甲状腺癌的CT诊断及误诊分析

CT diagnosis and misdiagnosis of the thyroid carcinoma

目的分析甲状腺癌的CT表现,探讨CT在甲状腺癌的诊断价值及误诊原因。方法回顾性分析32例甲状腺癌患者术前CT资料及术后病理检查结果。结果32例中24例癌性病灶边缘不规则,10例为囊性伴高密度乳头状结节,9例出现钙化,13例侵犯周围组织器官,14例颈部淋巴结转移。术前误诊8例,误诊为腺瘤4例,结节性甲状腺肿3例,弥漫性甲状腺肿1例。结论肿瘤突破被膜向周围浸润,转移淋巴结内颗粒状钙化,肿物囊性变伴高密度乳头状结节是甲状腺癌的特征性表现;而肿瘤较小,边缘清晰或合并其他甲状腺疾病是误诊的主要原因。

Objective To analyze the CT findings and misdiagnostic causes of the thyroid carcinoma. Methods CT data of 32 patients with pathologically proved thyroid carcinoma were analyzed retrospectively. Results Among 32 cases, The cancerous lesions with irregular margin were found in 24, cystic lesions with hyperdense papillary nodules in 10, intratumoral calcification in 9, those infiltrated into neighbour tissues and organs in 13, and metastases of cervical lymphonodi in 14. Preoperatively, 8 cases were misdiagnosed, who comprised 4 misdiagnosed as thyroid adenoma, 3 nodular thyrocele, and 1 diffuse thyrocele. Conclusion Broken capsule of the cancerous lesions and their infiltrating into neighbour structures, fine granular calcification in metastatic lymphonodi, and cystic change with hyperdense papillary nodules are characteristic findings of the thyroid carcinoma, while small tumors with clear margin or complicated with other thyroid diseases are the most frequently misdiagnostic causes of this disease.