1847.
[51]朱义荣.乳腺浸润性微乳头状癌的病理与临床[J].山西医药杂志:下半月刊,2007,1(3):218-219.
[52]张霞,何洁,李颖嘉,等.探讨桥本病与甲状腺乳头状癌的关系[J].中国医学影像技术,2012,28(8):1490-1498.
[53] Lagalla R,Caruso G,Romana M. Echocolor Doppler in thyroid disease[J]. Radiol MedTorino,1993,85(5):109-113.
[54] Wart AC,Ackerman LA,Windham JP,et al.Breast lesions:differential diagnosis usingdigital subtraction angiography[J].Radiology,1986,159(1):39-42.
[55]金蓉,李彦敏,王众.甲状腺肿瘤的彩色血管能量成像与病理微血管密度的对比研究[J].中国临床医学影像杂志,2006,17(6):315-317.
[56]郑敏,穆丹梅,戴险峰,等.2D、CDFI、PW及3D-CPA评价甲状腺结节良恶性89例分析[J].中国肿瘤,2008,17(7):615-617.
[57]张蒂荣,鲁树坤,王双双,等.甲状腺肿块的彩色多普勒血流频谱形态与病理对照研究[J].中国超声医学杂志,2004,20(4):256-258.
[58]薛恩生,林礼务,叶真,等.彩色多普勒血流显像在甲状腺疾病诊断中的应用[J].中国超声医学杂志.1993,9(2):90-92.
[59] Varverakis E,Neonakis E,Tzardi M,et al.Role of color Doppler ultrasonography in thepreoperative management of cold thyroid nodules[J].Hormones(Athens),2007,6(1):44-51.
[60]邹霞,李泉水,张家庭,等.超声显像鉴别甲状腺癌结节的价值[J].中国医学影像技术,2009,25(10):1777-1779.
[61] Chammas MC,Gerhard R,Oliveira IR,et al.Thyroid nodules:evaluation with powrDoppler and duplex Doppler ultrasound[J].Otolaryngol Head Neck Surg,2005,132(6):874-882.
[62]徐刚,宋德顺,王瑞清.超声诊断甲状腺实质性占位的价值[J].山东医药,2005,45(22):55.
[63]汪小芬.甲状腺结节的超声诊断[J].现代医药卫生,2005,21(5):513-514.
[64] Marc D,Coltreara MD.Evaluation and imaging of a thyroid nodule[J].SurgicalOncology Clinics of North America,2008,17(1):37-56.
[1]孙永宇,郑笑娟,史小龙,等.高频彩色多普勒对甲状腺肿瘤的诊断价值[J].现代中西医结合杂志,2008,17(28):4416-4417.
[2] Mortensen JG. Microscopic findings in clinically normal thyroid glands[J]. J ClinEndocrinol Metab,1955,15(10):1270-1280.
[3] Hoang JK,Lee M,et al.US Features of thyroid malignancy: pearis and pitfalls[J].Radiographics,2007,27(3):847-860.
[4]张缙熙.新编超声诊断问答[M].科学技术文献出版社,2008:239.
[5] Practice HC.The thyroid nodule[J].N Engl J Med,2004,351(17):1764-1771.
[6] Okamoto T, Yamashita T, Harasawa A, et al.Test performances of three diagnosticprocedures in evaluating thyroid nodules:physical examination, ultrasonography andfine-needle as piration cytology[J]. Endocr J,1994,41(3):243-247.
[7]丛淑珍,李康,吴丽桑,等.超声复合成像技术在甲状腺癌诊断中的实用价值[J].中国医学影像技术,2006,22(8):1183-1184.
[8] Shapiro RS. Management of thyroid nodules detected at sonography:Society ofRadiologists in Ultrasound Consensus Conference Statement[J].Thyroid,2006,16(3):209-210.
[9] Khati N,Adamson T,Johnson K,et al.Ultrasound of the thyroid and parathyroidglands[J].Ultrasound Q,2003,19(4):162-176.
[10] Chan BK,Desser TS,McDougall I,et al.Common and uncommon sonographic featuresof papillary thyroid carcinoma[J].J Ultrasound Med,2003,22(10):1083-1090.
[11] Frates MC,Benson CB,Charboneau JW,et al.Management of thyroid nodules detectedat US:Society of Radiologists in Ultrasound consensus conference statement[J].Ultrasound Q,2006,22(4):231-238;239-240.
[12]张缙熙,姜玉新.浅表器官及组织超声诊断学[M].科学技术文献出版社,2000:67.
[13] Kim DL,Song KH,Kim SK High prevalence of carcinoma in ultrasonography-guidedfine needle aspiration cytology of thyroid nodules[J].Endocrine Journal,2008,55(1):135-142.
[14] C.Cappellt,M.Castellano,I.Pirola,et al.The predictive value of ultrasound fingdings inthe management of thyroid nodules[J].Q J Med,2007,l00(1):29-35.
