多层螺旋CT显示乳头状结构特征对甲状腺病变的诊断价值

Characteristics of papillary structure of thyroidal lesions on multiple-slice spiral computed tomography for the diagnosis of thyroidal diseases

目的 评价多层螺旋CT（MSCT）显示甲状腺病变内部乳头状结构的特征对鉴别病变性质的价值.方法 回顾性分析从2003年3月至2010年4月天津市第一中心医院经手术病理证实的35例甲状腺病变伴乳头状结构患者的CT资料.所有患者均行CT平扫及增强检查.比较不同病变乳头状结构的数目、边界、形态、位置、钙化、乳头间是否存在间隔以及乳头的强化行为,用stata 10.1软件进行统计学处理.结果 甲状腺癌与腺瘤、结甲组间病变内部乳突状结构的边界、形态、位置比较差异有统计学意义（P＜0.05）;乳头状结构数目、乳头间有无分隔的比较差异无统计学意义（P＞0.05）.甲状腺癌的乳头状结构位于病变中心、边界不清、形态较锐利.良性病灶乳头状结构位于病变周边,边界清晰,边缘圆钝.结论 甲状腺病变内部乳头状结构的MSCT特征能够鉴别病变的性质。

Objective To evaluate the characteristics of papillary structure of thyroidal lesions on MSCT （multiple-slice spiral computed tomography ） for the diagnosis of thyroidal diseases. Methods Thirty-five cases of thyroidal diseases pathologically confirmed with plain and contrast MSCT data from March 2003 to April 2010 were retrospectively analyzed. The number, margin, shape, enhancement behavior,location, calcification and the delineation of papillary structure were compared by the stata 10.1 software.Results There were statistically significant differences between thyroidal carcinoma, thyroidal adenoma and nodular goiter in margin, shape and location of papillary structure （ P 〈 0.05 ）. Papillary structure of thyroidal carcinoma was most commonly located in central part with an indistinct margin. Psammoma, such as microcalcification, was characteristic of thyroidal cancer. Coarse and peripheral calcification was commonly observed in nodular goiter. No statistical difference existed in the number and internal septa of papillary structure among thyroidal carcinoma, thyroidal adenoma and nodular goiter （ P 〉 0.05 ）. It could offer a more distinct visualization of papillary structure during the venous phase. Conclusion The features of papillary structure on MSCT of various thyroidal lesions may help make the differential diagnosis of thyroidal lesions.