CT平扫对甲状腺单纯粗钙化结节良、恶性的预测价值

Predictive value of plain CT scan in thyroid benign and malignant simple coarse calcific thyroid nodules

目的：探讨CT平扫对甲状腺单纯粗钙化结节（SCCN）良、恶性的预测价值。方法：回顾分析经手术病理证实的92例92枚SCCN的CT资料，其中57枚为良性结节，35枚为恶性结节。对比骨窗（W 1 000~2 000 HU，L 300~350 HU）SCCN是否具有分隔，以及软组织窗（W 300~350 HU，L 35~40 HU）周围是否具有伪影。统计分隔及伪影征象在良、恶性结节中的分布，并采用χ2检验进行统计学分析。结果：92枚SCCN中，有分隔、无伪影和二者联合在良性结节和恶性结节中分别占50.9%（29/57）和80.0%（28/35）（χ2=7.803，P=0.005）、26.3%（15/57）和71.4%（25/35）（χ2=17.958，P=0.000）、3.5%（2/57）和57.1%（20/35）（χ2=34.284，P=0.000），其诊断恶性结节的敏感度和特异度分别为80.0%（28/35）和49.1%（28/57）、71.4%（25/35）和73.7% （42/57）、57.1%（20/35）和96.5%（55/57），无分隔和有伪影联合在良性结节和恶性结节中分别占38.6%（22/57）和5.7%（2/35）（χ2=12.162，P=0.000），其诊断良性结节的敏感度和特异度分别为38.6%（22/57）和94.3%（33/35）。结论：CT平扫对SCCN良、恶性的预测具有重要的价值，有分隔和无伪影有助于恶性结节的诊断，无分隔和有伪影则提示良性结节的诊断，二者联合可以明显提高诊断特异度。

Objective： To investigate the predictive value of plain CT scan in simple coarse calcific thyroid nodules（SCCN）. Methods： The CT data of 92 SCCN in 92 cases confirmed by operation and pathology were retrospectively analyzed, including 57 benign nodules and 35 malignant nodules. The bone window（W 1 000~2 000 HU, L 300~350 HU） and soft tissue window（W 300~350 HU, L 35~40 HU） were used to identify whether SCCN had septa and peripheral artifacts, respectively. The number of benign and malignant nodules which had septa and artifacts were counted, followed by χ2 test for statistical analysis. Results： In 92 SCCN, the proportions of septa, no artifacts and their combination in the benign and malignant nodules were 50.9%（29/57） and 80.0%（28/35）（χ2=7.803, P=0.005）, 26.3%（15/57） and 71.4%（25/35）（χ2=17.958, P=0.000）, 3.5%（2/57） and 57.1%（20/35）（χ2=34.284, P=0.000）, respectively. Their sensitivity and specificity of diagnosing malignant nodules were 80.0%（28/35） and 49.1%（28/57）, 71.4%（25/35） and 73.7%（42/57）, 57.1%（20/35） and 96.5%（55/57）, respectively. The combination of no septa and artifacts in benign and malignant nodules accounted for 38.6%（22/57） and 5.7%（2/35）（χ2=12.162, P=0.000）, respectively. Their sensitivity and specificity of diagnosing benign nodules were 38.6%（22/57） and 94.3%（33/35）. Conclusion： CT scan for predicting benign and malignant SCCN was of significant value. Septa and no artifacts contributed to the diagnosis of malignant nodules, while no septa and artifacts suggested the diagnosis of benign nodules. Their combination could significantly improve the diagnostic specificity.