[15] Obad Kovacevic MD,Mirna Smetana Skurla MD.Sonographic diagnosis of thyroidnodules:Correlation with the results of sonographically guided fine-needle aspirationbiopsy[J]. Journal Of Clinical Ultrasound,2007,35(2):63-67.
[16] Stacul F,Bertolotto M,DeGobbis F,et al.US,colour-Doppler US and fine-needleaspiration biopsy in the diagnosis of thyroid nodules[J].La radiologia medica,2007,112(5):751-762.
[17]王春荣.彩色多普勒超声在甲状腺良恶性肿瘤鉴别诊断中的应用[J].中国误诊学杂志,2008,8(18):4374-4375.
[18] Jun P,Chow LC,Jeffrey RB.The sonographic features of papillary thyroidcarcinomas[J].Ultrasound Q,2005,21(1):39-45.
[19] Suzuka Taki,Shintaro Terahata,Ryohei Yamashita,et al.Thyroid calcifications:Sonographic patterns and incidence of cancer[J].Journal of Clinical Imaging,2004,28(5):368-371.
[20] Dae Young Yoon,Joon Won Lee,Suk Ki Chang,et al. Peripheral CalcificationinThyroid Nodules:Ultrasonographic Features and Prediction of Malignancy[J].Ultrasound Med,2007,26(10):1349-1355.
[21] Kessler A,Rappaport Y,Blank A.Cystic Appearance of Cervical Lymph Nodes isCharacteristis of Metastatic Papillary Thyroid Carcinoma[J]. Journal of ClinicalUltrasound,2003,31(1):21-24.
[22] Johannes Zenk,Alessandro Bozzato,Joachim Hornung,et al.Neck Lymph Nodes:Prediction by computer-assisted contrast medium analysis?[J].Ultrasound inMed&Biol,2007,33(2):246-253.
[23]陈辉,赵敏,陈贤明等.彩超在诊断分化型甲状腺癌颈淋巴结转移中的应用[J].中国耳鼻喉头颈外科,2006,13(4):211-214.
[24] Ivanac G,Brkljacic B,Ivanac K,et al.Vascularisation of Benign And Malignant ThyroidNodules:CD US Evaluation[J].Ultrasound in der Medizin,2007,28(5):502-506.
[25]金蓉,李彦敏,王众.甲状腺肿瘤的彩色血管能量成像与病理微血管密度的对比研究[J].中国临床医学影像杂志,2006,17(6):315-317.
[26] Miyakawa M,Onoda N,Etoh M,et al. Diagnosis of thyroid follicular carcinoma by thevascular pattern and velocimetric parameters using high resolution pulsed and powerDoppler ultrasonography[J].Endocrine Journal,2005,52(2):207-212.
[27]张蒂荣,鲁树坤,王双双,等.甲状腺肿块的彩色多普勒血流频谱形态与病理对照研究[J].中国超声医学杂志,2004,20(4):256-258.
[28] Dietrch CF,Ignee A,Hocke M,et al.Pitfalls and artefacts using contrast enhancedultrasound[J].Z Gastroenterol,2011,49(3):350-356.
[29] Zhang B,Jiang YX,Liu JB,et al.Utility of contrast-enhanced ultrasound for evaluationof thyroid nodules[J].Thyroid,2010,20(1):51-57.
[30]俞倩,黄瑾,王燕.彩超诊断甲状腺恶性肿瘤的特征性表现和误诊分析[J].上海医学影像,2009,18(4):294-296.
[31] Mitchell JC,Parangi S.Angiogenesis in benign and malignant throid disease[J].Thyroid,2005,15(6):294-296.
[32]丁红,徐本华,夏罕生,等.实时灰阶超声造影诊断甲状腺乳头状癌的临床价值[J].上海医学影像,2010,7(3):168-170.
[33]计静丹,詹维伟,徐上研.彩色多普勒超声鉴别甲状腺结节良恶性价值的再探讨[J/CD].中华医学超声杂志(电子版),2011,12(6):62-65.
[34]李泉水,姜健,张家庭,等.超声显像与甲状腺癌病理类型的关系及良恶性结节并存的鉴别诊断[J/CD].中华医学超声杂志(电子版),2009,15(4):44-48.
[35] Bartolotta TV, Midiri M,Galia M,et al. Qualitative and quantitative evaluation ofsolitary thyroid nodules with contrast-enhanced ultrasound: initial results[J]. EurRadiol,2006,16(10):2234-2241.
[36] Li QS,Chen SH,Xiong HH,et al.Papillay thyroid carcinoma on sonography[J].ClinImaging,2010,34(2):121-126.
[37] Appetecchia M,Bacaro D,Brigida R,et al.Second generation ultrasonographic contrastagents in the diagnosis of neoplastic thyroid nodules[J].J Exp Clin CancerRes,2006,25(3):325-330.
[38] Tessler FN,Tublin ME.Thyroid sonography: current applications and futuredirections[J]. AJR Am J Roentgenol,1999,173(2):437-443.
