CAJ | 학술논문

目的：探讨甲状腺髓样癌（MTC）的超声特征。方法回顾性分析经手术病理证实的38例 MTC（42个结节）的超声特征：包括结节的形态、边缘、回声、声晕、纵横比、内部结构、实性部分的回声、钙化和血流模式。选取同期的53例甲状腺良性病变（60个结节）作为对照。如果 MTC 结节在超声表现上出现“微钙化、极低回声、边缘不整或微小分叶、纵横比﹥1”任一甲状腺癌的可疑恶性征象时，归为类癌样 MTC。如果未出现任一征象，归为类良性 MTC。结果 MTC 超声主要表现为：形态呈圆形或椭圆形（57.1％）、低或极低回声（88.1％）、边缘光滑（54.8％）、完全实性（81％）、纵横比≤1（90.5％）、实性部分回声均匀（64.3％）、无晕（78.6％）、钙化多见（52.4％）且多样，但仍以微钙化居多（42.9％）及混合型血流（54.8％）。类癌样 MTC 25个（59.5％），类良性 MTC 17个（40.5％）。MTC 与良性结节在边缘、回声、内部结构、钙化类型、血流模式之间的差异有统计学意义（ P ﹤0.05），形态、纵横比、实性部分回声及声晕间的差异无统计学意义（ P ﹥0.05）。结论 MTC 既具有甲状腺癌的典型超声特征，同时相当部分又具有形态椭圆、边缘光滑的类良性特征。当二维超声鉴别困难时，MTC 周边和中央丰富的血流有助于鉴别。
목적：탐토갑상선수양암（MTC）적초성특정。방법회고성분석경수술병리증실적38례 MTC（42개결절）적초성특정：포괄결절적형태、변연、회성、성훈、종횡비、내부결구、실성부분적회성、개화화혈류모식。선취동기적53례갑상선량성병변（60개결절）작위대조。여과 MTC 결절재초성표현상출현“미개화、겁저회성、변연불정혹미소분협、종횡비﹥1”임일갑상선암적가의악성정상시，귀위유암양 MTC。여과미출현임일정상，귀위류량성 MTC。결과 MTC 초성주요표현위：형태정원형혹타원형（57.1％）、저혹겁저회성（88.1％）、변연광활（54.8％）、완전실성（81％）、종횡비≤1（90.5％）、실성부분회성균균（64.3％）、무훈（78.6％）、개화다견（52.4％）차다양，단잉이미개화거다（42.9％）급혼합형혈류（54.8％）。유암양 MTC 25개（59.5％），류량성 MTC 17개（40.5％）。MTC 여량성결절재변연、회성、내부결구、개화류형、혈류모식지간적차이유통계학의의（ P ﹤0.05），형태、종횡비、실성부분회성급성훈간적차이무통계학의의（ P ﹥0.05）。결론 MTC 기구유갑상선암적전형초성특정，동시상당부분우구유형태타원、변연광활적류량성특정。당이유초성감별곤난시，MTC 주변화중앙봉부적혈류유조우감별。
Objective To analyze the sonographic characteristics of medullary thyroid cancer. Methods Preoperative sonographic fea-tures of 38 MTCs(42 nodules)were retrospectively reviewed,including shape,margin,echogenicity,halo,anteroposterior and transverse diame-ter ratio(A/ T),internal structure,echotexture of solid portion,calcification and color flow pattern. In addition,53 patients with benign thyroid lesions(60 nodules)during the same period were enrolled as the control group. Sonographic findings suggesting suspect malignancy included mi-crocalcifications,marked hypoechogenicity,an irregular or microlobulated margin,and anteroposterior/ transverse diameter ratio more than one. If even one of these sonographic features was present,the nodule was classified as MTC with similar malignant sign. If a nodule had none of the fea-tures described,it was classified as MTC with similar benign sign. Results The main sonographic features of MTC included ovoid to round shape(57. 1% ),marked hypoechogenicity or hypoechogenicity(88. 1% ),smooth margin(54. 8% ),complete solid content(81% ),A/ T ≤1(90. 5% ),homogeneous echotexture of solid portion(64. 3% ),the absence of halo(78. 6% ),calcification(52. 4% )including microcalcifi-cation(42. 9% )and mixed blood flow(54. 8% ). MTCs with similar malignant sign or with similar benign sign were respectively 25(59. 5% ) and 17(40. 5% ). There were significant differences between MTCs and benign nodules in margin,echogenicity,internal structure,types of calci-fication and color flow pattern( P ﹤ 0. 05),while no significant differences were found in shape,A/ T,echotexture of solid portion and halo( P﹥ 0. 05). Conclusion MTC has sonographic features of both typical thyroid carcinoma and similar thyroid benign lesion,such as ovoid shape and smooth margin. When two - dimensional ultrasound identification is difficult,MTC of peripheral and central rich blood flow could help to identify.