Spiezia S, Cerbone G, Colao A, Assanti AP, Picone GM, Lombardi G
Department of Surgery, Unit of Ultrasound-guided Surgery, S. Maria del Popolo degli Incurabili Hospital ASL NA1, Via M. Longo 50, 80138 Napoli, Italy
Eur J Ultrasound. 1997 Dec 1;6(3):165-170. doi: 10.1016/s0929-8266(97)10014-3.
Objective: The usefulness of power Doppler (PD), a new color Doppler ultrasonography technique, namely in the diagnosis and management of hypoechoic thyroid nodules in comparison with color Doppler (CD) is investigated in this study. Patients and methods: 157 hypoechoic thyroid nodules were studied by CD and PD. The distribution of vascular patterns was compared with the results obtained at cytology and/or histology. Results: Three characteristic PD patterns were found: type A=ring sign, defined as the perilesional vascular signal; type B=complex ring sign, subdivided into B1 for the perilesional and moderate intralesional vascular signal with regular vessels course and B2 for the perilesional and high intralesional vascularization, with anarchic structure and winding vessels course; C=delta sign, defined as a small vascular perilesional halo with a large afferent vessel and winding course and flow. All tumors, benign and malignant, showed a pattern type B2, except one which showed a pattern type C and another with a type B1. All the lesions with patterns A and B1 were hyperplasias. Forty-six hyperplastic lesions showed a pattern B2: in these cases the analysis of flow indices predicted the negative cytology. In fact, Doppler measurements showed that all 117 nodules with CD pattern type II and III had systolic peak velocity (Pv)<50 cm/s, 116/117 had resistance index (RI)</=0.75; all ten adenomas had Pv>50 cm/s and 9/10 had RI</=0.75; 7/10 carcinomas had Pv>50 cm/s and among these, four had RI>0.75 and two <0.75, while the patients with Pv<50 cm/s had RI>0.75. In this series of 157 thyroid nodules, both sensitivity and specificity of PD were higher than CD technique (95% versus 75% and 66.4% versus 38.7%). Conclusions: PD, when compared with CD allowed a more accurate characterization of hypoechoic thyroid nodules. Copyright 1997 Elsevier Science Ireland Ltd.
本研究探讨一种新的彩色多普勒超声技术——能量多普勒（PD）在诊断及处理甲状腺低回声结节方面相对于彩色多普勒（CD）的效用。患者与方法：对157个甲状腺低回声结节进行了CD和PD检查。将血管模式的分布与细胞学和/或组织学检查结果进行比较。结果：发现三种特征性的PD模式：A型=环状征，定义为病灶周围血管信号；B型=复合环状征，又细分为B1型，即病灶周围及病灶内中等血管信号且血管走行规则，以及B2型，即病灶周围及病灶内血管高度丰富，结构紊乱且血管走行迂曲；C型=三角征，定义为病灶周围小血管晕伴粗大传入血管且走行迂曲及血流。所有肿瘤，无论良性还是恶性，除一个表现为C型和另一个表现为B1型外，均表现为B2型。所有表现为A型和B1型的病变均为增生性病变。46个增生性病变表现为B2型：在这些病例中，血流指数分析预测细胞学结果为阴性。事实上，多普勒测量显示，所有117个CD模式为II型和III型的结节收缩期峰值速度（Pv）<50 cm/s，116/117个结节阻力指数（RI）≤0.75；所有10个腺瘤Pv>50 cm/s，9/10个腺瘤RI≤0.75；7/10个癌Pv>50 cm/s，其中4个RI>0.75，2个RI<0.75，而Pv<50 cm/s的患者RI>0.75。在这157个甲状腺结节系列中，PD的敏感性和特异性均高于CD技术（分别为95%对75%以及66.4%对38.7%）。结论：与CD相比，PD能更准确地对甲状腺低回声结节进行特征性描述。版权所有1997爱思唯尔科学爱尔兰有限公司。
