甲状腺癌CT表现及误诊原因分析

Analysis of CT features and misdiagnosis of thyroid carcinoma

目的:分析甲状腺癌CT影像表现,探讨甲状腺癌的CT诊断要点和误诊原因。方法:回顾性分析手术后病理证实的42例甲状腺癌CT资料,在PACS工作站采用任意窗宽窗位观察CT影像表现,分析误诊原因。结果:(1)42例甲状腺癌中31例密度不均匀,25例形状不规则,38例无完整强化环,20例出现钙化,11例侵犯周围组织器官,20例淋巴结肿大。(2)CT资料术前误诊13例(31%)。误诊为腺瘤9例,结节性甲状腺肿3例,弥漫性甲状腺肿1例。13例误诊者中直径小于1.5cm6例,两病共存3例。结论:瘤周无完整强化环、肿瘤突破被膜向周围浸润、颈部淋巴结肿大和微钙化是甲状腺癌CT定性诊断的主要依据。肿瘤体积较小或合并其他甲状腺疾病是误漏诊的主要原因。

Objective：To analyze the CT characteristics and the causes of misdiagnosis of thyroid carcinoma. Methods：CT findings in 42 thyroid carcinoma proved by operation and pathology were analyzed retrospectively, and the CT images were evaluated with different window levels and widths on PACS, and the causes of misdiagnosis were analyzed. Results：（1）Of 42 patients with thyroid carcinoma, 31 cases showed heterogeneous density, 25 cases showed irregular shape, 38 cases showed no complete enhanced ring around the turnout, 20 cases were detected calcifications, 11 cases infiltrated the adjacent structures and 20 cases were revealed metastatic lymphadenopathy on the neck.（2）13 out of 42 cases were misdiaguosed, including 9 cases of thyroid adenoma,3 cases of multi-nodular goiters and 1 case of diffuse thyroid disease.Among them, 6 cases were less than 1.5 cm in diameter and 3 cases were complicated two diseases in the thyroid gland simultaneously.Conclusion： No complete enhanced ring, invasion of surrounding structures, metastatic lymphadenopathy on the neck and micro-calcification were characteristic CT signs of malignancy. It is the main cause of misdiagnosis if the mass＇s diameter was less than 1.5 cm or there were more than two kinds of diseases in the thyroid gland.