[39]赵莹,黄道中,黄小莉.超声造影鉴别诊断甲状腺结节良恶性的价值[J].中国医学影像技术,2010,26(8):1441-1443.
[40] Xu HX,Lu MD,Zhou YQ,et al.Three-dimensional gray scale volume rendering of theliver:preliminary clinical experience[J].J Ultrasound Med,2002,21(9):961-970.
[41]江泉,张渊,张婉莹,等.三维灰阶超声与二维超声在甲状腺结节诊断中应用[J].上海医学影像,2006,15(4):278-280.
[42]李锐,郭燕丽,华兴,等.彩色多普勒血流图与三维彩色能量图在诊断甲状腺局限性病变中的应用价值[J].第三军医大学学报,2005,27(12):1282-1284．
[43]张超学,张新书,王玲,等.甲状腺腺瘤血管结构的三维重建及血管容积指数特点分析[J].中国超声医学杂志,2005,21(3):220-223.
[44] Chang RF,Huang SF,Moon WK,et al.Solid breast masses:neural network analysis ofvascular features at three-dimensional power Doppler US for benign or malignantclassification[J]. Radiology,2007,243(1):56-62.
[45]林锦蓉,郑笑娟,蒋勇,等.三维超声成像在甲状腺肿块良恶性鉴别诊断中的价值(附117例分析)[J].福建医药杂志,2008,30(1):115-116.
[46]张渊,江泉,陈剑,等.甲状腺单发结节三维超声定性诊断及其ROC曲线分析[J].中国临床医学影像杂志,2010,21(1):13-16.
[47] Acharys UR,Faust O,Sree SV,et al.Cost-effective and non-invasive automated benignand malignant thyroid lesion classification in3D contrast-enhanced ultrasound usingcombination of wavelets and textures:a class of ThyroScan algorithms[J].Technologyin Cancer Research&Treatment,2011,10(4):371-380.
[48] Hotel MR.Emerging technology in head and neck ultrasonography[J].Otolaryngol ClinNorth Am,2010,43(6):1267-1274.
[49] Molinari F,Mantovani A,Deandrea M,et al.Characterization of single thyroid nodulesby contrast-enhanced3-D ultrasound[J].Ultrasound Med Biol,2010,36(10):1616-1625.
[50] Tranquart F,Bleuzen A,Pierre-Renoult P,et al.Elastosonography of thyroid lesions[J]. JRadiol,2008,89(6):35-39.
[51] Wang Y,Dan HJ,Dan HY,et al.Differential diagnosis of small single solid thyroidnodules using real-time ultrasound elastography[J].J Int Med Res,2010,38(2):466-472.
[52] Friedrich-Rich M,Sperber A,Holzer K,et al.Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules[J].Exp Clin EndocrinolDiabetes,2010,118(9):602-609.
[53] Vorlander C,Wolff J,Saalabian S,et al.Real-time ultrasound elastography anoninvasive diagnostic procedure for evaluating dominant thyroid nodules[J].Langenbecks Arch Surg,2010,395(7):865-871.
[54] Oliver C,Vaillant-Lombard J,Albarel F,et al.What is the contribution of elastographyto thyroid nodules evaluation?[J]Ann Endocrinol(Paris),2011,72(2):120-124.
[55] Gietka-Czernel M,Kochman M,Bujalska K,et al.Real-time ultrasound elastography anew tool for diagnosing thyroid nodules[J]. Polish Journal of Endocrinology,2010,61(6):652-657.
[56] Merino S,Arrazola J,Cardenas A,et al.Utility and interobserver agreement ofultrasound elastography in the detection of malignant thyroid nodules in clinicalcare[J].Am J Neuroradiol,2011,32(3):2142-2148.
[57] Dighe M,Kim J,Luo S,et al.Utility of the ultrasound elastographic systolic thyroidstiffness index in reducing fine-needle aspirations[J].J Ultrasound Med,2010,29(4):565-574.
[58] Cooper DS,Doherty GM,Haugen BR,et al.Management guideline for patients withthyroid nodules and differentiated thyroid cancer[J].Thyroid,2006,16(2):109-142.
[59] Bae U,Dighe M,Dubinsky T,et al.Ultrasound thyroid elastography using caroid arterypulsation:preliminary study[J].J Ultrasound Med,2007,26(6):797-805.
[60]俞清,徐智章,毛枫,等.实时超声弹性成像在甲状腺占位性病变中的初步应用[J].上海医学影像,2007,16(3):189-193.
[61] Rago T,Santini F,Scutari M,et al.Elastography:new developments in ultrasound forpredicting malignancy in thyroid nodules[J].J Clin Endocrinol Metab,2007,92(8):2917-2922.
[62] Xing P,Wu L,Zhang C.et al.Differentiation of benign from malignant thyroidlesins:calculation of the strain ratio on thyroid sonoelastography[J].J UltrasoundMed,2011,30(5):663-669.
[63] Kagoya R,Monobe H,Tojima H.Utility of elastography for differential diagnosis ofbenign and malignant thyroid nodules[J].Otolaryngol Head Neck Surg,2010,143(2):230-234.
