二维及彩色多普勒超声对Graves病与桥本氏甲状腺炎鉴别诊断的应

1、二维及彩色多普勒超声对Graves病与桥本氏甲状腺炎鉴别诊断的应        【中文摘要】目的探讨二维及彩色多普勒超声在Graves病与桥本氏甲状腺炎鉴别诊断的价值。方法收集2008年8月至2008年12月在山东省立医院超声诊疗科门诊检查的正凡人、Graves病及桥本氏甲状腺炎患者共57例,其中Graves病患者(GD组)19例,桥本氏甲状腺炎患者(HT组)18例,正凡人(N组)20例。GD组与HT组患者均为初发病例,未经任何治疗,分歧并其余甲状腺疾病。N组均无甲状腺疾病病史。对所有患者及正凡人进行二维及彩色多普

2、勒超声检查,记录甲状腺体积参数(甲状腺左右叶前后径及峡部厚度)、甲状腺回声参数(甲状腺回声级别、甲状腺内低回声区分布特点、实质内是否有强回声网格样分隔)、甲状腺实质内血流模式以及双侧甲状腺上动脉参数(内径、PSV、EDV、RI)。所有患者及正凡人均经实验室检查fT3、fT4、TSH、Anti-TG、Anti-TPO。根据所测PSV,计算每人的PSVmean、PSVmax、PSVmin。除外Anti-TG、Anti-TPO阳性合并甲亢症状与体征的病例,降低桥本甲亢对本研究的影响。统计分析:数据处理应用SPSS13.0软件包,计数资料采用卡方检验,计量资料采用t检验,两两比较采用LSD法。以P0.

3、05为差异具有统计学意义。采用接受者操纵特征(ROC)曲线探讨PSV对鉴别GD与HT的价值。结果1.GD组与HT组甲状腺双侧叶前后径及峡部厚度与N组相较,均明显增大(P0.05)。GD组与HT组相较,各个径线无明显差异(P=0.114,0.096,0.412)。2.GD组与HT组病人甲状腺回声均明显减低。二者经统计学检验,无明显差异(x2=0.044 0.75P0.9)。在低回声区的分布方面,GD组以散在分布为主,而HT组则以弥漫性分布为主,二者经检验,有统计学差异(x2=6.190.025P0.01)。HT组甲状腺实质内网格样强回声显示率明显高于GD组,经统计学检验,有明显差异(x2=13.

4、77 P0.005)。3.正常对照组甲状腺血流局限于甲状腺周边血管,实质内几乎测不到血流信号。GD组与HT组甲状腺实质内血流信号均明显增多,大部分病例呈现火海征。部分GD与HT病人甲状腺实质内血流主要集中于甲状腺前2/3。4.GD组和HT组患者双侧内径均明显增宽,与正常对照组相比有明显差异(P0.001),但GD组HT组无明显差异(P=0.145,0.123)。GD组和HT组患者双侧PSV明显增高,与正常对照组相比,均有明显差异(P0.001),且GD组比HT组血流峰值流速增高更明显(P0.001)。对GD与HT鉴别诊断意义最大的指标是PSVmean与PSVmax,其诊断界点分别为71cm/s

5、与85cm/s,鉴别诊断的灵敏度与特异度分别为PSVmean:94.7%、83.3%,PSVmax:89.5%、88.9%。GD组和HT组患者甲状腺上动脉舒张术期血流速度与正常对照组相较均明显增高(P0.001),但是GD组和HT组无明显差异(P=0.042,0.020)。GD组、HT组与正常对照组三组RI无明显差异(右侧P=0.739,0.814,0.578左侧P=0.429,0.996,0.438)。结论1.甲状腺二维声像图中,实质内的网格样强回声分隔对GD和HT有鉴别诊断价值价值最大,但是由于网格样强回声是桥本氏甲状腺炎发展到一定阶段才会出现,所以无法鉴别早期阶段的HT与GD。2.广泛分

