A Preliminary Study On The Contrast-enhanced Ultrasound In The Differential Diagnosis Of Thyroid Nodule

Research background:The formation of thyroid tumors is due to its internal appear abnormal proliferation of growth of mass, the morphology of the lesion site, space conformation, texture are different from normal structure and function of mass. The number of women than men, the number of physical examination in recent years, people are also more and more, and a drop in the quality of the environment change and the air also lead to thyroid tumor patients increased year by year, in recent years there have been many studies have shown that most of the thyroid tumor or the nature of good, even malignant thyroid lesions, especially small papillary thyroid carcinoma(PTC) after treatment the prognosis is good, the rate of malignant probably account for just 2.7% to 17%. Have the above we can conclude that thyroid tumor nature of the decision is the key to the diagnosis, this method can also be based on corresponding diagnosis and treatment for patients. To reduce the death toll caused by thyroid carcinoma, the judgement in patients with thyroid tumor nature as soon as possible, so that as soon as possible for the patientsThe purpose and significance:By Shan Xi province people’s hospital clinical endocrinology clinic common ultrasonic examination in patients with thyroid nodules, screening of ordinary ultrasonic diagnostic difficulties and poor small nodules puncture feasibility of 388 patients with thyroid nodules of thyroid ultrasound imaging to identify benign and malignant thyroid nodule, and for the benign nodules angiography for clinical testing regularly, if accompanied by large benign nodules and appear the symptom such as oppressive or for surgical removal of the patients and their families to surgery was performed and histopathologic examination diagnosis; Consider nature is bad for mass screening patients for surgical resection and resection of mass pathological diagnosis in order to verify the reliability of imaging diagnosis. With the results of CEUS examination ofpatients with thyroid cancer after resection of tumor pathological diagnosis is consistent, explore the nature of the acoustic imaging in determining thyroid tumor specificity and sensitivity, better guide the clinical diagnosis of thyroid disease evil.CEUS development in the field of ultrasonic speed faster, the earliest has been used in some patients with liver tumor nature determination, especially in liver CEUS, blood vessels, CEUS, including cardiovascular and cerebrovascular using earlier and more widely, has already provide the important basis for clinical work; Believe in the near future will also play an important in determine the nature of thyroid nodule. Early clinical determine the nature of the thyroid nodule is crucial, early treatment and prognosis of patients so benign and malignant nodules early decision guidelines for the clinical diagnosis and treatment is particularly important for early diagnosis methods have a common two-dimensional ultrasonography, computed tomography(ct) scan, nuclide scan, FNAB, etc; B ultrasonic diagnosis of thyroid nodule is the preferred method of examination, CT examination is less than ultrasound, the specificity of the nuclide check is poorer, fine needle puncture cytological examination is not only influenced by many factors, and the specificity, sensitivity and accuracy of diagnosis was difficult to meet the requirements of clinical, ultrasonic imaging is minimally invasive, convenient, andMethods:Collected in Shan Xi province people’s hospital in July 2013 to July 2014, a total of 388 cases, suspicious nodules benign in 329 cases, 329 nodules(including 301 patients and regular follow-up, 28 patients(50 nodules) resection treatment; malignant 59 patients, 75 nodules(57 cases, surgical resection, 73 nodules declined to surgery, 2 patients require observation; pathological results showed that 85 underwent surgical resection, 32 cases(57 nodules) pathological tissue results in benign, 53 cases(66 nodules) in malignant histopathologic results. Conventional ultrasonic testing and qualitative difficult thyroid nodule(highly suspicious nodules), can these nodules by thyroid FNAB check. According to the indicators of CEUS were analyzed: contrast agent, contrast agent into the period of time in the thyroid nodule of thyroid nodule way, strengthen the intensity of the low(can be divided into no enhancement, enhance, enhancement, high enhancement), uniform distribution of contrast agent in the lesion site and the disappearance of thelesion. Based on the above indexes of qualitative diagnosis of thyroid tumor:(1). CEUS for benign(such as thyroid nodules, thyroid adenoma, thyroid cyst) as regular follow-up observations, there is oppression symptoms or malaise require surgery disease confirmed by pathology, surgery resection;(2). The tumor nature of CEUS directly for surgical treatment and partial malignant.Note: regular ultrasound to diagnosis of nodular or small nodules can’t fine needle puncture check nodules as suspicious nodulesResults:(1)compared with histopathology of CEUS in the diagnosis of specificity is 91.8%, the sensitivity was 86.0%, the accuracy is 90.2%, positive predictive value was 86.0%, negative predictive value of 91.8%.(2) ring enhancement and enhancement of benign lesions diagnosed helpful, or not of low enhancement malignant nodules, likely to rule out the possibility of cyst;(3) solitary tumor are helpful to the diagnosis of thyroid carcinoma, multiple tumors in patients with benign possibility;(4) compared with normal ultrasonic CEUS for less than 1 cm more advantage to judge the bad nature of thyroid nodule.Conclusion:CEUS has good sensitivity for the determination of nature of the tumor and has good specific degrees; Annular enhancement of nodules and the determination of nodules of benign lesions of enhancement has certain differential value, low enhanced nodule or increase possibility of malignant tumor is big, not to rule out cysts may; Single nodes are helpful to the diagnosis of thyroid carcinoma, multiple nodules are considered benign possibility is big, but must be tested periodically to prevent its progression; Compared with ordinary two-dimensional ultrasound is less than 1 cm of the diagnosis of thyroid carcinoma.