[64] Dhond MR,Nguyen TT,Dolan C,et al.Ultrasound-enhanced thrombolysis at20kHzwith air-filled and perfluorocarbon-filled contrast biospheres[J].J Am SocEchocardiogr,2000,13(11):1025-1029.
[2] Mortensen JD,Woolnerlb LB,Bennett WA.Gross and microscopic findings in clinicallynormal thyroid glands[J]. J Clin Endocrinol Metab,1955,15(10):1270-1280.
[3] Hoang JK,Lee WK,Lee M,et al.US Features of thyroid malignancy:pearis andpitfalls[J].Radiographics,2007,27(3):847-860.
[4]张缙熙.新编超声诊断问答[M].北京:科学技术文献出版社,2008:239.
[5] Hegedüs L. Clinical practice.The thyroid nodule[J]. N Engl J Med,2004,351(17):1764-1771.
[6] Camargo RY,Tomimori EK.Usefulness of ultrasound in the diagnosis and managementof well-differentiated thyroid carcinoma[J].Arq Bras EndocrinolMetabol,2007,51(5):783-792.
[7] Okamoto T,Yamashita T,Harasawa A,et al.Test performances of three diagnosticprocedures in evaluating thyroid nodules:physical examination,ultrasonography andfine needle as piration cytology[J]. Endocr J,1994,41(3):243-247.
[8]丛淑珍,李康,吴丽桑,等.超声复合成像技术在甲状腺癌诊断中的实用价值[J].中国医学影像技术,2006,22(8):1183-1184.
[9] Shapiro RS.Management of thyroid nodules detected at sonography:Society ofRadiologists in Ultrasound Consensus Conference Statement[J].Thyroid,2006,16(3):209-210.
[10] Khati N,Adamson T,Johnson KS,et al.Ultrasound of the thyroid and parathyroidglands[J].Ultrasound Q,2003,19(4):162-176.
[11] Chan BK,Desser TS,McDougall IR,et al.Common and uncommon sonographicfeatures of papillary thyroid carcinoma[J].J Ultrasound Med,2003,22(10):1083-1090.
[12] Frates MC,Benson CB,Charboneau JW,et al.Management of thyroid nodules detectedat US:Society of Radiologists in Ultrasound consensus conferencestatement[J].Radiology,2005,237(3):794-800.
[13]吕珂,姜玉新,张缙熙,等.甲状腺结节的超声诊断研究[J].中华超声影像学杂志,2003,12(5):285-288.
[14] Butros R,Boyvat F,Ozyer U,et al.Management of infracentimetric thyroidnodules withrespect to ultrasonographic features[J].Eur Radiol,2007,17(5):1358-1364.
[15] Tae HJ,Lim DJ,Baek KH,et al.Diagnostic value of ultrasonography to distinguishbetween benign and malignant lesions in the management of thyroid nodules[J].Thyroid,2007,17(5):461-466.
[16]韩治宇,梁萍,李欣,等.超声诊断甲状腺结节证实偏倚校正的临床研究[J].中国医学影像技术,2008,24(1):48-50.
[17]方积乾.医学统计学与电脑实验[M].上海科学技术出版社,2001:484-498.
[18]李河,麦劲壮,肖敏,等.哑变量在Logistic回归模型中的应用[J].循证医学,2008,8(1):42-45.
[19] Raab SS,Silverman JF,Elsheikh TM,et al.Pediatric thyroid nodules:disease demo-graphics and clinical management as determined by fine needle aspirationbiopsy[J].Pediatrics,1995,95(1):46-49.
[20]陈孝平.外科学[M].北京:人民卫生出版社.2005:425-428.
[21]方国恩,李莉.甲状腺结节的诊断和处理[J].中国实用外科杂志,2003,23(3):135-137.
[22]陈文,张武,苗立英.甲状腺恶性肿瘤的二维及彩色多谱勒超声征象及其临床意义[J].中国超声医学杂志,2000,16(7):495-497.
[23] Frates MC,Benson CB,Doubilet PM,et al.Prevalence and distribution of carcinoma inpatients with solitary and multiple thyroid nodule sonsonography[J].J Clin endocrinolMetab,2006,91(9):3411-3417．
[24] Lang W, Borrusch H,Bauer L.Occult carcinomas of the thyroid:evaluation of1,020sequential autopsies[J].Am J Clin Pathol,1988,90(1):72-76.
[25] Yoon DY,Lee JW,Chang SK,et al.Peripheral calcification in thyroid nodules:ultrasonographic features and prediction of malignancy[J]. Ultrasound Med,2007,26(10):1349-1357.
[26] Cappelli C,Castellano M,Pirola I,et al.Thyroid nodule shape suggests malignancy[J].Eur J Endocrinol,2006,155(1):27-31.
