王延海 WANG Yanhai杨泽宇 YANG Zeyu 王 博 WANG Bo

作者单位中国医科大学附属盛京医院超声科 辽宁沈阳 110004

不典型甲状腺髓样癌的超声误诊分析

王延海 WANG Yanhai杨泽宇 YANG Zeyu 王 博 WANG Bo

作者单位
中国医科大学附属盛京医院超声科 辽宁沈阳 110004

Department of Ultrasound， Shengjing Hospital Affliated to China Medical University，Shenyang 110004， China

Address Correspondence to: WANG Yanhai E-mail: wyanhai@126.com

R736.1；R730.41

中国医学影像学杂志

2016年 第24卷 第6期：423-425，429

Chinese Journal of Medical Imaging 2016 Volume 24 （6）: 423-425， 429

目的 分析不典型甲状腺髓样癌（MTC）的超声特点，寻找误诊原因，提高超声术前诊断率。资料与方法 选取2003年1月－2014年12月在中国医科大学附属盛京医院被误诊为甲状腺腺瘤（AN）的15例MTC患者，以同时期内性别、年龄相匹配的30例AN患者作为对照，比较两组患者的超声特点。结果 MTC组肿物周边多无完整声晕及完整的环绕血流，AN组肿物周边多有完整声晕及环绕血流，两组差异有统计学意义（χ2=34.393，P＜0.05；χ2=18.715，P＜0.05）；MTC组肿物内部回声以低回声、极低回声为主，AN组肿物内部可有高回声，两组差异有统计学意义（χ2=16.674，P＜0.05）。MTC组与AN组肿物在纵横比、边界、内部血流及钙化方面差异无统计学意义（P＞0.05）。结论 不典型MTC的误诊原因是其超声恶性特点不典型，但是仔细分析肿物的声晕、周边环绕血流及内部回声有助于MTC诊断，能提高术前超声诊断率。

甲状腺肿瘤；癌，髓样；超声检查，多普勒，彩色；误诊

【Abstract】Purpose To evaluate the sonographic features of misdiagnosed atypical medullary thyroid carcinoma （MTC）， and to analyze its causes. Materials and Methods The ultrasonic data of 15 misdiagnosed patients with histopathologically confrmed MTC who were treated in Shengjing Hospital from January 2003 to December 2014 were retrospectively studied. Thirty sex- and age-matched patients with histopathologically confirmed thyroid adenoma （AN） during the same period were enrolled as the control group. The pathological results were regarded as the gold standard. The ultrasonic features of MTC and adenoma were analyzed and compared. Results There was significant difference in halo， periphery blood supply and heterogeneously echo between two groups （χ2=34.393， 18.715 and 16.674， P＜0.05）. There was no complete halo and periphery blood supply in MTC group compared with those in AN group； there was hypoechoic or super hypoechoic in MTC group， while there was hyperechoic in AN group. There was no signifcant difference observed between the two groups in the boundary， anteroposterior-totransverse diameter ratio， internal blood supply and internal calcification （P＞0.05）. Conclusion The ultrasonic features of atypical medullary thyroid carcinoma were not characteristic， but halo， internal echo and periphery blood supply contribute to the differentiation diagnosis of medullary thyroid carcinoma.

【Key words】Thyroid neoplasms； Carcinoma， medullary； Ultrasonography， Doppler， color；Diagnostic errors

甲状腺髓样癌（medullary thyroid carcinoma，MTC）来源于分泌降钙素的甲状腺滤泡旁细胞，是临床上较少见的甲状腺恶性肿瘤。大部分MTC具有典型的甲状腺癌的超声特点［1-4］，不易漏诊及误诊，但是在临床诊断中发现有一部分MTC与甲状腺腺瘤（thyroid adenoma，AN）很相似，极易误诊，影响患者的进一步治疗。本研究回顾性分析15例MTC的超声图像特点，并与腺瘤超声图像进行对比分析，以提高术前诊断水平。……