Objective: To analyze the features of degenerating cystic thyroid nodules (DCTN) on conventional ultrasound and contrast-enhanced ultrasound (CEUS), and to explore the differentiation between DCTN and papillary thyroid carcinomas (PTC). Methods: A total of 46 DCTN (39 cases, including 12 males and 27 females, with an age range of 25 to 76 years) and 36 PTC (32 cases, including 8 males and 24 females, with an age range of 23 to 68 years) diagnosed via fine- needle aspiration (FNA) or surgery from February 2019 to January 2020 in the First Affiliated Hospital of Nanchang University were enrolled. The size, shape, margin, echogenicity, presence of shadowing, calcification and vascularity of DCTN and PTC were retrospectively evaluated, and 28 DCTN and 30 PTC underwent CEUS were separately analyzed and compared.The t test, χ² test or Fisher's exact test were implemented to compare the features of ultrasound among the two groups. The binary Logistic regression test was performed to determine whether the feature whose difference was statistically significant was an independent predictive risk factor. Results: A univariate analysis indicated that DCTN more frequently showed wider-than-tall shapes, marked hypoechogenicity, well-defined margin and no or dot-lined enhancement (wider-than-tall shapes: 36 vs. 17, χ2=8.511; well-defined margin: 30 vs. 15, χ2=4.523; marked hypoechogenicity: 27 vs. 9, χ2=9.310; no or dot-lined enhancement: 24 vs. 3, χ2=33.369; all P＜0.05). A multivariate analysis demonstrated that wider-than-tall shapes, well-defined margin and marked hypoechogenicity were independent predictors for DCTN (OR values were 5.204, 3.134 and 5.042, P values were 0.003, 0.031, and 0.003, respectively). Among 28 DCTN, 15 showed a decrease in mean maximum diameter (24.3±11.4 mm) with a mean time span of (18.6±10.5) months between the presence and absence of suspicious ultrasound features. Conclusions: Compared with PTC, DCTN shows the ultrasound characteristics of wider-than-tall shapes, well-defined margin, marked hypoechogenicity and no or dot-lined enhancement pattern. Ultrasound follow-up can help to identify spontaneous DCTN.
目的： 探究自发性甲状腺皱缩结节常规超声和超声造影检查下（contrast-enhanced ultrasound，CEUS）的表现特点，并与甲状腺乳头状癌（papillary thyroid carcinomas，PTC）进行鉴别诊断。 方法： 回顾性分析2019年2月至2020年1月于南昌大学第一附属医院就诊且经细针穿刺（fine-needle aspiration，FNA）细胞学或术后病理证实的39例自发性甲状腺皱缩结节患者（46个结节，即皱缩结节组），其中男12例，女27例，年龄25~76 岁，以及同时期经术后病理确诊的PTC患者中随机选取32例（36个癌灶，即PTC组），其中男8例，女24例，年龄23~68 岁。比较2组病变的大小、形状、边界、回声、钙化、血流信号等常规超声表现，其中28个皱缩结节及30个PTC在FNA或术前行CEUS检查，分析比较2组在增强模式下的表现。采用两独立样本t检验、χ²检验或Fisher精确检验比较2组的超声表现，差异有统计学意义者行二元Logistic回归检验是否为独立预测风险因素。 结果： 单变量分析示皱缩结节组与PTC组相比，更常表现纵横比<1、边界清晰、极低回声以及无或点线状增强方式，差异有统计学意义（纵横比<1者∶36比17，χ2 =8.511；边界清晰：30比15，χ2 =4.523；极低回声：27比9，χ²=9.310；无或点线状增强方式：24比3，χ2 =33.369；P值均<0.05），多变量Logistic回归分析示结节纵横比<1、边界清晰及极低回声为皱缩结节的独立风险预测因子（OR值分别为5.204、3.134和5.042，P值分别为0.003、0.031和0.003）。其中15个皱缩结节从良性表现至首次可疑恶性的时间跨度为（18.6±10.5）个月，初始最大长径缩小（24.3±11.4）mm。 结论： 皱缩结节相较于PTC超声检查中更常表现为纵横比<1、边界清晰、极低回声和无或点线状增强方式。结合随访过程中患者历史超声检查有助于诊断。.