[27] Papini E,Guglielmi R,Bianchini A,et al.Risk of malignancy in nonpalpable thyroidnodules: predictive value of ultrasound and color-Doppler features[J].J ClinEndocrinol Metab,2002,87(5):1941-1946.
[28] Stavros AT,Thickman D,Rapp CL,et al.Solid breast nodules:use of sonography todistinguish between benign and malignant lesions[J].Radiology,1995,196(1):123-134.
[29] Shimura H,Haraguchi K,Hiejima Y,et al.Distinct diagnostic criteria forultrasonogaphic examination of papillary thyroid carcinoma:a multicenter study[J].Thyroid,2005,15(3):251-258.
[30]温伟,金科,胡祥,等.甲状腺乳头状癌与结节性甲状腺肿CT成像特点的对比分析[J].实用放射学杂志,2008,24(9):1168-1711.
[31]曾金凤,胡文彬,陈毅馨.结节性甲状腺肿的超声征象与病理对比分析[J].临床超声医学杂志,2006,8(9):536-537.
[32] Frates MC,Benson CB,Doubilet PM,et al.Can color Doppler sonography aid in theprediction of malignancy of thyroid nodules?[J].J Ultrasound Med,2003,33(2):127-131.
[33] Nam-Goong IS,Kim HY,Gong G,et al.Ultrasonography-guided fine-needle aspirationof thyroid incidentaloma:correlation with pathological findings[J].Clin Endocrinol,2004,60(1):21-28.
[34] Fukunari N,Nagahama M,Sugino K,et al.Clinical Evaluation of color Doppler imagingfor the differential diagnosis of thyroid follicular lesions[J].World J Surg,2004,28(12):1261-1265.
[35] Kim DL,Song KH,Kim SK.High prevalence of carcinoma in ultrasonography-guidedfine needle aspiration cytology of thyroid nodules[J].Endocrine Journal,2008,55(1):135-142.
[36] Kovacevic DO,Skurla MS.Sonographic diagnosis of thyroid nodules: Correlation with theresults of sonographically guided fine-needle aspiration biopsy [J]. Journal Of ClinicalUltrasound,2007,35(2):63-67.
[37] McIvor NP,Freeman JL,Salem S.Ultrasonography of the thyroid and parathyroidglands [J].ORL J Otorhinolaryngol Relat Spec,1993,55(5):303-308.
[38] Solbiati L,Volterrani L,Rizzatto G,et al.The thyroid gland with low uptake lesions:evaluation by ultrasound [J].Radiology,1985,155(1):187-191.
[39] Ahuja AT. Practical head and neck ultrasound[M].London:Greenwich Medical MediaLimited,2000:35-63．
[40]路光中,何之彦,金宇飚,等.552例乳腺疾病的钙化分析[J].中华今日医学杂志,2003,3(16):3-5.
[41] Bassett LW,Jackson VP,Jahan R,et al.Diagnosis of the breast[M]. Philadelphia:WBSaunders Co,1997:113.
[42] Iannuccilli JD,Cronan JJ,Monchik JM.Risk for malignancy of thyroid nodules asassessed by sonographic criteria:the need forbiopsy[J].J Ultrasound Med,2004,23(11):1455-1464.
[43] Das DK,Mallik MK,Haji BE.Psammoma body and its precursors in papillary thyroidcarcinoma:a study by fine-needle as piration cytology[J].Diagn Cytopathol,2004,31(6):380-386.
[44]牛丽鹃,郝玉芝,周纯武.超声诊断甲状腺占位性病变的价值[J].中华耳鼻咽喉头颈外科杂志,2006,41(6):415-418.
[45] Cheng SP,Lee JJ,Lin J,et al. Eggshell calcification in follicular thyroid carcinoma[J].Eur Radiol,2005,15(8):1773-1774.
[46]丛淑珍,徐辉雄,吴丽桑,等.超声探测甲状腺结节内钙化的临床意义[J].中国超声医学杂志,2004,20(4):254-255.
[47] Moon WJ,Lung SL,Lee JH,et al.Benign and malignant thyroid nodules:USdiffertiation--muticenter retropective study[J].Radiology,2008,247(3):762-770.
[48] Vincenzo T,Edoardo G,Brunella L,et al.Microcalcifications and psammoma bodies inthyroid tumors[J].Thyroid,2008,18(9):1017-1018.
[49]刘洪枫,唐伟松,杨志英.甲状腺钙化性病症与甲状腺癌[J].中国医学科学院学报.2006,9(4):950-951.
[50]杨天高,张东辉,王志伟,等.乳腺浸润性微乳头状癌的病理与临床[J].航天航天医药,2010,28(10):1846-1847.
[51]朱义荣.乳腺浸润性微乳头状癌的病理与临床[J].山西医药杂志:下半月刊,2007,1(3):218-219.
[52]张霞,何洁,李颖嘉,等.探讨桥本病与甲状腺乳头状癌的关系[J].中国医学影像技术,2012,28(8):1490-1498.
[53] Lagalla R,Caruso G,Romana M. Echocolor Doppler in thyroid disease[J]. Radiol MedTorino,1993,85(5):109-113.