6、布低回声的模式对二者鉴别有一定意义,但是由于本次试验使用的菲利普HDI 5000采用了XRes与SonoCT技术,成像清楚,结构显示清楚,而其余的机器由于性能的差异,二维成像质量相差较大,鉴别诊断的价值受到了一定限制。3.峡部明显增厚不是HT独占的特征,不能鉴别GD与HT。4.双侧甲状腺上动脉血活动力学参数中对二者鉴别最有意义的指标时PSVmean与PSVmax,其诊断界点分别为71cm/s与85cm/s,鉴别诊断的灵敏度与特异度分别为PSVmean:94.7%、83.3%,PSVmax:89.5%、88.9%。这提示我们在日常工作中,当单侧甲状腺上动脉PSV大于或即是85cm/s时,可仅丈量

7、单侧甲状腺上动脉,减少重复丈量造成的人力物力的浪费;当单侧甲状腺上动脉PSV小于85cm/s之间时,需要丈量另外一侧甲状腺上动脉,减少误诊及漏诊。');【Abstract】 ObjectiveTo explore the diagnostic value of 2D and Color Doppler ultrasonography in the differential diagnosis of Graves' disease and Hashimoto's thyroiditis.MethodsFifty-seven people in Shandong provi

8、ncial hospital were selected for this study, which contain nineteen patients with Graves' disease(GD group),eighteen patients with Hashimoto's thyroiditis(HT group) and twenty normal persons(N group).All of the patients visited the hospital for thyroid disease for the first time without any

9、kind therapy including anti-thyroid drug therapy、I(131) therapy and surgical therapy.None of the normal persons had thyroid disease history before.All of the selected persons had US examination and laboratory test to gain the parameters as follows:(1) the parameters of thyroid volume:anterioposterio

10、r diameter of bilateral lobe and the thickness of the isthmus;(2)the parameters of echo characters of the thyroid:the echogenecity of the thyroid、the pattern of the hypoechoic distribution、the intraparenchma of the thyroid had hyperechoic septia or not;(3)the pattern of intraparenchma blood flow;(4)

11、the parameters of bilateral superior thyroid artery:the intradiameter、SPV、EDV、RI;(5) the endocrinal parameters:the value of fT3、fT4、TSH、Anti-TG、Anti-TPO.Calculate everyone's PSVmean、PSVmax、PSVmin according to PSVright、PSVleft。Statistical analysis:Statistical data-processing applies package SPSS

12、13.0.2-test is applied for enumeration data statistical analysis,and t-test is applied for numberic data statistical analysis.LSD method is applied for comparison between any two groups of the three groups.To P0.05 for the differences are statistically significant.ROC curve is applied to explore the

13、 differential diagnosis value of PSV.Results1.The anterioposterior diameters of bilateral lobe and the thickness of the isthmus are longer in GD group and HT group than N group(P0.05),but there isn't statistical difference between GD group and HT group in any parameters(for P=0.114,0.096,0.412).

14、2.The echogenecity of GD group and HT group is lower than N group.The low echo distribution is sporadic in most of GD patients and diffuse in most of HT patients (2=6.19 0.025P0.01).Most HT patients have hyperechoic septia(2= 13.77 P0.005).3.The blood flow in the intraparenchma is more in GD group a

15、nd HT group than N group,and there isn't statistical difference between GD group and HT group.A big part of the patients show thyroid infero.We observe that the blood flow aggregate in the anterior 2/3 parts in GD and HT groups.4.The same results happen to the diameter and EDV of superior thyroi

16、d artery as the blood flow(P0.001).The sequence of the PSV is N group、GD group、HT group from low to high.The most valuable parameters of bilateral superior thyroid arteries are PSVmean and PSVmax.There cut-off points are 71cm/s and 85cm/s.There differential diagnosis sensitivity and specificity are

17、PSVmean:94.7%、83.3%,PSVmax:89.5%、88.9%.There isn't any difference in RI in the three groups (right P=0.739,0.814,0.578,left P=0.429,0.996,0.438).Conclusions1.Hyperechoic septia is most valuable in all of parameters of 2D untrasonography in differential diagnosis between GD and HT,but it could no

18、t distinguish HT in early stage from GD because the hyperechoic septia is not visible when HT is just begun which correlated with the pathologic course.2.The distributional pattern of wide spread low echo is valuable for differential diagnosis.The application is limited in many other instruments because PHLIP HDI 5000 equiped with X-Res and Sono-CT and the photographs is more distincter.3.The obvious thicken i