Department of Diagnostic Imaging, Alpert Medical School, Brown University/Rhode Island Hospital, RI 02903 USA.
J Ultrasound Med. 2011 Jun;30(6):753-60. doi: 10.7863/jum.2011.30.6.753.
The purpose of this study was to further classify nonshadowing echogenic foci and examine the association with malignancy.
This study received Institutional Review Board approval and was Health Insurance Portability and Accountability Act compliant. A total of 371 consecutive thyroid nodules were evaluated in 189 patients (177 female and 12 male; mean age, 59 years; range, 21-92 years). Eighty-six nodules (23%) measured 5 mm or larger and contained nonshadowing echogenic foci with a mean nodule diameter of 16 mm (5-66 mm). Blinded review of these nodules 12 months later was performed. Echogenic foci were classified as follows: showing a comet tail artifact (type 1), linear and brightly echogenic (type 2), round and indeterminate (type 3), and microcalcifications (type 4). All available thyroid sonograms and pathologic data were then reviewed.
Nineteen nodules (22%) showed a classic comet tail artifact, with malignancy in 0 of 19. Six (32%) had negative pathologic results, and 9 (47%) had stable imaging follow-up (mean, 37 months). Twenty-nine nodules (34%) showed linear and brightly echogenic foci, with malignancy in 0 of 29. Fifteen (52%) had negative pathologic results, and 11 (38%) had stable imaging follow-up (mean, 34 months). Twenty-four nodules (28%) showed round and indeterminate echogenic foci, with 1 of 24 (4%) containing papillary carcinoma. Thirteen (54%) had negative pathologic results, and 8 (33%) had stable imaging follow-up (mean, 24 months). Fourteen nodules (16%) contained microcalcifications, with 4 of 14 (29%) containing papillary thyroid cancer. Nine (64%) had negative pathologic results, and 1 (7%) had stable imaging follow-up (63 months).
Nonshadowing brightly echogenic linear foci with or without a comet tail artifact may be a benign finding. Confirmatory studies are needed for this result to be applied clinically.
本研究旨在进一步对无声影强回声灶进行分类，并探讨其与恶性肿瘤的关系。
本研究获得了机构审查委员会的批准，并符合《健康保险流通与责任法案》的规定。共对 189 例患者的 371 个连续甲状腺结节进行了评估（177 名女性，12 名男性；平均年龄 59 岁；范围 21-92 岁）。86 个结节（23%）大小为 5mm 或更大，含有无声影强回声灶，平均结节直径为 16mm（5-66mm）。12 个月后对这些结节进行了盲法复查。将回声灶分为以下几类：彗星尾伪像（1 型）、线性强回声（2 型）、圆形不定型（3 型）和微钙化（4 型）。然后回顾所有可用的甲状腺超声和病理数据。
19 个结节（22%）显示典型彗星尾伪像，其中 19 个均无恶性肿瘤。6 个（32%）的病理结果为阴性，9 个（47%）的影像学随访稳定（平均 37 个月）。29 个结节（34%）显示线性强回声灶，其中 29 个均无恶性肿瘤。15 个（52%）的病理结果为阴性，11 个（38%）的影像学随访稳定（平均 34 个月）。24 个结节（28%）显示圆形不定型回声灶，其中 1 个（4%）含有甲状腺乳头状癌。13 个（54%）的病理结果为阴性，8 个（33%）的影像学随访稳定（平均 24 个月）。14 个结节（16%）含有微钙化，其中 4 个（29%）含有甲状腺乳头状癌。9 个（64%）的病理结果为阴性，1 个（7%）的影像学随访稳定（63 个月）。
伴有或不伴有彗星尾伪像的无声影强回声线性灶可能为良性表现。需要进一步的研究来验证这一结果是否具有临床应用价值。
