CT对原发性甲状腺恶性淋巴瘤诊断价值探讨

CT features of primary thyroid malignant lymphoma

目的探讨原发性甲状腺恶性淋巴瘤(PTML)的CT表现特征。方法回顾性分析中国医科大学附属第一医院2000年1月至2011年6月收治的14例PTML病人的CT资料,并对照手术及病理结果。结果 PTML的CT表现共同特征为:平扫肿物密度低于邻近肌肉,质地均匀,增强扫描后无明显强化或轻度强化,仍低于或接近邻近肌肉密度,钙化和坏死少见。CT表现可分为3种类型:本组单发结节型3例,为腺体内单发低密度结节;巨块型8例,肿物巨大,多质地均匀,包膜完整;弥漫渗透型3例,肿物多无明显包膜,向周围组织间隙渗透,增强扫描后于肿物边缘或内部可见狭窄条索状高密度影。结论 PTML的CT表现以巨块型最多见,而弥漫渗透型最具特征性。将CT表现特征与颈部肿物快速增大的病史及甲状腺自身抗体检查相结合有助于PTML的术前诊断。

Objective To evaluate the CT features of primary thyroid malignant lymphoma （PTML）. Methods The CT features of 14 cases of PTML admitted between January 2000 and June 2011 at the First Hospital of China Medical University were analyzed retrospectively and compared with surgical and pathological results. Results The common CT appearances were that the density of the enlarged thyroid mass was lower than that of the muscle nearby, unconspicuous enhancement in contrast-enhanced CT scan and calcification and necrosis were rare. The CT features were classified into three types：3 cases of solitary nodule （type 1）,which was a solitary nodule surrounded by normal thyroid tissue;8 cases of massive mass （type 2）,which were usually in homogeneous hypodense with integrated capsule;and 3 cases of pervasive mass （type 3）,which were manifested as unconspicuous enhancement mass with narrow cordlike hyperdense thyroid tissue around or inside in it. Conclusion The CT appearance of PTML is usually manifested as massive type. The pervasive type has its characteristic. The CT features combine with the history of rapidly growing thyroid mass and the increased thyroid antibody titer are helpful for preoperative diagnosis.