Objective To summarize the multimodal ultrasonographic characteristics primary thyroid lymphoma (PTLs), and to discuss the diagnosis and differential diagnosis of PTLs. Methods Multimodal ultrasonographic charactericsits of six cases of PTLs were analyzed retrospectively. All of the patients were examined by the conventional two-dimensional ultrasound (2DUS), color Doppler flow imaging (CDFI), contrast-enhanced ultrasound (CEUS), three-dimensional ultrasound (3DUS) reconstruction and elastography imaging (EI) from October 2011 to February 2016 in Changzheng Hospital, affiliated to Secondary Military Medical University. All diagnoses were confirmed by ultrasound-guided percutaneous biopsy.Results (1) 2DUS: six cases of PTLs without capsule were observed as diffusely enlargement type (two cases), unilateral nodular type (one case, on left lobe),and bilateral multiple nodular type (the other three cases). The margin of the multiple nodules were not clear, and some nodules were fused with each other.There were four cases of heterogeneous (extremely) hypoechogenicity and two cases of mixed echogenicity, All of the lesions were characterized by various striped and reticular hyperechogenicity interiorly on ultrasonograms, and only one case showed slightly posterior enhancement. Except one case, multiple cervical lymphnodes hyperplasia were identified on neck regionⅡ-Ⅴin five cases. (2) CDFI and CEUS:CDFI showed abundant blood flow signals in the PTLs nodules peripherally and internally. The striped blood flow was observed in the lesions, and spectrum showed as artery and veins. The plentiful vascular tree was also found in the enlarged lymphnodes. By using high frequency CEUS, six cases of the PTLs demonstrated diffuse and heterogeneous enhancement significantly, including little necrosis area without prominent contrast agent filling in two cases. (3) 3DUS reconstruction: Various striped and reticular hyperechoic features were found on the surface of six cases of PTL nodules. (4) EI: All lesions were soft in six cases. The ratio of elastic strain rate was 1.28-1.96, average (1.82±0.29).Conclusion The ultrasonographic features of PTLs are of certain characteristics, and multiple modes of ultrasound examination can help to grasp the comprehensive imaging informations of PTLs, which should be encouraged positively to facilitate the early detection, early diagnosis and early treatment for PTLs.%目的 总结原发性甲状腺淋巴瘤(PTLs)多种模式超声表现特征,探讨其诊断及鉴别诊断要点.方法 回顾性分析2011年10月至2016年2月第二军医大学长征医院收治的6例PTLs患者常规二维超声、彩色多普勒血流成像(CDFI)、超声造影(CEUS)、三维超声重建、弹性超声(EI)等多种模式超声表现.所有患者均经超声引导下穿刺活检病理证实.结果 (1)常规二维超声:6例PTLs病灶呈弥漫肿大型2例,左侧单发结节型1例,双侧多结节型3例,均无包膜,多发结节者边界不清,部分相互融合成团;呈不均匀(极)低回声型4例,混合回声型2例,内部均可见粗细不等的条索状及网格状高回声,仅1例后方回声轻度增强.除1例患者颈部淋巴结无异常,余5例PTLs同时伴双侧颈部Ⅱ～Ⅴ区不同程度的多发淋巴结异常肿大;(2)CDFI及CEUS:CDFI显示PTLs结节周边及内部血流信号多较丰富,PTLs病灶内可见点条状血流,为动静脉血流频谱,肿大淋巴结内亦可见丰富血管树.CEUS成像模式下,6例PTLs造影剂均显著增强,均为弥漫非均匀充盈型,其中2例肿块内可见少许小片状坏死组织未充盈区域;(3)三维超声重建:6例PTLs结节表面均清晰可见粗细不等的条索状及网格状高回声;(4)EI:6例病灶质地均较软,弹性应变率比值为1.28～1.96,平均(1.82±0.29).结论 PTLs的超声表现具有一定特征性,多种模式超声检查有助于全面把握PTLs影像学信息,对PTLs的早发现、早诊断、早治疗具有积极意义.
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