CT在腺瘤性结节性甲状腺肿和乳头状甲状腺癌鉴别诊断中的价值

Value of computed tomography in differentiation of adenomatoid nodule goiter from papillary thyroid carcinomas

目的探讨CT在腺瘤性结节性甲状腺肿(ANG)和乳头状甲状腺癌(PTC)鉴别诊断中的价值。方法搜集经病理证实的105例112枚ANG和181例196枚PTC的CT资料,对性别、年龄、瘤体的形态、甲状腺边缘中断征、钙化、强化程度、增强后边界、淋巴结转移进行分析,统计强化程度高于周围甲状腺对ANG的诊断和甲状腺边缘中断征对PTC的诊断敏感度、特异度、阳性预测值、准确度。结果 ANG和PTC在瘤体形态、甲状腺边缘中断征、细钙化、粗钙化、强化程度、增强后瘤体边缘等方面均有统计学意义(均P<0.05),而在是否多发、环状钙化方面均无统计学差异(均P>0.05)。181例PTC中,淋巴结转移75例。强化程度高于周围甲状腺对ANG诊断的敏感度、特异度、阳性预测值、准确度分别为67.9%、100%、100%、87.6%。甲状腺边缘中断征对PTC诊断的敏感度、特异度、阳性预测值、准确度分别为87.0%、91.1%、93.6%、88.6%。结论瘤体形态规则、强化程度高于周围甲状腺有助于ANG的诊断,而瘤体形态不规则、甲状腺边缘中断征、细钙化、粗钙化、淋巴结转移等有助于PTC的诊断;是否多发和环状钙化对ANG和PTC的鉴别诊断无意义。

Objective To assess the value of computed tomography （CT） in differentiation of adenomatoid nodule goiter tANG） from papillary thyroid carcinomas （PTC）. Methods CT findings of 112 thyroid lesions in 105 patients with ANG and 196 thyroid lesions in 181 patients with PTC were retrospectively analyzed, all cases had pathology diagnosis. The gender, age, shape of lumps, thyroid edge interruption, calcification, degree of enhancement, tumor boundaries after contrast enhancement, lymph node metastasis were observed. The sensitivity, specificity, positive predictive value and accuracy were calculated, us- ing higher degree of enhancement than thyroid around for diagnosis of ANG and using thyroid edge interruption for diagnosis of PTC. Results There were significant differences in the shape of tumors, thyroid edge interruption, fine granular calcification, coarse calcification, degree of enhancement, tumor boundaries after contrast enhancement between ANG and PTC （P〈0.05）, while there were no differences in ring calcification ratio between two groups （P 〉0.05）. Lymph node metastasis were founded in 75 patients. Using higher degree of enhancement than thyroid around for the diagnosis of ANG, the sensitivity, specificity, positive predictive value and accuracy were 67.9%, 100.0%, 100.0% and 87.6%, respectively. Using thyroid edge interruption for the diagnosis of PTC, the sensitivity, specificity, positive predictive value and accuracy were 87.0%, 91.1%, 93.6% and 88.6%, respectively. Conclusion The findings of CT scan have value in differentiation of adenomatoid nodule goiter from pap- illary thyroid carcinomas.