弹性图像分析
弹性图像可分为定性与定量分析两大类，其中定性分析是根据弹性图像颜色分级标准进行综合评估，而定量分析是使用多种参数（如应变指数、杨氏模量、距离比、面积比、变化率等）对弹性图进行综合评估。法国声科和德国西门子属于定量分析，而日本日立等属于定性分析。
下面以日本日立公司推出的超声弹性成像硬度分级标准为例介绍一下甲状腺结节的超声弹性成像[1，61]。
根据病灶区显示的不同颜色（即不同相对硬度），甲状腺实性结节的弹性图像表现可分为5级，弹性图像以彩色编码代表不同组织的弹性大小，绿色表示ROI内的平均硬度，红色表示较平均硬度更软，蓝色表示比平均硬度更硬（表14-3）。
不同甲状腺疾病的超声弹性图表现为两种。
1.甲状腺良性结节：以腺瘤、结节性甲状腺肿多见，其弹性图分级多为1～2级。由于良性病灶组织多由大小不等的腺泡组成，其内含有丰富的胶质，因此组织硬度较小。但因为病灶组织与周围正常组织的硬度相近，有时在弹性图中很难辨别肿块，必须与二维图像同时显示，这种情况在甲状腺结节较小时多见（图14-40）。
表14-3 甲状腺实性结节的弹性超声图像
图14-40 甲状腺良性结节，弹性评分2级
2.甲状腺恶性结节：一般以乳头状癌居多，其弹性图分级多为3～4级。肿块形态多不规则，边界尚清晰。一般说来，组织的硬度与其内部的病理改变密切相关，如恶性病变的生成可以改变其病灶的组织结构，坚硬的肿瘤组织导致组织弹性降低、组织硬度相应增加，因此组织弹性分级较高。正因为肿瘤与周围组织硬度相差较大，所以在弹性图中肿瘤的边界显得更清晰一些（图14-41）。
图14-41 甲状腺恶性结节，弹性评分3级
参考文献
[1] 燕山，詹维伟.甲状腺与甲状旁腺超声影像学（精）[M].北京：科学技术文献出版社， 2009.
[2] Hegedüs L, Perrild H, Poulsen L R, et al.The determination of thyroid volume by ultrasound and its relationship to body weight, age, and sex in normal subjects[J].Journal of Clinical Endocrinology & Metabolism, 1983, 56(2):260-263.
[3] Cappelli C, Pirola I, Gandossi E, et al.Ultrasound findings of subacute thyroiditis: a single institution retrospective review [J].Acta Radiologica, 2014, 55(4):429-433.
[4] Bhargava, Amit, Kaur, et al.What is the diagnosis? The patient was diagnosed with subacute;thyroiditis and booked for a repeat ultrasound in 10 weeks, with a view;to biopsy the solitary nodule in the right lobe of the thyroid[J].Endocrine Practice, 2013, 19(3):562-563.
[5] Park S Y, Kim E K, Kim M J, et al.Ultrasonographic characteristics of subacute granulomatous thyroiditis[J].Korean Journal of Radiology, 2006, 7(4):229-234.
[6] Gunas I, Prokopenko S, Melnik M.Sonographic parameters of the pancreas and gall bladder in healthy men from Podillya region of Ukraine of different somatotypes[J].Current Issues in Pharmacy & Medical Sciences, 2016,29(2):94-96.
[7] Dai N, Zhang W, Ultrasound D O.Ultrasonographic characteristics of Hashimoto’s thyroiditis with nodules lesions[J].Anhui Medical Journal, 2016.
[8] Reznichenko V M.Prognostic value of color Doppler ultrasonography of the thyroid gland in autoimmune thyroiditis[J].Likarska Sprava, 2005,(4):58-61.
[9]白耀.甲状腺病学[M].北京：科学技术文献出版社，2003.
[10] Slman R, Monpeyssen H, Desarnaud S, et al.Ultrasound,elastography, and fluorodeoxyglucose positron emission tomography/computed tomography imaging in Riedel’s thyroiditis: report of two cases[J].Thyroid Official Journal of the American Thyroid Association, 2011, 21(7):799-804.
[11] Wang C J, Wu T J, Lee C T, et al.A misdiagnosed Riedel’s thyroiditis successfully treated by thyroidectomy and tamoxifen[J].Journal of the Formosan Medical Association, 2012, 111(12):719-723.
[12] Annaert M, Thijs M, Sciot R, et al.Riedel’s thyroiditis occurring in a multinodular goiter, mimicking thyroid cancer[J].Journal of Clinical Endocrinology &Metabolism, 2007, 92(92):2005-2006.
[13] 安亚伟， 张立阳， 马恩陵，等.罕见Riedel甲状腺炎的诊断及处理[J].中国普外基础与临床杂志， 2007，14（5）：604-606.
[14] Marina Baldini M D, Orsatti A, Bonfanti M T, et al.Relationship between the sonographic appearance of the thyroid and the clinical course and autoimmune activity of Graves’disease[J].Journal of Clinical Ultrasound,2005, 33(8):381-385.
