二维及彩色多普勒超声对亚急性甲状腺炎和桥本甲状腺炎的鉴别诊断价值分析
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摘要
目的探讨二维及彩色多普勒超声对亚急性甲状腺炎(SAT)和桥本甲状腺炎(HT)的鉴别诊断价值。方法对2016年6月-2018年6月我院临床确诊的40例SAT患者及40例HT患者超声资料进行回顾性分析。结果40例SAT患者超声表现为甲状腺肿大,峡部无明显增厚,甲状腺实质内显示单个或数个小片状低回声区,缺乏立体感,边界不清,形态不规则;彩色多普勒血流显像可见少量血流信号或无血流信号。HT超声表现:甲状腺弥漫性肿大,两侧基本对称,峡部增厚明显,腺体四周回声弥漫性减低,并可伴网格样结构,边界清楚;彩色多普勒血流显像可见血流信号丰富,常呈"火海征"。SAT组实质内回声为Ⅰ级比例明显高于HT组(P<0.05),Ⅱ级比例及网格样回声比例均明显低于HT组(P<0.05)。甲状腺实质血流状况,SAT组以0级、Ⅰ级为主,HT组以Ⅱ、Ⅲ级为主,两组差异有统计学意义(P<0.05);HT组较SAT组甲状腺动脉PSV明显增大(P<0.05)。结论二维及彩色多普勒超声对SAT与HT鉴别诊断有重要价值。
Objective To investigate the differential diagnosis of subacute thyroiditis(SAT)and Hashimoto's thyroiditis(HT)by two-dimensional and color Doppler ultrasound.Methods The ultrasound data of 40 patients clinically diagnosed with SAT and 40 patients with HT in our hospital from June 2016 to June 2018 were retrospectively analyzed.Results Ultrasound performance of 40 patients with SAT:thyroid enlargement,no obvious thickening in the isthmus,single or several small lobular hypoechoic areas in the thyroid parenchyma,lack of stereoscopic effect,unclear boundary,irregular shape;a small amount of blood flow signal or no blood flow signal by color Doppler Blood flow imaging.HT ultrasound performance:diffuse thyroid enlargement,bilateral symmetry,thick isthmus,diffuse echo around the gland,and can be associated with a grid-like structure with clear boundaries;rich visible blood flow signal with color Doppler flow imaging,often showing"fire sea sign."The grade I intra-epithelial echo of the SAT group was significantly higher than that of the HT group(P<0.05),and the ratio of grade II and grid-like echo was significantly lower than that of the HT group(P<0.05).About the thyroid parenchymal blood flow,The SAT group was mainly level 0 and level I and The HT group was mainly grade II and III(P<0.05).The HT group had significantly increasement of PSV in the thyroid artery compared with the SAT group(P<0.05).Conclusion Two-dimensional and color Doppler ultrasound is of great value in the differential diagnosis of SAT and HT.
Objective To investigate the differential diagnosis of subacute thyroiditis(SAT)and Hashimoto's thyroiditis(HT)by two-dimensional and color Doppler ultrasound.Methods The ultrasound data of 40 patients clinically diagnosed with SAT and 40 patients with HT in our hospital from June 2016 to June 2018 were retrospectively analyzed.Results Ultrasound performance of 40 patients with SAT:thyroid enlargement,no obvious thickening in the isthmus,single or several small lobular hypoechoic areas in the thyroid parenchyma,lack of stereoscopic effect,unclear boundary,irregular shape;a small amount of blood flow signal or no blood flow signal by color Doppler Blood flow imaging.HT ultrasound performance:diffuse thyroid enlargement,bilateral symmetry,thick isthmus,diffuse echo around the gland,and can be associated with a grid-like structure with clear boundaries;rich visible blood flow signal with color Doppler flow imaging,often showing"fire sea sign."The grade I intra-epithelial echo of the SAT group was significantly higher than that of the HT group(P<0.05),and the ratio of grade II and grid-like echo was significantly lower than that of the HT group(P<0.05).About the thyroid parenchymal blood flow,The SAT group was mainly level 0 and level I and The HT group was mainly grade II and III(P<0.05).The HT group had significantly increasement of PSV in the thyroid artery compared with the SAT group(P<0.05).Conclusion Two-dimensional and color Doppler ultrasound is of great value in the differential diagnosis of SAT and HT.
引文
[1]范景丽,马玉琴,汪春雷,等.121例亚急性甲状腺炎患者流行病学及临床特点的回顾性分析[J].中华地方病学杂志,2017,36(5):338.
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[9]李媛,韩东,刘红雨,等.非典型性亚急性甲状腺炎超声诊断价值[J].中国现代医学杂志,2014,24(34):77.
[10]代妮娜,张文君.桥本氏甲状腺炎合并结节样病变的超声影像特征分析[J].安徽医学,2016,37(8):988.
[11]董鸿,晏昱婧,刘谨文,等.血清甲状腺过氧化物酶抗体对合并桥本甲状腺炎甲状腺微小癌淋巴结转移影响[J].现代生物医学进展,2015,15(17):3345.
[12]Pan F S,Wang W,Wang Y,et al.Sonographic features of thyroid nodules that may help distinguish clinically atypical subacute thyroiditis from thyroid malignancy.[J].Journal of Ultrasound in Medicine,2015,34(4):689.
[2]冉张申,郭洪霞,李湘奇.桥本甲状腺炎实时超声弹性成像评分与自身免疫的相关性探讨[J].中国免疫学杂志,2016,32(8):1204.
[3]李平,张峰,姚建.DWI定量分析在鉴别Graves病甲亢和早期桥本甲状腺炎中的应用价值[J].医学影像学杂志,2017,27(4):621.
[4]张魁,俞子东,俞远成,等.超声检查对桥本甲状腺炎伴发结节良恶性的鉴别诊断价值[J].浙江医学,2015,37(8):674.
[5]许瑞霞,王正辉,郭俊敏.超声对桥本甲状腺炎的诊断及误诊分析[J].山西医药杂志,2016,45(14):1649.
[6]陈蕾,王彬,张惠,等.IgG4阳性桥本甲状腺炎超声表现[J].中国介入影像与治疗学,2017,14(12):738.
[7]高笑莲.灰阶及彩色多普勒超声诊断桥本氏甲状腺炎的应用价值[J].中国超声医学杂志,2015,31(9):842.
[8]袁小青,李德,刘娟,等.亚急性甲状腺炎129例临床分析[J].实用临床医药杂志,2017,21(21):206.
[9]李媛,韩东,刘红雨,等.非典型性亚急性甲状腺炎超声诊断价值[J].中国现代医学杂志,2014,24(34):77.
[10]代妮娜,张文君.桥本氏甲状腺炎合并结节样病变的超声影像特征分析[J].安徽医学,2016,37(8):988.
[11]董鸿,晏昱婧,刘谨文,等.血清甲状腺过氧化物酶抗体对合并桥本甲状腺炎甲状腺微小癌淋巴结转移影响[J].现代生物医学进展,2015,15(17):3345.
[12]Pan F S,Wang W,Wang Y,et al.Sonographic features of thyroid nodules that may help distinguish clinically atypical subacute thyroiditis from thyroid malignancy.[J].Journal of Ultrasound in Medicine,2015,34(4):689.