| 摘要: |
| 目的 探讨甲状腺实性结节微波消融治疗后消融区的动态声像学特征。方法 选择2015年1月至2018年12月因甲状腺结节在海军军医大学（第二军医大学）第二附属医院、上海国际医学中心就诊并接受超声引导下经皮穿刺微波消融术治疗的364例患者434枚结节，其中良性结节消融组329枚、恶性结节（甲状腺乳头状癌）消融组105枚，所有结节均予完全消融。回顾性分析消融后第1、3、6、12个月时两组消融区的声像学特征，包括消融区回声、周边晕环、消融针道、钙化、纵横比、边界及彩色多普勒血流变化，总结两组的异同之处。同时收集恶性结节消融组105枚结节消融前的超声图像，对两组结节消融区的声像学特征与恶性结节消融前的声像学特征进行比对分析，探讨其相似的特征及鉴别要点。结果 甲状腺良性、恶性结节消融后消融区整体呈低回声，内可见消融针道，周边可见低回声晕环形成，内部无血流信号。其中20枚结节在术后12个月针道完全吸收，其余消融针道随着时间延长呈现吸收趋势；晕环在术后第1个月多显示不完整，术后第3个月较为完整、清晰，第6、12个月逐渐模糊；边界在术后第3、6个月最为清晰，第1、12个月较为模糊；术后1~12个月消融区内均无血流信号；伴钙化的消融区一般在术后3个月出现聚集，随着时间延长聚集更明显。甲状腺乳头状癌消融前表现为实性低回声、边界不清、边缘毛糙、不完整晕环、散在的微钙化、内部及周边有血供，与各时间节点良性结节消融组、恶性结节消融组消融区特征类似。结论 甲状腺良性、恶性结节消融区的多个声像学特征的出现一致，其部分声像学特征与甲状腺乳头状癌未消融治疗时的声像特征较为相似，但可通过消融针道、周边晕环、钙化分布特征、消融区血供等特征进行鉴别。 |
| 关键词: 甲状腺结节 甲状腺乳头状癌 微波消融 回声 晕环 针道 边界 钙化 血供 |
| DOI：10.16781/j.CN31-2187/R.20210929 |
| 投稿时间：2021-09-18修订日期：2021-11-16 |
| 基金项目: |
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| Ultrasonographic findings of solid thyroid nodules after microwave ablation |
| ZHANG Hang1△,ZHANG Jian-quan2△*,DIAO Zong-ping1,YAN Lei3 |
(1. Department of Ultrasound, The Second Affiliated Hospital of Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Department of Ultrasonic Intervention, Shanghai International Medical Center, Shanghai 201318, China;
3. Department of Special Diagnosis, No. 904 Hospital of Joint Logistics Support Forces of PLA, Suzhou 215007, Jiangsu, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the dynamic ultrasonographic characteristics of the ablation areas of solid thyroid nodules after microwave ablation. Methods A total of 434 nodules of 364 patients treated with ultrasound-guided percutaneous microwave ablation in The Second Affiliated Hospital of Naval Medical University (Second Military Medical University) and Shanghai International Medical Center from Jan. 2015 to Dec. 2018 were selected, including 329 in benign nodule ablation group and 105 in malignant nodule (thyroid papillary carcinoma) ablation group. All nodules were completely ablated. The ultrasonographic features (including the echo, peripheral acoustic halo, needle tract, calcification, aspect ratio, boundary and the change of the color Doppler flow) of the ablation areas of the 2 groups at 1, 3, 6 and 12 months after ablation were analyzed retrospectively, and the similarities and differences between the 2 groups were summarized. At the same time, the ultrasonic images of the 105 nodules in the malignant nodule ablation group were collected before ablation. The ultrasonic characteristics of the nodule ablation areas in the 2 groups were compared with those of malignant nodules before ablation, so as to explore their similar characteristics and key points for differentiation. Results The ablation areas of the benign and malignant thyroid nodules showed hypoechoic echo with needle tract and hypoechoic acoustic halo after ablation, with no internal blood flow signal. The ablation needle tracts of 20 nodules were absorbed 12 months after operation, and the other needle tracts showed an absorption trend over time. The acoustic halo was incomplete at 1 month after operation, was complete and clear at 3 months, and was gradually blurred at 6 and 12 months. The clearest boundary was found at 3 and 6 months after operation, but blurred at 1 and 12 months. There was no blood flow signal in the ablation areas from 1 to 12 months after operation. The ablation areas with calcification generally aggregated at 3 months after operation, and the aggregation became more obvious over time. Before the ablation, papillary thyroid carcinoma showed solid hypoecho, unclear boundary, coarse margin, incomplete acoustic halo and scattered microcalcification, with internal and peripheral blood supply, which were similar to the characteristics of ablation areas in the benign and malignant nodule ablation groups at all time points. Conclusion The ultrasonographic features of benign and malignant thyroid nodules in the ablation areas are consistent, and some of the ultrasonographic features are similar to those of papillary thyroid carcinoma without ablation, but they can be identified by needle tract, acoustic halo, calcification distribution and blood supply in the ablation areas. |
| Key words: thyroid nodule papillary carcinoma of the thyroid microwave ablation echo acoustic halo needle tract boundary calcification blood supply |
