甲状腺微小乳头状癌的CT特征性征象与病理的对照研究

Comparative study of CT features and pathological findings of papillary thyroid microcarcinoma

目的:探讨甲状腺微小乳头状癌(PTMC)CT特征性征象与病理特点的相关性。方法:回顾性分析经手术病理证实的72例共77枚PTMC的CT特征性征象,包括平扫CT值、强化方式、假包膜征、边缘中断征及钙化情况,并观察相应的病理组织学特点,评估PTMC的CT特征性征象与病理的相关性。结果:测量69枚PTMC的平扫CT值,病理表现以实质为主型PTMC的CT值最低[(49.21±10.13)HU],间质为主型CT值最高[(66.42±16.64)HU],实质与间质比例相当型CT值介于两者之间,为[(57.17±11.75)HU];3组间差异有统计学意义(P<0.05)。77枚PTMC中,32枚均匀强化,其中实质为主型10枚、间质为主型4枚、实质与间质比例相当型18枚;45枚不均匀强化,病理表现为中央实质、外周间质为主34枚,肿瘤实质被间质分隔为岛状分布11枚。50枚有假包膜征,病理上为纤维结缔组织增生形成的假包膜。CT平扫诊断边缘中断征与病理一致性最高(K=0.67)。CT诊断钙化的敏感度、特异度、符合率分别为0.32、1.00、42.86%。结论:PTMC的CT特征性征象有其相应的病理学特点。

Objective:To evaluate the correlation between CT features and pathological findings of papillary thyroid microcarcinoma(PTMC).Methods:The CT features of 77 tumors in 72 patients confirmed by pathology were reviewed retrospectively.The CT features included CT value in non-enhanced CT,enhancement features,pseudocapsule sign,edge interruption sign and calcification.The correlation between CT features and pathological findings of PTMC were observed and analyzed statistically.Results:The plain CT values of 69 tumors were measured.The parenchyma-dominated PTMC had the lowest CT value[(49.21±10.13)HU],and the stroma-dominated PTMC had the highest[(66.42±46.64)HU],while the parenchyma-stroma-dominated PTMC showed the intermediate CT value[(57.17±11.75)HU],and the difference among the three type PTMC was statistically significant.Among 77 tumors,32 showed homogenous enhancement(10 of the parenchyma-dominated,4 of the stroma-dominated and 18 of the parenchyma-stroma-dominated PTMC),45 tumors showed inhomogenous enhancement(34 of the central parenchyma and peripheral stroma,11 of islands-shaped parenchyma separated by stroma).50 tumors had pseudocapsule sign.The edge interruption sign detected by CT plain scan had the best consistency with pathology(K=0.67).The sensitivity,specificity and coincidence rate of CT diagnosis of calcification were 0.32,1.00 and 42.86%.Conclusion:CT features of PTMC are related to the corresponding pathological characteristics.