甲状腺结节CT各征象的诊断价值

Diagnostic value of CT features on thyroid nodule

目的:探讨CT征象在甲状腺结节诊断中的意义。方法:回顾性分析经手术病理确诊的30例甲状腺结节(38个结节)的CT平扫及三期增强扫描图像,由2名及以上高年资医师对所有CT征象进行判读,结合病理资料,分析CT各征象对甲状腺结节良恶性鉴别的价值。结果:33个良性结节表现为边界清晰,有完整或不完整强化包膜,结节实性部分明显强化,有不强化囊变坏死区,强化时间密度曲线27个为流出型,6个良性结节因囊性部分多,实性部分少,无法准确测量CT值,无法分型,4个结节出现钙化,形态为斑状、结节状、环状粗钙化,1例甲状腺多发结节患者颈Ⅵ区出现相同表现形式结节;5个恶性结节表现为边界模糊,无包膜,时间密度曲线为缓升平台型,3例有区域性淋巴结转移,2个结节出现钙化,为斑点状成簇分布钙化。结论:依据有无淋巴结转移判定甲状腺结节良恶性是首要指标;结节边界、有无包膜、钙化形态、时间密度曲线等CT征象是进行甲状腺结节良恶性鉴别的有效方法。

Objective：To explore the diagnostic value of CT features on thyroid nodule.Methods：The plain and three-phase enhanced CT scan images of 30 cases with thyroid nodules（38 nodules）proved with pathology were analyzed retrospectively,and two experienced senior doctors were responsible to evaluate each CT feature and analyzed the value of them in qualitative diagnosis.Results：The boundaries of 33 benign nodules were clear with complete or incomplete strengthened envelope.The nodular solid part was significantly enhanced with nonenhanced cystic necrotic area.There was outflow type of 27 cases in the strengthened timedensity curve,6 benign nodules could not be classified due to that the cystic portion is more and the solid part is less and the CT value can＇t be measured accurately,4 nodules occurred with porphyritic,nodular and cyclic coarse calcifications.The cervical Ⅵ region of one case with multiple thyroid nodules had the same form.5 malignant nodules showed blurred edges,no envelope,and ramp platform type time-density curve,3 cases had regional lymph node metastasis and 2 nodules had punctate cluster distributed calcifications.Conclusion：Lymph node metastasis is the leading indicator that distinguishes benign thyroid nodules from the malignant ones.Nodule border,the presence of capsule,calcification shape,time-density curve,and other CT signs are effective methods to identify the benign and malignant thyroid nodules.