李旭 林宇 成一鸣 赵晓宇 苟涛华 张艳

摘要：目的 探讨超声对甲状腺轮辐状血流表现结节的诊断价值。方法 收集超声检查甲状腺结节血流呈轮辐状表现患者的病例资料，记录结节灰阶超声特征，以病理结果为金标准，比较美国放射学会甲状腺影像报告与数据系统（ACR TI-RADS）和中国甲状腺影像报告与数据系统（C-TIRADS）及联合特异指标对甲状腺轮辐状血流结节的诊断效能。结果 最终纳入患者64例，其中恶性结节47例，良性结节17例。除一般超声特征外，中央瘢痕多见于恶性结节（χ2=5.968，P=0.015），而中央区粗钙化多见于良性结节（χ2=10.899，P=0.001）。联合中央瘢痕和中央区粗钙化，ACR-TIRADS和C-TIRADS诊断甲状腺轮辐状血流结节的效能均明显提高（P均＜0.001）。结论 甲状腺结节超声呈轮辐状血流表现时应警惕恶性的可能，联合中央瘢痕及中央区粗钙化可提高超声诊断准确性。

关键词：甲状腺结节；超声；瘢痕；轮辐状

中图分类号： R445.1  文献标识码： A  文章编号：1000-503X（2024）03-0370-07

DOI：10.3881/j.issn.1000-503X.15894

Diagnostic Value of Ultrasound for Thyroid Nodules With a Spoke-Wheel Blood Flow Pattern

LI Xu 2，LIN Yu 3，CHENG Yiming2，ZHAO Xiaoyu2，GOU Taohua 2，ZHANG Yan 2

1Chinese PLA Medical School，Beijing 100853，China

2Department of Ultrasound，3Department of Pathology，The First Medical Center of Chinese PLA General Hospital，Beijing 100853，China

Corresponding authors：ZHANG Yan Tel：010-6693524 E-mail：zhangyaner301@126.com

ABSTRACT：Objective To explore the diagnostic value of ultrasound for thyroid nodules with a spoke-wheel blood flow pattern.Methods The clinical data of the patients with thyroid nodules presenting a spoke-wheel blood flow pattern examined by ultrasound were collected，and the gray-scale ultrasound features of the nodules were recorded.The diagnostic performance of the Thyroid Imaging Reporting and Data System by American College of Radiology （ACR TI-RADS），Chinese Thyroid Imaging Reporting and Data System （C-TIRADS），and combined specific indicators for the thyroid nodules with a spoke-wheel blood flow pattern was evaluated by comparison with the pathological results，which was regarded as the gold standard.Results A total of 64 patients with thyroid nodules were finally included，including 47 patients with malignant nodules and 17 patients with benign nodules.In addition to the general ultrasound features，central scar mostly appeared in malignant nodules （χ2=5.968，P=0.015），while central coarse calcification was more common in benign nodules （χ2=10.899，P=0.001）.After the combination of central scar and central gross calcification，the diagnostic performance of ACR TI-RADS and C-TIRADS was improved （both P<0.001）.Conclusions When the thyroid nodule shows a spoke-wheel blood flow pattern，one should be cautious of the possibility of malignancy.Combining central scar and central coarse calcification can improve the accuracy of ultrasonic diagnosis.

Key words：thyroid nodule；ultrasound；scar；spoke-wheel pattern

Acta Acad Med Sin，2024，46（3）：370-376

甲状腺癌是最常见的内分泌恶性肿瘤［1］，我国每年以20%的速度持续增长［2］，高分辨率超声的广泛应用，特别是在体检领域，已经使大量甲状腺癌在早期阶段被检出。彩色多普勒血流成像（color Doppler flow imaging，CDFI）作为超声检查的重要技术之一，在评估多个脏器肿瘤性质及预测其侵袭性方面发挥着重要作用，但在甲状腺结节良恶性鉴别诊断方面长期以来一直存在学术上的争议［3-7］。为规范报告术语，提高诊断能力，各国学者相继建立各自的甲状腺影像报告和数据系统（Thyroid Imaging Reporting and Data System，TI-RADS）［8-13］指导管理甲状腺结节，但均未将血流作为参考因素。……