甲状腺良恶性病变的CT表现与病理对照分析

Analysis of CT findings and pathology of benign and malignant thyroid lesions

目的探讨甲状腺良恶性病变的CT表现与病理结果的相关性,评价CT在甲状腺良恶性病变诊断及鉴别诊断中的价值。方法回顾性分析78例经手术病理证实的甲状腺良性肿瘤59例(腺瘤53例、囊肿4例、结节性甲状腺肿2例)和恶性肿瘤19例(乳头状癌16例、滤泡癌2例、髓样癌1例)患者的术前CT表现,并与手术病理对照,对所获数据进行检验。结果 59例良性病变,单侧发病42例、双侧发病17例,共83个病灶;19例恶性病变,18例单侧发病、1例双侧发病,共20个病灶。边界:良性病变边界不清13个(13/83,15.7%)、恶性病变11个(11/20,55.0%),两者差异有统计学意义(P<0.01)。钙化:良恶性病变出现钙化率分别是12/83(14.5%)和9/20(45.0%),恶性病变钙化发生率高于良性病变,两者差异有统计学意义(P<0.05)。囊性变:良恶性病变的发生率分别为35/83(42.2%)和3/20(15.0%),良性病变囊变的发生率高于恶性病变,两者差异有统计学意义(P<0.05)。甲状腺包膜的不完整性:良恶性病变分别为5/83(6.0%)和15/20(75.0%),两者差异有统计学意义(P<0.01)。强化程度:明显强化者良恶性病变分别为27/83(32.5%)和14/20(70.0%),两者差异有统计学意义(P<0.01)。"镶嵌征":良恶性病变出现率分别为0和8/20(40.0%),两者差异有统计学意义(P<0.01)。淋巴结转移和(或)远处转移:良恶性病变发生率为0和5/19(26.3%),两者差异有统计学意义(P<0.01)。结论当甲状腺病变内出现钙化、包膜不完整、增强后见"镶嵌征",伴颈部淋巴结肿大时,要高度考虑甲状腺癌的诊断,建议临床穿刺活检或手术切除。

Objective To investigate the correlation of CT manifestations and pathology in benign and malignant thyroid lesions, and to evaluate CT value in differential diagnosis of benign and malignant lesions.Methods A retrospective analysis of 59 cases with pathologically confirmed benign thyroid gland lesion （53 with adenoma, 4 with cyst and 2 with nodular goiter） and 19 cases with pathologically confirmed malignant tumor （16 with papillary carcinoma, 2 with follicular carcinoma and 1 with medullary carcinoma） was performed. The preoperative CT findings were compared with surgical pathology. All data were analyzed by χ2 test.Results 59 benign cases had 83 lesions. Among them, 42 were unilateral and 17 were bilateral. 19 malignant cases had 20 lesions. 18 were unilateral and 1 was bilateral. Ill-defined margin appeared in 13 benign lesions （13/83, 15.7%） and 11 malignant lesions （11/20, 55.0%）（P〈0.01）. The calcification rates in benign and malignant lesions were 14.5% （12/83） and 45.0% （9/20）, respectively, with significant difference （P〈0.05）. The incidences of cystic degeneration in benign and malignant lesions were 42.2% （35/83） and 15.0% （3/20）, respectively, with significant difference （P〈0.05）. Thyroid capsule incompleteness was shown in 5/83 （6.0%） benign lesions and 15/20 （75.0%） malignant lesions （P〈0.01）. Significant enhancement appeared in 27/83 （32.5%） benign lesions and 14/20 （70.0%） malignant lesions （P〈0.01）. The incidences of mosaic symptoms in benign and malignant lesions were 0 and 40.0% （8/20）, respectively （P〈0.01）. The rates of lymph node metastasis and distant metastasis in benign and malignant lesions were 0 and 26.3% （5/19）, respectively （P〈0.01）.Conclusion When calcification, incomplete capsule, and mosaic symptoms after enhancement accompanied with enlargement of neck lymph nodes are present, the diagnosis of thyroid cancer should be highly considered. Clinical biopsy and surgical resection are proposed.