45例甲状腺癌MSCT误诊、漏诊原因分析

The Causes of Misdiagnosis and Missed Diagnosis of Thyroid Carcinoma by MSCT:Analysis of 45 Cases

目的分析甲状腺癌MSCT误诊、漏诊原因,以提高CT诊断的准确率。方法对45例CT误诊、漏诊而手术、病理学确诊的甲状腺癌患者资料进行回顾性分析。结果 45例中,误诊腺瘤13例(28.9%);结节性甲状腺肿漏诊合并甲状腺癌19例(42.2%);原发甲状腺功能亢进合并甲状腺癌误诊合并结节性甲状腺肿6例(13.3%);甲状腺转移癌误诊结节性甲状腺肿7例(15.6%)。误诊、漏诊主要原因为:CT表现不典型27例(60.0%);良、恶性并存观察不仔细15例(33.3%);认识不足及综合分析能力不足23例(51.1%)。结论甲状腺癌CT表现不典型,与良性病灶并存及认识不足时容易误诊、漏诊。要降低甲状腺癌CT误诊、漏诊率,应在提高对甲状腺癌CT不典型表现认识的同时,结合临床表现和ECT检查等综合分析。

Objective To analyze the causes of misdiagnosis and missed diagnosis of thyroid carcinoma by multi-slice spiral CT （MSCT） in order to improve its diagnostic accuracy. Methods The clinical data of 45 patients with pathologi- cally proved thyroid carcinoma, in whom the thyroid disease was misdiagnosed or the diagnosis of thyroid carcinoma was missed by preoperative MSCT, were retrospectively analyzed. Results Of the 45 patients, the carcinoma was misdiag- nosed as adenoma in 13 （28.9%） ; and the diagnosis of thyroid carcinoma was missed in 19 （42.2%） , in whom nodular goiter was also present; primary hyperthyroidism complicated by thyroid carcinoma was misdiagnosed as thyroid carcinoma associated with nodular goiter in 6 patients （ 13.3% ） ; metastatic carcinoma of thyroid was misdiagnosed as nodular goiter in 7 patients （ 15.6% ）. The main causes of misdiagnosis and missed diagnosis were atypical CT manifestations （ n = 27, 60.0% ） , careless observation for coexisting benign and malignant lesions （ n = 15, 33.3% ） and lack of professional knowledge and insufficient comprehensive analysis ability （n = 23, 51.1% ）. Conclusion Atypical CT manifestations of thyroid carcinoma, thyroid carcinoma with coexisting benign lesions and lack of imaging knowledge can cause misdiagnosis and missed diagnosis. In order to reduce the occurrence of misdiagnosis and missed diagnosis, the understanding of atypical CT manifestations of thyroid carcinoma should be further improved, and both the clinical and ECT findings should be taken into consideration.