桥本甲状腺炎超声声像图分析

·浅表器官超声影像学·

桥本甲状腺炎超声声像图分析

李传红　宋修芹　张良岩　王允芹　张忠英　史少华

【摘要】　目的　以超声引导细针穿刺作为诊断桥本甲状腺炎的金标准，探讨桥本甲状腺炎超声

表现。方法　回顾性总结216例超声引导下细针穿刺确诊的桥本甲状腺炎患者超声表现。超声观察指标为：甲状腺两侧叶大小及峡部厚度、内部回声特点、甲状腺内血流分布、甲状腺上动脉血流速度、甲状腺周围有无肿大淋巴结。根据患者甲状腺功能分成甲状腺功能亢进组、甲状腺功能减低组、甲状腺功能正常组，比较3组患者的甲状腺上动脉血流速度。结果　仅84例患者（38.9%，84/216）具有经典桥本甲状腺炎超声表现：甲状腺两侧叶及峡部体积增大，回声减低，血流丰富；132例患者（61.1%，

132/216）具有不典型桥本甲状腺炎超声表现：甲状腺体积不大，实质回声增粗或呈局限片状低回声。25.0%（54/216）合并实性结节，2.8%（6/216）合并甲状腺乳头状癌。桥本甲状腺炎甲状腺内血流分布较正常增多，甲状腺功能亢进组甲状腺上动脉血流平均速度为（39.0±20.5）cm /s ，甲状腺功能减低组为（41.1±21.4）cm /s ，甲状腺功能正常组为（35.6±17.1）cm /s ，3组间差异无统计学意义（F =0.39，P =0.68）。93.1%（201/216）的桥本甲状腺炎甲状腺下极周围可见肿大淋巴结。结论具有经典桥本甲状腺炎超声图像患者仅占少部分，应重视不典型桥本甲状腺炎超声表现，减少漏诊。桥本甲状腺炎甲状腺内血流不能成为判断甲状腺功能的指标；甲状腺下极周围淋巴结的检出可协助该病诊断。

【关键词】　超声检查；桥本甲状腺炎；细针穿刺活检

Hashimoto's thyroiditis ultrasound manifestation under fine needle aspiration LI Chuan⁃hong ，SONG

Xiu⁃qin ，

ZHANG Liang⁃yan ，WANG Yun⁃qin ，ZHANG Zhong⁃ying ，SHI Shao⁃hua.Department of Ultrasound ，The Yantaishan Hospital of Yantai City in Shandong Province ，Yantai 264000，China

【Abstract 】　Objective To discuss the ultrasound manifestation of Hashimoto's thyroiditis by using

ultrasonic guided fine needle aspiration

（U⁃FNA ）as the gold standard of Hashimoto's thyroiditis.Methods The ultrasound images of 216patients with Hashimoto 's thyroiditis were retrospectively investigated ，with observation of the following indexes ：the size of two lateral lobes ，the thickness of isthmus ，the echo pattern ，blood flow distribution ，superior thyroid artery flow velocity and enlarged lymph nodes.According to the throid

function ，

all Hashimoto's thyroiditis were divided in to the hyperthyroidism group ，the hypothyroidism group and the euthroidism group ，

and the superior thyroid artery flow velocity was compared among the three groups.Results Sonographic features of typical Hashimoto's thyroiditis were only showed in 38.9%cases （84/216）.Sonographic characteristics of atypical Hashimoto's thyroiditis included normal thyroid volume ，coarse parenchyma echo ，partial hypoechoic area ，25.0%（54/216）with solid nodules ，and 2.8%（6/216）associated with thyroid carcinoma.Blood flow distribution was more abundant in Hashimoto's thyroiditis than

in normal thyroid.The superior thyroid artery mean flow velocity was

（39.0±20.5）cm /s in the hyperthyroidism group ，it was （41.1±21.4）cm /s in the hypothyroidism group and it was （35.6±17.1）cm /s

in the euthroidism group.There was no significant difference among the three groups

（F =0.39，P =0.68）.93.1%

（201/216），enlarged lymph nodes were detected in the lower pole area of Hashimoto's thyroiditis cases.Conclusions Only a small portion of Hashimoto's thyroiditis cases presented the typical sonographic features.Attention should be paid to those with atypical sonographic features to avoid misdiagnosis.Blood flow

velocity of thyroid artery in Hashimoto's thyroiditis is not well⁃correlated with thyroid function ；

detection of lymph nodes at thyroid lower pole area might be helpful for diagnosis.

【Key words 】　Ultrasonography ；Hashimoto's thyroiditis ；Fine needle aspiration DOI ：10.3877/cma.j.issn.1672⁃6448.2012.01.019

作者单位：264000　山东省烟台市烟台山医院超声科（李传红、

宋修芹、王允芹、张忠英、史少华），内分泌科（张良岩）

桥本甲状腺炎又称自身免疫性甲状腺炎，近年

来发病率显著上升。随着甲状腺细针穿刺活检

（fine needle aspiration ，FNA ）的开展，大量不典型病例被临床确诊，FNA 已成为诊断桥本甲状腺炎的金

标准［1⁃2］

。本研究回顾性分析我院自2008年开展