[54] Wart AC,Ackerman LA,Windham JP,et al.Breast lesions:differential diagnosis usingdigital subtraction angiography[J].Radiology,1986,159(1):39-42.
[55]金蓉,李彦敏,王众.甲状腺肿瘤的彩色血管能量成像与病理微血管密度的对比研究[J].中国临床医学影像杂志,2006,17(6):315-317.
[56]郑敏,穆丹梅,戴险峰,等.2D、CDFI、PW及3D-CPA评价甲状腺结节良恶性89例分析[J].中国肿瘤,2008,17(7):615-617.
[57]张蒂荣,鲁树坤,王双双,等.甲状腺肿块的彩色多普勒血流频谱形态与病理对照研究[J].中国超声医学杂志,2004,20(4):256-258.
[58]薛恩生,林礼务,叶真,等.彩色多普勒血流显像在甲状腺疾病诊断中的应用[J].中国超声医学杂志.1993,9(2):90-92.
[59] Varverakis E,Neonakis E,Tzardi M,et al.Role of color Doppler ultrasonography in thepreoperative management of cold thyroid nodules[J].Hormones(Athens),2007,6(1):44-51.
[60]邹霞,李泉水,张家庭,等.超声显像鉴别甲状腺癌结节的价值[J].中国医学影像技术,2009,25(10):1777-1779.
[61] Chammas MC,Gerhard R,Oliveira IR,et al.Thyroid nodules:evaluation with powrDoppler and duplex Doppler ultrasound[J].Otolaryngol Head Neck Surg,2005,132(6):874-882.
[62]徐刚,宋德顺,王瑞清.超声诊断甲状腺实质性占位的价值[J].山东医药,2005,45(22):55.
[63]汪小芬.甲状腺结节的超声诊断[J].现代医药卫生,2005,21(5):513-514.
[64] Marc D,Coltreara MD.Evaluation and imaging of a thyroid nodule[J].SurgicalOncology Clinics of North America,2008,17(1):37-56.
[1]孙永宇,郑笑娟,史小龙,等.高频彩色多普勒对甲状腺肿瘤的诊断价值[J].现代中西医结合杂志,2008,17(28):4416-4417.
[2] Mortensen JG. Microscopic findings in clinically normal thyroid glands[J]. J ClinEndocrinol Metab,1955,15(10):1270-1280.
[3] Hoang JK,Lee M,et al.US Features of thyroid malignancy: pearis and pitfalls[J].Radiographics,2007,27(3):847-860.
[4]张缙熙.新编超声诊断问答[M].科学技术文献出版社,2008:239.
[5] Practice HC.The thyroid nodule[J].N Engl J Med,2004,351(17):1764-1771.
[6] Okamoto T, Yamashita T, Harasawa A, et al.Test performances of three diagnosticprocedures in evaluating thyroid nodules:physical examination, ultrasonography andfine-needle as piration cytology[J]. Endocr J,1994,41(3):243-247.
[7]丛淑珍,李康,吴丽桑,等.超声复合成像技术在甲状腺癌诊断中的实用价值[J].中国医学影像技术,2006,22(8):1183-1184.
[8] Shapiro RS. Management of thyroid nodules detected at sonography:Society ofRadiologists in Ultrasound Consensus Conference Statement[J].Thyroid,2006,16(3):209-210.
[9] Khati N,Adamson T,Johnson K,et al.Ultrasound of the thyroid and parathyroidglands[J].Ultrasound Q,2003,19(4):162-176.
[10] Chan BK,Desser TS,McDougall I,et al.Common and uncommon sonographic featuresof papillary thyroid carcinoma[J].J Ultrasound Med,2003,22(10):1083-1090.
[11] Frates MC,Benson CB,Charboneau JW,et al.Management of thyroid nodules detectedat US:Society of Radiologists in Ultrasound consensus conference statement[J].Ultrasound Q,2006,22(4):231-238;239-240.
[12]张缙熙,姜玉新.浅表器官及组织超声诊断学[M].科学技术文献出版社,2000:67.
[13] Kim DL,Song KH,Kim SK High prevalence of carcinoma in ultrasonography-guidedfine needle aspiration cytology of thyroid nodules[J].Endocrine Journal,2008,55(1):135-142.
[14] C.Cappellt,M.Castellano,I.Pirola,et al.The predictive value of ultrasound fingdings inthe management of thyroid nodules[J].Q J Med,2007,l00(1):29-35.
[15] Obad Kovacevic MD,Mirna Smetana Skurla MD.Sonographic diagnosis of thyroidnodules:Correlation with the results of sonographically guided fine-needle aspirationbiopsy[J]. Journal Of Clinical Ultrasound,2007,35(2):63-67.
[16] Stacul F,Bertolotto M,DeGobbis F,et al.US,colour-Doppler US and fine-needleaspiration biopsy in the diagnosis of thyroid nodules[J].La radiologia medica,2007,112(5):751-762.
