摘要
目的：探讨CT在乳头状甲状腺微小癌（PTMC）和微小结节性甲状腺肿（MNG）鉴别诊断中的价值。方法：回顾分析经手术、病理证实的212例共313枚直径在0.5～1.0 cm甲状腺微小结节的CT资料，其中106例共143枚PTMC（合并最大径0.5～1.0 cm的MNG 8例共15枚），106例共170枚MNG。结果：PTMC与MNG在发病状态、瘤体形态、增强后瘤体边界、甲状腺边缘中断征、细颗粒状钙化等方面具有统计学差异（P＜0.05），在混合钙化方面无统计学差异（P＞0.05）。7枚MNG合并腺瘤样增生，其中5枚瘤体强化程度高于周围正常甲状腺。CT平扫未显示的18枚PTMC和41枚MNG中，合并甲状腺炎分别为9枚和36枚。结论：单发、形态不规则、增强后边界较平扫模糊、甲状腺边缘中断征、细颗粒状钙化、瘤体周围多发小淋巴结有助于PTMC的诊断；多发、形态呈规则的圆形或椭圆形、增强后边界较平扫清晰、无甲状腺边缘中断征则提示MNG的诊断；瘤体增强后强化程度高于周围甲状腺组织则倾向腺瘤或MNG合并腺瘤的诊断；甲状腺炎可以掩盖甲状腺微小结节引起漏诊。
Abstract
Objective: To evaluate the value of CT in the differential diagnosis of papillary thyroid microcarcinoma(PTMC) and micronodular goiters(MNG). Methods: CT findings of 313 micronodules of thyroid in 212 patients(diameter 0.5 to 1.0 cm) were retrospecctively analyzed. All of the patients had pathologic diagnosis, and 143 leisions in 106 patients were PTMC(15 leisions in 8 patients were combined with MNG), and 170 lesions in 106 patients were MNG. Results: There was statistical difference in pathogenetic number, the appearance of lesions, the margin of the lesions on contrast-enhanced CT scan, the discontinous edge of the thyroids and the fine calcification ratio between PTMC and MNG(P＜0.05). However no statistical difference in mixed calcification ratio was found between the two groups(P＞0.05). MNG with adenoma were found in 7 lesions, and 5 of them showed higher density than thyroid on post-contrast CT. Eighteen lesions of PTMC and 41 lesions of MNG were not shown on non-enhanced CT, among which 9 PTMC and 36 MNG were combined with thyroiditis. Conclusions: Single lesions with irregular shape, more indistinct margin of the lesion on post-contrast CT than on non-enhanced CT, discontinous edge of the thyroids, fine calcifications and multiple small lymph nodes around the lesion conduce to the diagnosis of PTMC. Multiple lesions with round or oval shape, more distinct margin of lesions on post-contrast CT than on non-enhanced CT, continous edge of the thyroids conduce to the diagnosis of MNG. High degree of enhancement on post-contrast CT conduces to the diagnosis of adnoma or MNG with adenoma. It should be concerned that thyroiditis may hide PTMC.
关键词
甲状腺肿瘤 /
甲状腺肿 /
结节性 /
体层摄影术 /
螺旋计算机
Key words
Thyroid neoplasms /
Goiter /
nodular /
Tomography /
spiral computed
韩志江;陈文辉;舒艳艳;赖旭峰;项晶晶.
乳头状甲状腺微小癌和微小结节性甲状腺肿的CT鉴别诊断[J]. 中国临床医学影像杂志. 2013, 24(2): 88-92
HAN Zhi-jiang;CHEN Wen-hui;SHU Yan-yan;LAI Xu-feng;XIANG Jing-jing.
Value of CT in the differential diagnosis of papillary thyroid microcarcinoma and micronodular goiters[J]. Journal of China Clinic Medical Imaging. 2013, 24(2): 88-92
中图分类号：
Ｒ736.1
Ｒ581.3
Ｒ814.42
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