[15] Schulz S L, Seeberger U, Hengstmann J H.Color Doppler sonography in hypothyroidism[J].European Journal of Ultrasound Official Journal of the European Federation of Societies for Ultrasound in Medicine & Biology, 2003,16(16):183-189.
[16] Zhang J Z, Hu B.Sonographic features of thyroid follicular carcinoma in comparison with thyroid follicular adenoma[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine, 2014, 33(2):221-227.
[17] Yazici B, Simsek E, Erdogmus B, et al.Evaluation of the thyroid blood flow with Doppler ultrasonography in healthy school-aged children[J].European Journal of Radiology, 2007, 63(2):286-289.
[18] 赵胜， 黄道中， 李银珍，等.结节性甲状腺肿的高频及彩色多普勒超声征象与病理对照分析[J].临床外科杂志， 2005， 13（5）：294-295.
[19] 皮小兰， 李泉水， 许晓华，等.结节性甲状腺肿声像图特征与病理对照分析[J].中国超声医学杂志，2001， 17（12）：924-927.
[20] Rago T, Vitti P.Diagnostic role of ultrasound and elastosonography in nodular goiter[J].Best Practice &Research Clinical Endocrinology & Metabolism, 2014,28(4):519-529.
[21] 岳林先.甲状腺超声诊断[M].北京：人民卫生出版社，2015.
[22] Park J Y, Lee H J, Jang H W, et al.A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma[J].Thyroid, 2009,19(11):1257-1264.
[23] Wong K T, Ahuja A T.Ultrasound of thyroid cancer[J].Cancer Imaging the Official Publication of the International Cancer Imaging Society, 2005, 5(1):157-166.
[24] Trimboli P, Nasrollah N, Amendola S, et al.Should we use ultrasound features associated with papillary thyroid cancer in diagnosing medullary thyroid cancer?[J].Endocrine Journal, 2012, 59(6):503-508.(https://www.daowen.com)
[25] Brito J P, Gionfriddo M R, Al N A, et al.The accuracy of thyroid nodule ultrasound to predict thyroid cancer:systematic review and meta-analysis[J].Journal of Clinical Endocrinology & Metabolism, 2014, 99(4):1253-1263.
[26] Smith-Bindman R, Lebda P, Feldstein V A, et al.Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study[J].Jama Internal Medicine, 2013, 173(19):1788-1796.
[27] Saller B, Moeller L, Görges R, et al.Role of conventional ultrasound and color Doppler sonography in the diagnosis of medullary thyroid carcinoma[J].Experimental &Clinical Endocrinology & Diabetes, 2002, 110(8):403-407.
[28] Gu W J, Yan H X, Luo Y K, et al.Characterization of papillary thyroid microcarcinomas using sonographic features in malignant papillary thyroid cancer: a retrospective analysis[J].Medicine, 2015, 94(21) :36.
[29] Zhang X L, Qian L X, Ultrasound D O, et al.Ultrasonic features of papillary thyroid microcarcinoma and nonmicrocarcinoma[J].Experimental & Therapeutic Medicine, 2014, 8(4):1335-1339.
[30] Shi C, Li S, Shi T, et al.Correlation between thyroid nodule calcification morphology on ultrasound and thyroid carcinoma[J].Journal of International Medical Research, 2012, 40(1):350-357.
[31] Camargo R Y, Tomimori E K.Usefulness of ultrasound in the diagnosis and management of well-differentiated thyroid carcinoma[J].Arq Bras Endocrinol Metab, 2007,51(5):783-792.
[32] Kim G R, Kim M H, Moon H J, et al.Sonographic Characteristics Suggesting Papillary Thyroid Carcinoma According to Nodule Size[J].Annals of Surgical Oncology,2013, 20(3):906-913.
[33] Dideban S, Abdollahi A, Meysamie A, et al.Thyroid Papillary Microcarcinoma: Etiology, Clinical Manifestations,Diagnosis, Follow-up, Histopathology and Prognosis[J].Iranian Journal of Pathology, 2016, 11(1):1-19.
[34] L.H.Sobin.Histological typing of thyroid tumours[J].Histopathology, 1990, 6: 513.
[35] Hedinger C, Sobin LH.Histologic typing of thyroid tumours.In: Hedinger C, Williams E D, Sobin LH, editors.International histological classification of tumours[M].2nd edn New York: Springer-Verlag, 1988.
[36] R.A.DeLellis.Pathology and genetics of tumours of endocrine organs[J], World Health Organization, 2004.
[37] Y.C.Lim, E.C.Choi, Y.H.Yoon, et al.Central lymph node metastases in unilateral papillary thyroid microcarcinoma[J].Br J Surg, 2009,97: 253-257.
[38] G.Mercante, A.Frasoldati, C.Pedroni, D.Formisano,L.Renna, S.Piana, G.Gardini, R.Valcavi, V.Barbieri,Prognostic factors affecting neck lymph node recurrence and distant metastasis in papillary microcarcinoma of the thyroid: results of a study in 445 patients[J].Thyroid,2009,19:707-716.
