甲状腺结节性病变的MSCT诊断

MSCT diagnosis of thyroid nodules diseases

目的探讨甲状腺结节性病变的MSCT诊断和鉴别诊断要点。方法回顾性分析经手术病理证实的149例甲状腺结节性病变CT表现。结果本组149例中,甲状腺瘤55例,结节性甲状腺肿63例,甲状腺癌31例;单发结节89例,其中甲状腺瘤53例,结节性甲状腺肿8例,甲状腺癌28例;多发结节60例,其中甲状腺瘤2例,结节性甲状腺肿55例,甲状腺癌3例。术前CT诊断符合率:甲状腺瘤为84.31%,结节性甲状腺肿为75.64%,甲状腺癌为75.00%;良性病变诊断符合率为79.10%,恶性病变诊断符合率为75.00%。甲状腺瘤典型CT表现为单发密度均匀、边界光整的低密度结节,显著均质强化,周边光整环状强化;结节性甲状腺肿典型CT表现为多发密度不均的低密度结节,可有宽大的岛状壁结节,外形多不规则,实性结节中度强化,边缘可见厚薄不均强化环,与周围组织分界尚清晰;甲状腺癌典型CT表现为单发的低密度结节,密度不均匀,肿瘤壁不规则,边界模糊不清,形态多不规则,内部细沙砾状钙化,增强环不完整呈"强化残圈征",突破甲状腺包膜呈"节段缺损征"和转移。结论掌握各种甲状腺结节性病变的CT特点及其与周围结构的关系、以及有无颈部淋巴结转移,对其诊断及鉴别诊断具有重要意义。

Objective To observe CT features of common thyroid nodules lesions and to improve their CT diagnosis and differential diagnosis.Methods The data of thyroid nodules in 149 cases confirmed by both surgery and pathology were analyzed retrospectively.Results Thyroid nodules were found in 149 cases,including thyroid adenoma（55 cases）,nodular goiter（63 cases）and thyroid carcinoma（31 cases）as well.Solitary nodules were found in 89 cases,including thyroid adenoma（53 cases）,nodular goiter（8 cases）and thyroid carcinoma（28 cases）.Multiple nodules in 60 cases were thyroid adenoma（2 cases）,nodular goiters（55 cases）and thyroid carcinomas（3 cases）,respectively.CT diagnostic accordance rate was 84.31% for the thyroid adenoma,75.64% for the nodular goiter and 75.00% for the thyroid carcinoma,while CT diagnostic accordance rate was 79.10% for the benign and 75.00% for the malignant.Typical CT findings of thyroid adenoma were single heterogeneous nodule,tide margin,high homogeneous enhanced and completed circular enhanced,while CT characteristics of goiter include many low density nodules,and large peninsular tubercles around the tumor,irregular tumor outline,solid nodular middle enhanced,thick and thin circular enhanced and relative tide margin.The characteristic CT findings of thyroid carcinomas were solitary hypo-attenuation nodus,heterogeneous,untidy margin,irregular shape,discrete granular calcification,heterogeneous enhancement,invading neighbor structure and cervical lymph node metastasis,showing uncomplete enhanced ring around the tumor＇s ring.Conclusion In the diagnosis and differential diagnosis of nodular diseases of thyroid,it is important to understand the CT features and relationship of lesions with the surrounding structures and whether there is lymph node metastasis on the neck.