[17]王春荣.彩色多普勒超声在甲状腺良恶性肿瘤鉴别诊断中的应用[J].中国误诊学杂志,2008,8(18):4374-4375.
[18] Jun P,Chow LC,Jeffrey RB.The sonographic features of papillary thyroidcarcinomas[J].Ultrasound Q,2005,21(1):39-45.
[19] Suzuka Taki,Shintaro Terahata,Ryohei Yamashita,et al.Thyroid calcifications:Sonographic patterns and incidence of cancer[J].Journal of Clinical Imaging,2004,28(5):368-371.
[20] Dae Young Yoon,Joon Won Lee,Suk Ki Chang,et al. Peripheral CalcificationinThyroid Nodules:Ultrasonographic Features and Prediction of Malignancy[J].Ultrasound Med,2007,26(10):1349-1355.
[21] Kessler A,Rappaport Y,Blank A.Cystic Appearance of Cervical Lymph Nodes isCharacteristis of Metastatic Papillary Thyroid Carcinoma[J]. Journal of ClinicalUltrasound,2003,31(1):21-24.
[22] Johannes Zenk,Alessandro Bozzato,Joachim Hornung,et al.Neck Lymph Nodes:Prediction by computer-assisted contrast medium analysis?[J].Ultrasound inMed&Biol,2007,33(2):246-253.
[23]陈辉,赵敏,陈贤明等.彩超在诊断分化型甲状腺癌颈淋巴结转移中的应用[J].中国耳鼻喉头颈外科,2006,13(4):211-214.
[24] Ivanac G,Brkljacic B,Ivanac K,et al.Vascularisation of Benign And Malignant ThyroidNodules:CD US Evaluation[J].Ultrasound in der Medizin,2007,28(5):502-506.
[25]金蓉,李彦敏,王众.甲状腺肿瘤的彩色血管能量成像与病理微血管密度的对比研究[J].中国临床医学影像杂志,2006,17(6):315-317.
[26] Miyakawa M,Onoda N,Etoh M,et al. Diagnosis of thyroid follicular carcinoma by thevascular pattern and velocimetric parameters using high resolution pulsed and powerDoppler ultrasonography[J].Endocrine Journal,2005,52(2):207-212.
[27]张蒂荣,鲁树坤,王双双,等.甲状腺肿块的彩色多普勒血流频谱形态与病理对照研究[J].中国超声医学杂志,2004,20(4):256-258.
[28] Dietrch CF,Ignee A,Hocke M,et al.Pitfalls and artefacts using contrast enhancedultrasound[J].Z Gastroenterol,2011,49(3):350-356.
[29] Zhang B,Jiang YX,Liu JB,et al.Utility of contrast-enhanced ultrasound for evaluationof thyroid nodules[J].Thyroid,2010,20(1):51-57.
[30]俞倩,黄瑾,王燕.彩超诊断甲状腺恶性肿瘤的特征性表现和误诊分析[J].上海医学影像,2009,18(4):294-296.
[31] Mitchell JC,Parangi S.Angiogenesis in benign and malignant throid disease[J].Thyroid,2005,15(6):294-296.
[32]丁红,徐本华,夏罕生,等.实时灰阶超声造影诊断甲状腺乳头状癌的临床价值[J].上海医学影像,2010,7(3):168-170.
[33]计静丹,詹维伟,徐上研.彩色多普勒超声鉴别甲状腺结节良恶性价值的再探讨[J/CD].中华医学超声杂志(电子版),2011,12(6):62-65.
[34]李泉水,姜健,张家庭,等.超声显像与甲状腺癌病理类型的关系及良恶性结节并存的鉴别诊断[J/CD].中华医学超声杂志(电子版),2009,15(4):44-48.
[35] Bartolotta TV, Midiri M,Galia M,et al. Qualitative and quantitative evaluation ofsolitary thyroid nodules with contrast-enhanced ultrasound: initial results[J]. EurRadiol,2006,16(10):2234-2241.
[36] Li QS,Chen SH,Xiong HH,et al.Papillay thyroid carcinoma on sonography[J].ClinImaging,2010,34(2):121-126.
[37] Appetecchia M,Bacaro D,Brigida R,et al.Second generation ultrasonographic contrastagents in the diagnosis of neoplastic thyroid nodules[J].J Exp Clin CancerRes,2006,25(3):325-330.
[38] Tessler FN,Tublin ME.Thyroid sonography: current applications and futuredirections[J]. AJR Am J Roentgenol,1999,173(2):437-443.
[39]赵莹,黄道中,黄小莉.超声造影鉴别诊断甲状腺结节良恶性的价值[J].中国医学影像技术,2010,26(8):1441-1443.
[40] Xu HX,Lu MD,Zhou YQ,et al.Three-dimensional gray scale volume rendering of theliver:preliminary clinical experience[J].J Ultrasound Med,2002,21(9):961-970.
[41]江泉,张渊,张婉莹,等.三维灰阶超声与二维超声在甲状腺结节诊断中应用[J].上海医学影像,2006,15(4):278-280.
