Department of Surgery, University Hospital Regensburg, Regensburg, Germany.
Clin Hemorheol Microcirc. 2012;52(2-4):197-203. doi: 10.3233/CH-2012-1597.
Preoperative differentiation of thyroid nodules in benign and malignant pathologies still represents an unsolved problem in endocrinology. In the presented study, contrast-enhanced ultrasonography (CEUS) was applied as a new diagnostic tool detecting the microvascularisation of thyroid carcinomas.
167 patients underwent surgery for suspicious thyroid nodules between 05/2011 and 08/2012. Contrast-enhanced ultrasonography (CEUS) with a linear probe (6-9 MHz, LOGIQE9/GE), color coded Doppler sonography (CCDS) and Power Doppler ultrasonography (PD) were performed in all patients preoperatively. Removed nodules were proved by histology. In case of carcinoma morphological characteristics and especially microvascularization were analyzed using time intensity curves (TIC) in selected regions of interest (ROI).
In total, 22 thyroid carcinomas could be identified by histology. Using CEUS thyroid carcinomas in 19 patients showed early and irregular arterial vascularization followed by early arterial central wash-out. CCDS/PD, however, revealed irregular peripheral vascularization with low flow only in 8 cases. Further analysis resulted in a significant higher area under the curve (AUC) at the edge than in the tumor center but in a similar time to peak (TTP) in both regions.
CEUS represents a highly sensitive method for the detection of the microvascularization of thyroid carcinomas. Future studies should compare these findings to benign pathologies in order to establish CEUS as a standard diagnostic procedure in the preoperative evaluation of suspicious thyroid nodules.
在内分泌学中，甲状腺结节的良恶性术前鉴别仍然是一个未解决的问题。在本研究中，对比增强超声（CEUS）被应用于一种新的诊断工具，用于检测甲状腺癌的微血管化。
2011 年 5 月至 2012 年 8 月期间，167 名患者因可疑甲状腺结节接受了手术。所有患者均在术前进行了对比增强超声（CEUS）检查（使用线性探头，6-9MHz，LOGIQE9/GE）、彩色编码多普勒超声（CCDS）和功率多普勒超声（PD）。切除的结节通过组织学证实。在癌的情况下，使用时间强度曲线（TIC）在选定的感兴趣区域（ROI）中分析形态特征，特别是微血管化。
总共通过组织学识别出 22 例甲状腺癌。在 19 例患者中，CEUS 显示甲状腺癌的早期和不规则动脉血管化，随后出现早期动脉中央冲洗。然而，仅在 8 例中，CCDS/PD 显示不规则的周边血管化，血流低。进一步分析显示，边缘的曲线下面积（AUC）显著高于肿瘤中心，但在两个区域的达峰时间（TTP）相似。
CEUS 是检测甲状腺癌微血管化的一种高度敏感的方法。未来的研究应将这些发现与良性病变进行比较，以便将 CEUS 确立为可疑甲状腺结节术前评估的标准诊断程序。
