探讨640层螺旋CT对甲状腺单发良、恶性结节的鉴别诊断价值

The Values of Differential Diagnosing Benign and Malignant Single Nodules in Thyroid Gland with 640⁃slice Spiral CT

目的 探讨640层螺旋CT对甲状腺单发良、恶性结节的诊断及鉴别诊断价值。方法 回顾性分析经手术及病理证实的48例甲状腺单发结节CT表现,包括28例甲状腺乳头状癌和20例甲状腺良性结节(16例结节性甲状腺肿和4例甲状腺腺瘤)。观察指标包括:(1)甲状腺腺体情况:体积、形态、密度;(2)结节CT征象:大小、部位、密度(均匀或不均匀、是否有钙化)、边界(咬饼征)、强化情况(强化方式、强化幅度、边界是否比平扫清晰、范围是否比平扫缩小);(3)周围结构改变:气管偏移、淋巴结转移。结果 甲状腺单发的良、恶性结节在大小、边界(咬饼征)、强化情况、甲状腺腺体情况的差异具有统计学意义(P<0.05),在部位、密度、气管移位的差异无统计学意义(P>0.05);淋巴结转移只出现于甲状腺乳头状癌。结论 尽管甲状腺单发的良、恶性结节在CT征象上有重叠,仔细观察其CT平扫+增强扫描典型及不典型征象,结合甲状腺腺体情况及淋巴结转移,还是能较准确地作出定性诊断。

Objective To evaluate the values of diagnosing and distinguishing benign and malignant single nodules in thyroid gland with 640⁃slice spiral CT.Methods The CT manifestations of thyroid gland’s single nodules in 48 patients were retrospectively analyzed,including 28 crestoid carcinoma of the thyroid gland and 20 benign thyroid nodules(16 nodu⁃lar goiter and 4 thyroid adenomas).All cases were proved by operation and histopathology.The observed indexes were as:(1)Thyroid general condition:volume,shape and density.(2)The CT finding of nodules:size,location,densities(homoge⁃neity or unhomogeneity,calcification),margin(the cookie bite sign),enhancing condition(enhancing mode,strength,clea⁃rer margin and smaller than non⁃enhancing).(3)The organ changing around thyroid gland:tracheal displacement,lymphatic metastasis.Results The size,margin(the cookie bite sign),enhancing strength and Thyroid general condition had markedly statistical significance between benign and malignant single nodules in thyroid gland(P<0.05).The location of nodules,density and tracheal displacement hadn’t statistical significance between benign and malignant single nodules in thyroid gland(P>0.05),but lymphatic metastasis justly was seen in crestoid carcinoma of the thyroid gland.Conclusion The CT manifestations between benign and malignant single nodules of thyroid gland appeared overlapping,but accurately qualitative diagnosing could be obtained by means of observing carefully typical and atypical CT finding,combining thyroid general condition and lymphatic metastasis.