[42]李锐,郭燕丽,华兴,等.彩色多普勒血流图与三维彩色能量图在诊断甲状腺局限性病变中的应用价值[J].第三军医大学学报,2005,27(12):1282-1284．
[43]张超学,张新书,王玲,等.甲状腺腺瘤血管结构的三维重建及血管容积指数特点分析[J].中国超声医学杂志,2005,21(3):220-223.
[44] Chang RF,Huang SF,Moon WK,et al.Solid breast masses:neural network analysis ofvascular features at three-dimensional power Doppler US for benign or malignantclassification[J]. Radiology,2007,243(1):56-62.
[45]林锦蓉,郑笑娟,蒋勇,等.三维超声成像在甲状腺肿块良恶性鉴别诊断中的价值(附117例分析)[J].福建医药杂志,2008,30(1):115-116.
[46]张渊,江泉,陈剑,等.甲状腺单发结节三维超声定性诊断及其ROC曲线分析[J].中国临床医学影像杂志,2010,21(1):13-16.
[47] Acharys UR,Faust O,Sree SV,et al.Cost-effective and non-invasive automated benignand malignant thyroid lesion classification in3D contrast-enhanced ultrasound usingcombination of wavelets and textures:a class of ThyroScan algorithms[J].Technologyin Cancer Research&Treatment,2011,10(4):371-380.
[48] Hotel MR.Emerging technology in head and neck ultrasonography[J].Otolaryngol ClinNorth Am,2010,43(6):1267-1274.
[49] Molinari F,Mantovani A,Deandrea M,et al.Characterization of single thyroid nodulesby contrast-enhanced3-D ultrasound[J].Ultrasound Med Biol,2010,36(10):1616-1625.
[50] Tranquart F,Bleuzen A,Pierre-Renoult P,et al.Elastosonography of thyroid lesions[J]. JRadiol,2008,89(6):35-39.
[51] Wang Y,Dan HJ,Dan HY,et al.Differential diagnosis of small single solid thyroidnodules using real-time ultrasound elastography[J].J Int Med Res,2010,38(2):466-472.
[52] Friedrich-Rich M,Sperber A,Holzer K,et al.Real-time elastography and contrast-enhanced ultrasound for the assessment of thyroid nodules[J].Exp Clin EndocrinolDiabetes,2010,118(9):602-609.
[53] Vorlander C,Wolff J,Saalabian S,et al.Real-time ultrasound elastography anoninvasive diagnostic procedure for evaluating dominant thyroid nodules[J].Langenbecks Arch Surg,2010,395(7):865-871.
[54] Oliver C,Vaillant-Lombard J,Albarel F,et al.What is the contribution of elastographyto thyroid nodules evaluation?[J]Ann Endocrinol(Paris),2011,72(2):120-124.
[55] Gietka-Czernel M,Kochman M,Bujalska K,et al.Real-time ultrasound elastography anew tool for diagnosing thyroid nodules[J]. Polish Journal of Endocrinology,2010,61(6):652-657.
[56] Merino S,Arrazola J,Cardenas A,et al.Utility and interobserver agreement ofultrasound elastography in the detection of malignant thyroid nodules in clinicalcare[J].Am J Neuroradiol,2011,32(3):2142-2148.
[57] Dighe M,Kim J,Luo S,et al.Utility of the ultrasound elastographic systolic thyroidstiffness index in reducing fine-needle aspirations[J].J Ultrasound Med,2010,29(4):565-574.
[58] Cooper DS,Doherty GM,Haugen BR,et al.Management guideline for patients withthyroid nodules and differentiated thyroid cancer[J].Thyroid,2006,16(2):109-142.
[59] Bae U,Dighe M,Dubinsky T,et al.Ultrasound thyroid elastography using caroid arterypulsation:preliminary study[J].J Ultrasound Med,2007,26(6):797-805.
[60]俞清,徐智章,毛枫,等.实时超声弹性成像在甲状腺占位性病变中的初步应用[J].上海医学影像,2007,16(3):189-193.
[61] Rago T,Santini F,Scutari M,et al.Elastography:new developments in ultrasound forpredicting malignancy in thyroid nodules[J].J Clin Endocrinol Metab,2007,92(8):2917-2922.
[62] Xing P,Wu L,Zhang C.et al.Differentiation of benign from malignant thyroidlesins:calculation of the strain ratio on thyroid sonoelastography[J].J UltrasoundMed,2011,30(5):663-669.
[63] Kagoya R,Monobe H,Tojima H.Utility of elastography for differential diagnosis ofbenign and malignant thyroid nodules[J].Otolaryngol Head Neck Surg,2010,143(2):230-234.
[64] Dhond MR,Nguyen TT,Dolan C,et al.Ultrasound-enhanced thrombolysis at20kHzwith air-filled and perfluorocarbon-filled contrast biospheres[J].J Am SocEchocardiogr,2000,13(11):1025-1029.