CT在甲状腺炎性结节与甲状腺癌鉴别诊断中的价值

The Value of CT in the Differential Diagnosis of Inflammatory Thyroid Nodules and Thyroid Carcinoma

目的探讨CT在甲状腺炎性结节与甲状腺癌鉴别诊断中的价值。方法收集本院2012年3月至2017年10月间12例甲状腺炎性结节及23例甲状腺癌病例,对两类病变的形态、大小、边缘、位置、结节内部情况、数目、钙化、周围间隙、淋巴结肿大及密度、强化程度等进行分析及测算,对比两种病变CT征象的差异性。结果甲状腺炎多有弥漫性肿大,其结节边缘模糊、多发、形态规则、少钙化或为粗大钙化、少囊变、多累及峡部、颈部淋巴结肿大不明显、多为强化均匀且延时强化。甲状腺癌多为边界不清、形态不规则、单发、细颗粒状或针尖样钙化、多见坏死囊变、少累及峡部、颈部淋巴结肿大、密度不均匀、明显不均匀强化,可见"咬饼征"或"轮廓连线中断征"、"孤岛征"等。甲状腺炎性结节与甲状腺癌病灶在年龄、性别、边缘、病灶最大径没有明显差别(P>0.05)。在病灶形态、数目、囊变、钙化、峡部累及情况、颈部淋巴结肿大方面及强化情况(均匀程度)等存在明显不同,差异有统计学意义(P<0.05)。结论CT在甲状腺炎性结节与甲状腺癌鉴别诊断中的有较高价值,值得在临床工作中推广应用。

Objective To explore the value of CT in the differential diagnosis of inflammatory thyroid nodules and thyroid carcinoma.Methods A total of 12 cases of inflammatory thyroid nodules and 23 cases of thyroid cancer were collected between March 2012 and October 2017,and the morphology,size,edge,position,internal condition,number,calcification,peripheral clearance,lymph node enlargement and density and degree of enhancement of the two types of lesions were analyzed and measured,and the differences of CT manifestations of the two lesions were compared.Results Thyroiditis is more diffuse enlargement,the edge of the nodules are fuzzy,multiple,morphological rules and less calcified or for change,the more bulky calcification,less sac involving spondylolysis,cervical lymph node enlargement is not obvious,much as strengthening and delay strengthening.Thyroid cancer is boundary is not clear,form more irregular,single,fine granular or tip necrosis capsule calcification,see more,less involvement spondylolysis,neck lymph node enlargement,uneven density,strengthening the obvious and uneven,visible"bite of bread"or"contour connection interruption sign"and"islands",etc.Thyroid inflammatory nodules and thyroid cancer lesions were not significantly different in age,gender,edge,lesion maximum diameter(P >0.05).In lesions form,number,cystic change and calcification,isthmus,involvement and cervical lymph node enlargement and the enhancement(evenness)is obviously different,the difference was statistically significant(P<0.05).Conclusion CT has high value in the differential diagnosis of inflammatory thyroid nodules and thyroid carcinoma,and it is worth promoting the application in clinical practice.