Messina G, Viceconti N, Trinti B
Servizio Autonomo di Ecotomografia, Ospedale Madre Gjuseppina Vannim, ASL RM/C di Roma.
Ann Ital Med Int. 1996 Oct-Dec;11(4):263-7.
Ultrasound examination of the thyroid gland is used extensively in the diagnosis of thyroid carcinoma: it is easy and rapid to perform and widely available. Ultrasound enables easy identification of the image of disease foci within the gland, especially when high frequency probes (7.5-10 MHz) are used. Thyroid nodules are subdivided on the basis of their echostructure into hypoechoic solid, isoechoic solid, and hyperechoic solid, mixed, and liquid. In neoplastic pathologies, a hypoechoic echostructure is not pathognomonic of malignancy but must be regarded with suspicion, especially if it is an isolated nodule in a male patient and continues to grow during suppressive therapy. In fact, thyroid neoplasms evidence a hypoechoic echostructure in 60-70% of the cases, while a hyperechoic echostructure is present in only 2-4%. Only 15-25% of neoplasms appear as isoechoic nodules; a mixed echostructure is rarely (5-10% of the cases) seen. Color-Doppler patterns are classified into four types: I) nodules without internal or perinodular vascularization; II) nodules with vascularization confined to extranodular tissue; III) nodules with significant intra- and perinodular vascularization; IV) increased vascularization (or "thyroid inferno"). The vast majority of thyroid carcinoma (90%) presents type III vascularization. We therefore suggest the routine use of ultrasonography and color-Doppler studies in conjunction with fine-needle aspiration cytology for the diagnostic evaluation of thyroid carcinoma.
它操作简便、快速，且普及程度高。超声能够轻松识别甲状腺内疾病病灶的图像，尤其是使用高频探头（7.5 - 10 MHz）时。甲状腺结节根据其回声结构可细分为低回声实性、等回声实性、高回声实性、混合性和液性。在肿瘤性病变中，低回声结构并非恶性肿瘤的特征性表现，但必须引起怀疑，特别是当它是男性患者的孤立结节且在抑制性治疗期间持续生长时。事实上，60 - 70%的甲状腺肿瘤病例表现为低回声结构，而高回声结构仅占2 - 4%。只有15 - 25%的肿瘤表现为等回声结节；混合回声结构很少见（占病例的5 - 10%）。彩色多普勒模式分为四种类型：I）结节内部或结节周围无血管化；II）血管化局限于结节外组织的结节；III）结节内部和结节周围有显著血管化；IV）血管化增加（或“甲状腺火海”）。绝大多数甲状腺癌（90%）表现为III型血管化。因此，我们建议常规使用超声检查和彩色多普勒研究，并结合细针穿刺细胞学检查来对甲状腺癌进行诊断评估。