[39] C.P.Lombardi, R.Bellantone, C.De Crea, et al.Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases, and risk factors for recurrence in a high prevalence of goiter area[J].World J Surg, 2010,34:1214-1221.
[40] Y.H.Xu, H.J.Song, Z.L.Qiu, et al.Brain metastases with exceptional features from papillary thyroid carcinoma:report of three cases[J].Hell J Nucl Med, 2011, 3: 56-59.
[41] M.Varsavsky, M.Cortes Berdonces, G.Alonso, et al.Metastatic adenopathy from a thyroid microcarcinoma:final diagnosis of a presumed paraganglioma[J].Endocrinol Nutr, 2011, 58: 143-144.
[42] Wang Y, Li L, Wang Y X J, et al.Ultrasound Findings of Papillary Thyroid Microcarcinoma: AReview of 113 Consecutive Cases with Histopathologic Correlation[J].Ultrasound in Medicine & Biology, 2012, 38(10):1681-1688.
[43] Choi Y J, Kim S M, Choi S I.Diagnostic accuracy of ultrasound features in thyroid microcarcinomas[J].Endocrine Journal, 2008, 55(55):931-938.
[44] Duan S B, Yu J, Li X, et al.Diagnostic value of twodimensional shear wave elastography in papillary thyroid microcarcinoma[J].Oncotargets & Therapy, 2016,9:1311-1317.
[45] Zhou M, Fei X, Zhan W, et al.Common characteristic of papillary microcarcinoma of thyroid in ultrasound and pathology[M].Chinese Journal of Medical Ultrasound,2014.
[46 Leboulleux S, Girard E, Rose M, et al.Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer[J].Journal of Clinical Endocrinology & Metabolism, 2007, 92(9):3590-3594.
[47] Rosário P W, De F S, Bicalho L, et al.Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine, 2005,24(10):1385-1389.
[48] Ada Kessler M D, Yoram Rappaport M D, Annat Blank M D, et al.Cystic appearance of cervical lymph nodes is characteristic of metastatic papillary thyroid carcinoma[J].Journal of Clinical Ultrasound, 2003, 31(1):21-25.
[49] H S H, Orloff L A.Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer [J].Laryngoscope, 2011,121(3):487-491.
[50] Nield D A.Ultrasound Criteria of Malignancy for Cervical Lymph Nodes in Patients Followed for Differentiated Thyroid Cancer[J].Lancet, 2004, 364(9442):1289-1290.
[51] Jin Y K, Kim E K, Min J K, et al.Papillary Microcarcinoma of the Thyroid: Predicting Factors of Lateral Neck Node Metastasis[J].Annals of Surgical Oncology, 2009, 16(5):1348-1355.
[52] Moon S J, Kim D W, Kim S J, et al.Ultrasound assessment of degrees of extrathyroidal extension in papillary thyroid microcarcinoma[J].Endocrine Practice Official Journal of the American College of Endocrinology & the American Association of Clinical Endocrinologists, 2014,20(10):1037-1043.
[53] Shin Y G, Oh K S.Ultrasonographic Features of Metastatic Lymph Node in Papillary Thyroid Microcarcinoma(PTMC): Comparison With Macrocarcinoma[J].Ultrasound in Medicine & Biology, 2013, 39(5):S72.
[54] Sohn Y M, Kwak J Y, Kim E K, et al.Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy[J].Ajr American Journal of Roentgenology, 2010,194(1):38-43.
[55] Kim D W, Choo H J, Lee Y J, et al.Sonographic features of cervical lymph nodes after thyroidectomy for papillary thyroid carcinoma[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine, 2013, 32(7):1173-1180.
[56] Rosário P W, De F S, Bicalho L, et al.Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma[J].Journal of Ultrasound in Medicine Official Journal of the American Institute of Ultrasound in Medicine, 2005,24(10):1385-1389.
[57] Scaperrotta G, Ferranti C，Costa C, el a1．Role of sonoelastography in nonpalpable breast lesions[J]．Eur Radial,2008,18(11)：238l-2389．
[58] Bae U，Dighe M，Dubinsky T，et a1.Ultrasound thyroid elastography using carotid artery pulsation：preliminary study[J].Ultrasound Med,2009,26(3):797-805．
[59] Harada N, Soejima Y，Taketomi A，et a1．Assessment of graft fibrosis by transient elastography in patients with recurrent hepatitis C after living donor liver transp1antation[J].Transplantation,2008，85(1)：69-74．
[60] Carneiro-Pla D.Ultrasound elastography in the evaluation of thyroid nodules for thyroid cancer[J].Current Opinion in Oncology, 2013, 25(1):1-5.
[61] Moon H J, Kim E K, Yoon J H, et al.Clinical Implication of Elastography as a Prognostic Factor of Papillary Thyroid Microcarcinoma[J].Annals of Surgical Oncology,2012, 19(7):2279-2287.