摘要
目的：分析结节性甲状腺肿（Nodular goiter，NG）的多层螺旋CT特征表现，以提高其诊断准确性。方法：回顾性分析60例经手术及穿刺病理证实的NG病例，术前行螺旋CT平扫加三期（动脉期、静脉期及平衡期）增强扫描，1例为颈椎间盘CT平扫时发现，4例为胸部CT检查发现，55例行甲状腺CT检查发现，观察其CT征象，与病理结果作对照分析，提出诊断及鉴别要点。结果：①病变部位、数目、大小、密度：无一例超出甲状腺包膜，43例多发，17例单发，单发者外形相对多发者较大，平均3.5cm，多呈囊变；32例表现为混杂密度，低密度为主，11例病灶表现为高密度。②病理类型：病理诊断NG 49例，其中NG伴乳头状增生或腺瘤性结节18例，NG伴腺瘤7例，NG伴甲状腺乳头状癌4例。③螺旋CT表现：病灶多发多见，密度多混杂，低密度为主，本组11例平扫时表现为高密度，呈花环状、片状或均匀稍高密度结节；31例见钙化；15例病灶内见分隔；24例见包膜征象；49例不同程度囊变，其中12例完全囊变；22例增强扫描时表现为病灶内多发乳头状强化，平衡期扫描呈填充改变32例，囊变区不强化呈大小不等裂隙状低密度，26例呈等密度填充。结论：NG的CT影像表现（甲状腺境界清、增强扫描后病灶内多发乳头状强化影及平衡期呈均匀等密度填充、中心低密度裂隙征、病灶的钙化形态及分布、病灶内分隔影、病灶内光整圆形小囊变）有特异性，在定性诊断上有重要价值。
Abstract
Objective: To analyse the specific characteristics spiral CT signs of nodular goiter in order to improve its diagnostic accuracy. Methods: Sixty cases confirmed surgically and pathologically to be nodular goiter which were found by preoperative spiral CT scans plus three phase enhanced scans, 1 case was found by cervical disc CT scan, 4 cases were found by chest CT examination. CT signs were observed, and correlated with pathological findings. Diagnostic criteria and differential points were advocated. Results: ①Site, number, size and density of lesions: no lesion protrudes beyond the thyroid capsule, multiple lesions in 43 cases, single in 17 cases, the size of single lesion was larger than that of the multiple lesions with an average of 3.5cm, mostly cystic; mixed density mostly low in 32 cases, high density in 11 cases. ②Pathological types: Forty-nine cases were diagnosed as nodular goiter pathologically, including nodular goiter with papillary hyperplasia or adenomatous nodules in 18 cases, nodular goiter with adenoma in 7 cases, nodular goiter with papillary carcinoma in 4 cases. ③Characteristics of spiral CT: multiple lesions were more common, mixed dominantly low in density, garland-like; patchy; or homogeneously high density in 11 cases. Calcification seen in 31 cases; septations within lesion in 15 cases; capsule were seen in 24 cases; various degree of cystic formation in 49 cases in which completely cystic changes in 12 cases. On enhanced scan, 22 cases showed multiple papillary enhancement, filling enhangcement seen in 32 cases on balanced phase; various size of slit like low density within the cystic area; isodensity on the balanced phase in 26 cases. Conclusion: Specific CT signs of nodular goiter include well defined margin of thyroid; multiple papillary enhanced nodules on contrast scan; homogeneous filling density on balanced phase; central slit-like low density; morpholy and distribution of calcification; septation within lesion; smooth small round cystic area within lesion. These spectific signs have important diagnostic value.
关键词
甲状腺肿 /
结节性 /
体层摄影术 /
螺旋计算机
Key words
Goiter /
nodular /
Tomography /
spiral computed
胡燕标;苏明进;肖维华;付 峰.
结节性甲状腺肿的病理基础与螺旋CT特异征象相关分析[J]. 中国临床医学影像杂志. 2011, 22(8): 544-548
HU Yan-biao;SU Ming-jin;XIAO Wei-hua;FU Feng.
The pathological basis of nodular goiter and correlative with specific signs of spiral CT[J]. Journal of China Clinic Medical Imaging. 2011, 22(8): 544-548
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