甲状腺结节钙化灶在CT增强前后的差异性及其临床价值

The difference and application value of thyroid nodule calcification before and after CT enhancement

目的:探讨CT增强前后甲状腺结节钙化灶边缘的变化特点及其鉴别甲状腺良恶性结节的临床应用价值。方法:选取医院经手术病理证实并具有钙化的92例甲状腺结节患者,依据诊断结果将其中的48例结节性甲状腺肿患者纳入良性组,44例甲状腺乳头状癌患者纳入恶性组。两组均行颈部CT平扫和双期增强扫描,分析比较两组CT增强前后钙化类型及钙化变化差异,绘制受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC),分析诊断效能。结果:增强后良性组病灶内钙化假性增大、边缘模糊分别占35.4%和22.9%;恶性组病灶分别占75.0%和63.6%;两组比较差异均有统计学意义(x^(2)=14.497,x^(2)=15.587;P<0.05);良性组病灶内含有微钙化的占41.7%,恶性组病灶内含有微钙化的占77.3%,两组差异有统计学意义(x^(2)=12.005,P<0.05)。增强后结节内钙化假性增大、边缘模糊和平扫微钙化征的AUC分别为0.698、0.704和0.678,诊断恶性结节的灵敏度和特异度分别为75.0%和64.6%、63.6%和77.1%、77.3%和58.3%。结论:CT增强后甲状腺结节内钙化假性增大、边缘模糊多提示为恶性结节;结合CT平扫结节中微钙化可辅助提高甲状腺良恶性结节的鉴别诊断能力。

Objective:To investigate the characteristics of changes at the margin of calcification of thyroid nodules before and after computed tomography(CT)enhancement and the application value of that in differentiating benign and malignant thyroid nodules.Methods:92 patients with thyroid nodules who had calcification and were confirmed by operation and pathology in hospital were selected.According to the diagnostic results,48 patients with nodular goiter were divided into benign group and 44 patients with papillary thyroid carcinoma were divided into malignant group.Both two groups underwent CT plain scan and biphasic enhancement scan.And the type of calcification and the difference of calcification change of two groups before and after CT enhancement were analyzed and compared.And then,the receiver operating characteristics(ROC)curve was drawn,and the area under curve(AUC)of ROC curve was calculated and the diagnostic efficiency was analyzed.Results:The ratios of false enlargement of calcification within lesion and edge blur of benign group after CT enhancement were 35.4%and 22.9%,respectively.And these of malignant group were 75.0%and 63.6%,respectively.The differences of those between two groups were significant(x^(2)=14.497,x^(2)=15.587,P<0.05).The ratio of micro-calcification within lesion was 41.7%in benign group,and that was 77.3%in malignant group,and the difference of that between two groups was significant(x^(2)=12.005,P<0.05).The AUCs of false enlargement of calcification within nodule,edge blur and micro-calcification of plain scan were 0.698,0.704 and 0.678 after CT enhancement.And the sensitivities and specificities of diagnosing malignant nodule were 75.0%and 64.6%,63.6%and 77.1%,and 77.3%and 58.3%,respectively.Conclusion:After CT enhancement,the false enlargement of calcification within thyroid nodules and edge blur indicates most of them are malignant nodules.The combination of the micro-calcification in the nodule of CT plain scan can assist to improve the diagnostic ability of differentiating benign and malignant thyroid nodules.