分化型甲状腺癌肺转移的CT影像学表现分析

An Analysis of CT Findings for Pulmonary Metastasis of Differentiated Thyroid Carcinoma

目的探讨C T检查在分化型甲状腺癌(differentiated thyroid carcinoma,DTC)肺转移中的表现及诊治价值。方法回顾性分析121例DTC患者临床资料,均经CT引导下穿刺活检或外科手术病理检查确诊,接受胸部CT检查。记录并分析CT检查对DTC肺转移的诊断敏感性、特异性和准确性,观察肺转移患者的CT表现特点。结果此次入组的121例DTC患者经穿刺活检或手术病理检查确诊肺转移9例,所占比例为7.4%;CT检查正确诊断肺转移6例,正确诊断非肺转移100例,胸部CT检查对DTC肺转移的诊断敏感性、特异性和准确性分别为66.7%(6/9)、89.3%(100/112)和87.6%(106/121);6例CT正确诊断肺转移患者均显示病灶直径均>3mm,其中病灶为3-5mm者3例,病灶超过5mm者3例;图像可见多个大小不等的圆形、粟粒形结节或肿块影,结节灶密度较均匀且边界多较为清晰,大部分分布于双侧肺中、下野外带。结论胸部CT检查可作为辅助诊断DTC肺转移的有效手段应用于临床诊疗工作中,为后续针对性治疗工作的顺利开展提供依据。

Objective To investigate the findings and diagnostic value of CT in pulmonary metastasis of differentiated thyroid carcinoma. Methods The clinical data of 121 patients with DTC were retrospectively analyzed. All were confirmed by CT guided biopsy or surgical pathology and underwent chest CT examination. The sensitivity, specificity and accuracy of CT examination in the diagnosis of DTC with pulmonary metastasis were recorded and analyzed and the CT findings of patients with pulmonary metastasis were observed. Results Among the 121 cases of DTC patients, 9 cases were diagnosed with pulmonary metastasis by biopsy or surgical pathology, accounting for 7.4%; 6 cases with pulmonary metastasis and 100 cases of non-pulmonary metastasis were correctly diagnosed by CT. The sensitivity, specificity and accuracy of chest CT for DTC with pulmonary metastasis were 66.7%（6/9）, 89.3%（100/112） and 87.6%（106/121）, respectively; 6 patients with pulmonary metastasis diagnosed by CT showed that the diameter of the lesions was 〉3mm, including 3 cases with lesions of 3-5mm and 3 cases larger than 5mm; The images showed multiple different sizes of circular, miliary nodules or masses. The nodules density was homogeneous and the boundaries were clear, most of them distributed in the bilateral lung and outside the inferior field. Conclusiononclusion Chest CT examination can be used as an effective method for the clinical assistant diagnosis and treatment of DTC with pulmonary metastasis and provide basis for the successful development of the follow-up treatment.