The Image Contrast Color Dppler Ultrasonography With Radioisotope Scanning Of Thyroid Carcinoma

Thyroid cancer is the malignant tumor of thyroid gland torganization,the disease incidence rate is quite high (about 5.1 percent)in brain and neck tumor,and 90 pencent of which is highly spilt up thyroid cancer.The thyroid cancer is good ,but it can diffuse by directly invasion ,blood vessel invasion,blood line and other ways,there are 30 percent patients will recur ,and 2/3 happended 10 years after operation,especially in neck ,the recur is heavily.The proportion of thyroid cancer in thyroid disease is little,when the tumor is small ,it is hard to diffenrentiate it with benign tumor .The patint mostly are women, within all ages ,but take the middle-age as most,the male is bad .But the pre-operation and early diagnosis of pencent of thyroid cancer are quite difficulty.The common image study diagnosis methods to malignant tumor of thyroid gland organization are use, Radionuclide development,CT,MRI.With the development and renewal of all kinds of monitoring device,the colored doppler supersonic , ^99m Tcthyroid gland,CT, pintle puncture cytology inspection , and Blood serum thyroid gland immunity globulin determination and so on have been applied in clinical widespreadly.But the sensitivity of all these methods is irregular,in order to have a Comprehensive understanding to the image study performance of the thyroid cancer,further enhance the accuracy of pre-operation diagnosis,we compare the colored doppler supersonic with Radionuclide development to the 54 suspicion malignant tumor of thyroid ,and constrast the surgery specimen organization pathology diagnosis result,then discusses respective superiority.Thyroid is in the shallow position,apart from the body surface only 1.5cm,and move up and down with the swallow,which provide good conditions for the supersonic examination to the thyroid disease. The apply of high frequency colored Doppler supersonic technology has improved check rate of thyroid rumor.Firstly,demonstrate and observe the mumber,location,distribution,size,sound image chart characteristic,relationship with the surrouding,same side neck blood vessel periphery,situation of collar bone nest lymph node and so on of the pathological change;then observe the blood stream distribution number, rich degree within and along the tubercle;in the end check the blood stream parameters such as vmax and RI with Pulse Doppler.When is necessaried ask the patient to swallow to identify the resource of the tumor.and constrast it with its pathology diagnosis result, tumor micro calcification is one of the highest parameters to diagnosis the thyroid cancer currently.In this class the check rate of the thyroid cancer by micro calcification is about 65.1%.but there are 57.5% patients are found lymph node tumescent,which is lower greatly then the rate(73.1%)of confirmation existence lymph node transformation in the operation.One of the reason is that in the early stage of our work ,doctors did not inspect the lymph node of the pate and collar bone ,the other reason is that the small lymph node are concealed after the chest locks the mastoid process muscle,which are difficult to couch .The sensitivity is very low especially to the second thyroid cancer operation(9%) examples are second thyroid cancer recur ,check rate is.The reason is that the mormal tissue are destroyed in the first operation ,it is very difficult to judge it is thyroid scar tissue or recured thyroid caner or shift lymph node.Nuclein scanning is first assistance inspection to thyroid caner diagnosis, the specificity is worse,can not qualitify,the price is expensive ,so the clinical application is limited.Some dates show that within the 80% thyroid gland tubercle are cold tubercle there are only 20% are proved caner,but within the 10% warm thyoid gland tubercle are10% proved caner.In this class,36 examples cold tubercle in the thyoid caner (about 66.7%),especially the solid tubercle checked out by Colored Doppler ultra inspection is caused clinical value.But the ECT scaning can chow the residual thyroid tissue and image situation of the shift,so the ECT scaning is necessary after the 1311 treatment,and shoud be routin inspection.In this class , ECT scaning examples,the result shows that :residual thyroid tissue 4 examples,neck lymph node shift 11 examples, lung shift 1 example, tone shift 1example. Mazzaferri report that partial recurs is most commonly in the neck lymph node about 74%,next is residual thyroid tissue about 20%,far-end shift accout 21%,the lung shift is most common.99mTc-MIBI have made a great improve in the accuracy of the thyroid caner diagnosis by nuclear medicine,which has the seclective affinity to the malignant tumor cell,in our study 54 patients,%are positive reactions,which show that lots of MIBI are concentrated in tumor tissues.Another benefit is to show the sickness stove shift location at the same time,such as the neck lymph node,lung shift .Nuclear scanning have special or selective absorb to some radioactivity matters ,and supersonic have identify ability to thyroid cancer physical property(solid or pouch),we make use of their characters,combine two results to analyze,then we can draw a Objective reasonable judgement to rumor.The supersonic check show the thyroid tumor are soide swell ,131 I scanning shows cold tubercle,analyze with tumor characters ,we can judge the rumor is the