CAJ | 학술논문

目的探讨甲状腺实性结节区域血流灌注特征.方法对舟山医院2013年10月至2015年5月的59例甲状腺实性结节患者术前行超声造影,绘制时间-强度曲线获得结节旁正常组织、结节边缘及中心定量参数峰值强度(PI)、达峰时间(TP)、曲线下面积(AUC)、平均渡越时间(MTT).术后病理切片行免疫组化,测定微血管密度(MVD),并与定量参数进行相关性分析.结果恶性组中,癌旁组织、结节边缘及中心的PI分别为28％±6％、21％±7％、14％±5％,差异有统计学意义(P＜0.05);AUC分别为(1865±1079)％S、(1 376±595)％S、(805 ±412)％S,结节中心与结节边缘及癌旁组织比较差异有统计学意义(P ＜0.05);MVD分别为(33士6)、(27±6)、(17±6)条/HP,差异有统计学意义(P＜0.05).良性组三个区域定量参数及MVD比较差异无统计学意义(P＞0.05).甲状腺癌与结节性甲状腺肿的PI与MVD均呈正相关(r分别为0.819、0.838),且差异有统计学意义(P＜0.05).结论超声造影定量参数的差异为甲状腺良恶性结节的鉴别诊断提供了重要依据,在一定程度上可反映肿瘤微血管分布特征,可作为评价肿瘤血管生成的依据之一.
목적 탐토갑상선실성결절구역혈류관주특정.방법 대주산의원2013년10월지2015년5월적59례갑상선실성결절환자술전행초성조영,회제시간-강도곡선획득결절방정상조직、결절변연급중심정량삼수봉치강도(PI)、체봉시간(TP)、곡선하면적(AUC)、평균도월시간(MTT).술후병리절편행면역조화,측정미혈관밀도(MVD),병여정량삼수진행상관성분석.결과 악성조중,암방조직、결절변연급중심적PI분별위28％±6％、21％±7％、14％±5％,차이유통계학의의(P＜0.05);AUC분별위(1865±1079)％S、(1 376±595)％S、(805 ±412)％S,결절중심여결절변연급암방조직비교차이유통계학의의(P ＜0.05);MVD분별위(33사6)、(27±6)、(17±6)조/HP,차이유통계학의의(P＜0.05).량성조삼개구역정량삼수급MVD비교차이무통계학의의(P＞0.05).갑상선암여결절성갑상선종적PI여MVD균정정상관(r분별위0.819、0.838),차차이유통계학의의(P＜0.05).결론 초성조영정량삼수적차이위갑상선량악성결절적감별진단제공료중요의거,재일정정도상가반영종류미혈관분포특정,가작위평개종류혈관생성적의거지일.
Objective To compare the difference between the different perfusional regions in solid thyroid nodules.Methods From October 2013 to May 2015, CEUS was performed in 59 patients who hospitalizated in Zhoushan Hospital with solid thyroid nodules before operation.The time-intensity curve (TIC) of normal thyroid tissue, tumor edge and tumor center was drawn to collect perfusion index like the peak intensity (PI), time to peak (TP), area under the curve (AUC), mean transit time (MTT).After surgery, immunohistochemical staining was performed to evaluate the MVD in surgical specimens.Quantitative parameters and MVD were assessed by the Spearman correlation analysis.Results There were 31 thyroid papillary carcinomas and 28 nodular goiters.In malignant tumor group, the PI of normal thyroid tissue, tumor edge and tumor center were 28％ ±6％ ,21％ ±7％ and 14％ ±5％ ,respectively,while the AUC and MVD of the same regions were (1 865 ± 1 079) ％ S, (1 376 ± 595) ％ S, (805 ± 412) ％ S and (33 ± 6), (27 ± 6)/HP, (17 ± 6)/HP, respectively.The differences were statistically significant.However, in benign tumor group, there was no obvious statistic difference in the quantitative parameters and MVD between the three regions.The PI values of thyroid carcinomas and nodular goiters all were positively correlated with MVD (r =0.819, r =0.838, P ＜ 0.05).Conclusions The variance of perfusion parameters were valuable diagnostic basis in differential diagnosis between benign and malignant thyroid nodules.They were associated wit h MVD, which might reflect the microvessel distributional characteristics of neoplasm and might be one of bases used to evaluate neoplasm angiogenesis.