甲状腺核素显像、血清TSH及超声检查对甲状腺结节的诊断价值

探讨甲状腺核素显像、血清TSH及超声检查对甲状腺结节的鉴别诊断价值。以术后病理结果为标准,回顾性分析89例患者的141个甲状腺结节,将核素显像、血清TSH水平及超声检查结果进行比较。结果表明,核素显像冷结节恶性率为35.3%,实性冷结节恶性率达57.1%,核素显像与血清TSH水平相关,热结节TSH水平低,冷结节TSH水平高(P0.05)。TSH水平升高伴随着恶性率增高(P0.05)。冷结节中恶性结节TSH水平显著高于良性结节(P0.05),TSH诊断甲状腺癌最佳界值为1.695mIU/L,灵敏度、特异性分别为83.8%、77.3%。实性冷结节中TSH诊断甲状腺癌最佳界值为1.675mIU/L,灵敏度、特异性分别为83.3%、100%。热、温、凉结节中良恶性结节的TSH水平无明显差异(P0.05)。以上结果表明,核素显像有助于评价甲状腺结节的功能状态和形态特点,结合血清TSH检测及超声检查,对鉴别诊断甲状腺结节良恶性有重要价值。

Values of Radionuclide Imaging,Serum TSH and Ultrasonography in the Diagnoses of Thyroid Nodules

Evaluate the values of SPECT ,serum TSH and ultrasonography in the diagnoses of benign and malignant thyroid nodules. Retrospective analysis of SPECT , serum TSH, and ultrasonography results of 89 patients with 141 thyroid nodules . And the examination results were compared with the post-operative pathological findings. It has statistical signif- icance when the P-value of the significance test is smaller than 0.05. On SPECT, malignantrate of the ＂cold＂ nodules was 35.3% ,and increased accompanied with the raising of serum TSH level （P〈0.05） . The results image were corresponding to the serum TSH level. A high serum TSH level ofen appeared in the ＂cold＂ nodules and a low serum TSH level ofen appeared in the ＂hot＂ nodules （P〈0.05）. （2）The rate of malignant increased accompanied with the raising of serum TSH level （P〈0.05） . The serum TSH level in patient with ma- lignant cold nodule is higher than patient with benign cold nodule （P〈0.05）, and the best diagnosis TSH level is 1. 695 mIU/L with sensitivity and specificity 83.8% and 77.3%, re- spectively. The best diagnosis TSH level in patient with solid cold nodule is 1. 675 mIU/L with sensitivity and specificity 83.3% and 100%,respectively. Therefor,TSH level has no diagnositic significance in patient with hot,warm,or cool nodules （P〉0.05） . The combina- tion of thyroid imaging may help to evaluate the functions and the form of thyroid nodules, serum TSH and ultrasonography so that it plays an important role in the differentiation of benign and malignant thyroid nodules.