甲状腺微小乳头状癌CT强化方式与病理对照研究

The correlation between CT enhancement features and pathological findings of papillary thyroid microcarcinoma

目的探讨甲状腺微小乳头状癌(PTMC)CT强化方式与病理特征的相关性。方法选取78例共83枚经手术病理证实为PTMC的CT和病理资料。根据CT强化方式分为均匀强化和不均匀强化。均匀强化病灶分别测量平扫、增强早期和晚期CT值,计算增强早期CT值的上升幅度、增强晚期CT值的下降比率。不均匀强化病灶观察相对不均匀强化的部位、形态和强化方式。根据PTMC的病理特征进行分类,分析CT强化方式与病理特征间的相关性。结果83枚病灶中,均匀强化53枚,不均匀强化30枚。病理分类:实质为主型(Ⅰ型)19枚,实质与间质相间分布型(Ⅱ型)22枚,间质为主型(Ⅲ型)12枚,实质与间质分区分布型(Ⅳ型)19枚,继发囊变型(Ⅴ型)11枚。Ⅰ型、Ⅱ型和Ⅲ型呈均匀强化。Ⅰ型在增强早期CT值的上升幅度要高于Ⅲ型(P<0.05)。Ⅰ型在增强晚期CT值的下降比率要高于Ⅱ型和Ⅲ型(P<0.001)。Ⅳ型因实质和间质分区分布而不均匀强化,Ⅴ型因病灶外周存在囊变而不均匀强化。结论PTMC的CT强化方式与病理组织成分及其分布形式密切相关。

Objective To evaluate the correlation between CT enhancement features and pathological findings of papillary thyroid microcarcinoma(PTMC).Methods The CT and pathological data of 78 cases with PTMCs were analyzed retrospectively.According to the CT enhancement modes,the PTMCs were divided into two types:homogeneous or heterogeneous enhancement.For the PTMCs with homogeneous enhancement,the CT values on unenhanced and enhanced CT(including early and late phase)were measured respectively.The rising range of CT value in the early phase and the decline ratio of CT value in the late phase were calculated respectively.For the PTMCs with heterogeneous enhancement,the location,shape and enhancement mode of inhomogeneous area were observed.According to the pathological characteristics of PTMCs,the correlation between CT enhancement modes and pathological features was analyzed.Results Of the 83 nodules,53 nodules were homogeneous enhancement and 30 were heterogeneous enhancement.Pathologically,these cases were divided into five types:parenchyma predominant type(type I,n=19),parenchyma and stroma interlaced distribution type(type II,n=22),stroma predominant type(type III,n=12),parenchyma and stroma separated distribution type(type IV,n=19),and secondary cystic change type(type V,n=11).The homogeneous enhancement was found in type I,type II and type III.In the early phase of enhanced CT,the rising range of CT value of type I was higher than that of type III(P<0.05).In the late phase of enhanced CT,the decline ratio of CT value of type I was higher than that of type II and III(P<0.001).The nodules of typeⅣwere heterogeneous enhancement due to the zonal distribution of parenchyma and stroma.The heterogeneous enhancement of the nodules of type V was attributed to the secondary peripheral cystic changes.Conclusion The CT enhancement features of PTMC are closely related to the compositions and distributions of its pathological tissue.