桥本甲状腺炎对超声造影诊断甲状腺癌淋巴结转移的影响机制研究
Study on Impact Mechanism of Hashimoto’s Thyroiditis on the Diagnosis of Lymph Node Metastasis in Thyroid Cancer Using Contrast-Enhanced Ultrasound
摘要: 桥本甲状腺炎(Hashimoto’s Thyroiditis, HT)与甲状腺癌(尤以乳头状癌为主)共病现象普遍，且HT引发的慢性炎症微环境会干扰超声造影(Contrast-Enhanced Ultrasound, CEUS)对甲状腺癌淋巴结转移的诊断准确性，这一问题已成为临床影像诊断的重要挑战。本文系统综述了HT的病理特征与免疫微环境(包括自身抗体谱、淋巴细胞浸润、细胞因子网络调控及甲状腺滤泡细胞–免疫细胞相互作用)，阐述了CEUS诊断的血流动力学基础、定量参数的病理学意义及淋巴结转移的特征性表现，深入分析了HT通过调控微血管密度与通透性、炎症因子直接干扰造影剂动力学等机制对CEUS诊断的影响，并总结了多参数联合诊断模型、灰度超声与弹性成像的协同应用、动态增强超声(DCE-US)等诊断优化策略。同时，本文指出了当前研究在抗体滴度与CEUS参数的相关性、组织学验证样本量、动物模型构建等方面的局限性，并展望了单细胞测序解析HT特异性血管内皮细胞亚群、人工智能辅助的CEUS参数动态分析系统开发、靶向免疫微环境的分子影像探针设计等未来研究方向，为提升HT背景下甲状腺癌淋巴结转移的CEUS诊断效能提供理论依据与实践参考。
Abstract: Hashimoto’s Thyroiditis (HT) frequently coexists with thyroid cancer, predominantly Papillary Thyroid Carcinoma (PTC). The chronic inflammatory microenvironment induced by HT interferes with the diagnostic accuracy of Contrast-Enhanced Ultrasound (CEUS) in assessing cervical lymph node metastasis of thyroid cancer, posing a significant challenge in clinical imaging. This review systematically summarizes the pathological characteristics and immune microenvironment of HT, including the autoantibody profile, lymphocyte infiltration, cytokine network regulation, and thyrocyte-immune cell interactions. We elaborate on the hemodynamic basis of CEUS diagnosis, the pathological significance of quantitative parameters, and the characteristic manifestations of lymph node metastasis. Furthermore, we analyze the mechanisms by which HT affects CEUS diagnosis, such as the regulation of microvascular density and permeability, and the direct interference of inflammatory factors with contrast agent kinetics. Additionally, diagnostic optimization strategies are summarized, including multi-parameter combined diagnostic models, the synergistic application of grayscale ultrasound and elastography, and Dynamic Contrast-Enhanced Ultrasound (DCE-US). Meanwhile, this review highlights current research limitations, such as the controversy regarding the correlation between antibody titers and CEUS parameters, insufficient sample sizes for histological verification, and technical difficulties in animal model construction. Finally, future research directions are prospected, including the use of single-cell sequencing to analyze HT-specific vascular endothelial cell subsets, the development of artificial intelligence-assisted dynamic analysis systems for CEUS parameters, and the design of molecular imaging probes targeting the immune microenvironment. This review aims to provide a theoretical basis and practical reference for improving the CEUS diagnostic efficacy for thyroid cancer lymph node metastasis in the context of HT.
文章引用：邢奕峰, 印国兵. 桥本甲状腺炎对超声造影诊断甲状腺癌淋巴结转移的影响机制研究[J]. 临床医学进展, 2026, 16(2): 1270-1279. https://doi.org/10.12677/acm.2026.162512

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