solid rumor lose the function of I obsorb,this kind of tumor with invasion actions is the character of malignant tumor.The combination of two metholds is the best way to diagnosis the thyroid caner correctly and prevent the sencond operation.Material and method1.research objectThe Colored Doppler supersonic inspection and nuclein scanning before operation proved thyroid have significant changes,gain the prove of operation and pathology,have complete date,the 54 thyroid caner patients are the research object2. Instrument and method(1) Supersonic inspection instrumentation is vivid7 colour Supersonic made in american GE company, Pokes head in the frequency 12MHz.The patient takes supinely lie, shoulder department pad pillow,made a crosswise scan in the thyroid,move up and down to constrast the two sides,then made the two sides longitudinal scan.Observe carefully the echo in gland,inspect the thyroid with two-dimensional supersonic,then make sure the location of tubercle,when it necessary ask the patient to swallow to identify the resource of rumor,routine inspection in Neck vessel periphery, about collar bone nest.Observation content:①the number ,size,boundary,Whether there is Membrane,sound corona,echo inside,thyroid tissue around,the whole outline and surface,Various diameteral wires of thyroid,relationships with surrounding .②observe the Blood stream distribution number, rich degree of the tubercle inside and Peripheral.survey the Blood stream parameter such as Vmax and RI with pulse Doppler.③inspection the Neck vessel periphery, about collar bone nest in the same side,and write down the size,number and shape.(2) Nuclein scanning inspection is made in GE company SPECT, 20 min after IV 99mTcO-474～185MBq show image.body posture: the patient take supine lie, Under shoulder a pad pillow to make the neck fully extend,make the neck exposed.Observe contents: The pathological change place absorbs the Tc function, the tubercleperformance'the cold tubercle','the warm tubercle','the hottubercle'. Whether there is shifts.(3) recording the result ,make the diagnosis,constrast with the pathology.(4) The computation statistics target, counts the material group's comparison to use x examination. Result and disscussionThe typical 2D- ultrasonic characteristic of thyroid cancer ,include: irregular shape, margin ambiguity, spiculated margin, niso-resonance , posterior attenuation,acoustic halo,microcalcification,low level echo, corpora mammillaria dense echo in spina bifida cystica echo, thyroid diffuse and so on.Color Doppler ultrasound imaging, include:abundant blood flow , irregular shape blood flow , peripheral blood flow and penetration blood flow.Thyroid cancer had almostly typical hypersound change. Diagnose accordance rate of preoperative hypersound was 92.7%. Diagnose accordance rate of preoperative lymphatic gland metastasis was 92.7%. Diagnose accordance rate of preoperative thyroid cancer relapse wasRadioisotope scanning detection:Ascendancy of color Doppler ultrasonography was that it was the first routine examination in the glandula thyreoidea examination,it was convenient,hadn't traumatic occlusion,hadn't X radiation.It was easy,economic and convenient of operation .It could repeat many times ,accuratly indicate the size,form and nature of thyroid gland,indicate affection distinctly and exactly(especially minutefocus of infection and Microcalcification ) and raise that hypersound evaluated primary primary lesion,which raised accurate rate of demi-qualitation or qualitation for benign tumor and malignant tumor.It was firstly method of population screening. There was important to diagnose thyroid cancer.We should pay attention to low echo-level,aniso-quality tumor or scobination with amicula and abnormal bouncary. Color Doppler ultrasound detected blood flow of tumor vessel,which indirectly reflected blood supply of tumor.Tumor vessel could form many rete vasculosums.On the one hand it was concerned with infiltrative growth,on the other hand it increased chance of diversion.The emphasis observed blood form and blood flow in the perim. Pulse Doppler measured crest value flow rate of period of contraction(Vmax) ,resistent index(RI) and so on.Blood flow character of tumor had overlap phenomenon,so diagnosis of thyroid cance depended on 2D-high-frequency ultrasound.The method that detected the metastasis of thyroid cancer(lymphatic gland) was significantly lower than that of radioisotope scanning. Radioisotope scanning of thyroid cancer displayed"cold nodule",especially tumor in the hypersound which increased selectivity affinity of malignant tumor cell and detection rate of thyroid cancer. Radioisotope scanning could definitely diagnosis recurrence of thyroid cancer when hypersound couldn't detect or judge nature of tumor.It could judge whether the distant place was the metastasis tumours or not ,such as mediastinal septum, lung and bone.In a word, high-frequency color Doppler ultrasonography and radioisotope scanning significantly raised preoperative diagnosis of thyroid cancer,contributed to choice the position of operative incision and reduced injury and difficulty of operation.It could understand wether tumor encroach peripherad tissue or not.If cancer situtated upper pole or anus perineum of glandula thyreoidea,we would beware of injurying nervus laryngeus superior and nervus laryngeus recurrens,protect parathyroid gland and degrade recurrence of thyroid cancer.