- 期刊
鎝99-m同位素掃描與超音波檢查對甲狀線疾病的診斷價值
Scintigraphic and Sonographic Studies in Thyroid Diseares
摘要
於民國76年9月至12月間，我們對18位正常者與86位甲狀線疾病患者，進行一項觀察，以探討同位素掃描〈RN〉〈99mTc-pertechnetate scan〉與超音波檢查〈US〉〈real-time ultrasound〉用於診斷甲狀線疾病的效果與地位。 RN的結果依甲狀線的大小、形狀、放射活性的分佈情形，與結節的冷、熱性，而區分成不同的類型，以資判讀。對於瀰漫性甲狀線腫〈DTG〉與部份或次全甲狀線切除術後〈PTR〉的診斷，RN相當可靠。依結節的冷熱性來判斷，對良惡性結節的區分，則完全不可能。整體而言，RN可判斷96.5%〈83/86〉的甲狀線異常，對於結節性病變的檢出率為90%〈45/50〉。 US的結果依甲狀線的回音均勻性與結節的特性〈外形、回音性、有無囊性變化、有無侵氾甲狀線外莢等〉而判讀。對於DTG與PTR的診斷較有困擾，然對結節的型態變化之觀察，則解像力頗佳。懷疑侵犯甲狀線外莢的7例結節性形態變化中，6例〈85.7%〉為惡性結節，佔惡性結節的55%〈6/11〉；因此；甲狀線外莢的遭受侵犯是惡性結節的可靠表徵。整體而言，診斷甲狀線異常的敏感性為93%〈79/85〉，而診斷結節性病變的檢出率為90%〈45/50〉。 RN與US結果不相符者7例。2例RN顯示出兩側性結節，US只看到單側結節；1例RN只看到單側結節，US顯示出兩側性病灶。2例RN顯示結節性病變，而US卻正常。1例US為兩側性不均勻回音性，而US正常。另1例則US發現兩個結節，RN只明確地顯示1個。探究其因，RN的功能性顯像，與US的高解像力，應為兩相矛盾的主因。 結論是：1.同位素掃描兼具功能性與解剖性的造影效果；2.超音波檢查則解像力佳，對於形態學變化的觀察較為理想，且可偵測50%左右的惡性甲狀線結節；3.兩者相輔相成，合併使用，最為理想。
關鍵字
無資料並列摘要
A prospective study was conducted to evaluate99m Tc-pertechnetate radionuclide (RN) thyroid scan and real-time ultrasound (US) in the diagnosis of thyroid diseases during September through December 1987. Eighteen normal subjects and 86 thyroid patients were included. Based on size, contour, distribution of radioactivity, and presence of cold/cool/hot nodule(s) of the thyroid gland, for diagnosis of thyroid abnormality the sensitivity was 96.6% (83/86). RN detected 90%(45/50) of the thyroid nodules, but failed in detection of its malignancy. Us detected 93.0% (79/85) of thyroid abnormalities, and detected 90%(45/50) of the thyroid nodules. A protruding-out of the nodule(s) through the thyroid capsule was a reliable sign for malignancy (6/11, 55% vs 1/39, 3%; p＜0.01, x2-test c Yate’s correction); while size, multinodularity, cystic change and margin of the nodule(s) were not. Seven cases showed discrepancy between RN and US scans. This was probably due to (1)an inability of the US scan to demenostrate some nodules that were functionally abnormal and(2)relatively poor resolution of RN scan. In conclusion it appeared that the RN scan can demonstrate the thyroid lesion both morphologically and functionally, while US scan shows relatively good resolution; and they are certainly complementary to each other as imaging modalities.