多层螺旋CT对儿童甲状腺肿瘤的诊断和鉴别诊断价值

Multi-slice CT in diagnosis of thyroid neoplasm in children

目的探讨儿童甲状腺肿瘤的CT表现特征及良、恶性病变的鉴别要点。方法回顾性分析经手术和病理证实的32例儿童甲状腺肿瘤的CT表现。采用平扫和增强CT,分析肿瘤的边界、密度和强化程度以及颈部淋巴结转移情况。结果 32例患儿中包括20例单发甲状腺肿瘤、10例多发甲状腺肿瘤,以及2例甲状腺炎伴肿瘤。20例单发肿块中包括腺瘤17例、腺癌3例。腺瘤中9例为实性肿块、8例为囊实性肿块。边界不清、密度不均、包膜不完整均见于腺瘤和腺癌,肿块明显不均匀强化和淋巴结肿大仅见于腺癌病例。多发肿块10例,其中腺瘤6例、腺癌4例。多发微腺癌可表现为甲状腺弥漫性病变。4例多发腺癌中,3例伴淋巴结增大、1例血管侵犯。亚急性甲状腺炎伴发腺瘤1例,双侧桥本甲状腺炎伴发腺癌1例。结论在甲状腺单发病灶中,肿块的强化方式和颈部淋巴结转移对于腺癌诊断具有特异性。在多发病灶中,CT对于显示甲状腺多发微腺癌有局限性。

Objective To evaluate multi-slice CT in differential diagnosis of thyroid neoplasm in children. Methods CT findings including the margin, density and enhancement of tumors on plain and enhanced CT scan in 32 children with surgically and pathologically confirmed thyroid neoplasm were analyzed. Results There were 20 cases with solitary tumor （17 adenomas and 3 adenocarcinomas）, 10 cases with multiple tumor （6 adenomas, 4 adenocarcinomas） and 2 thyroiditis with tumor. CT features such as undefined margin, uneven density and spoiled capsule were present in benign and malignant tumor. However, heterogeneous enhancement and cervical adenophyma were specific in the cases with adenocarcinoma. Although CT could not detect small mass in cases with diffuse micro-adenocarcinoma, it could find cervical vessels and lymph nodes invasion in 3 cases. Conclusions CT findings of heterogeneous enhancement and cervical adenophyma are specific for distinguishing adenocarcinoma from adenoma. However, it is difficult to detect some micro- adenocarcinoma on CT images.