摘要
目的：探讨不同CT征象及其联合应用在甲状腺乳头状癌（Papillary thyroid carcinoma，PTC）诊断中的价值。方法：回顾性分析经组织学证实的直径＞1.0 cm的PTC的CT表现，共184例192枚，包括结节形态、咬饼症、增强后范围缩小/模糊及微钙化，并与同期直径＞1.0 cm的170例222枚结节性甲状腺肿（Nodular goiters，NG）的CT征象相比较，计算不同CT征象及联合应用的敏感度、特异度、准确度。结果：12例12枚PTC及5例6枚NG因完全钙化或桥本氏甲状腺炎的影响，病灶形态或强化特点显示不清，予以排除，172例180枚PTC及165例216枚NG符合纳入标准。两组在结节形态、咬饼症、增强后范围缩小/模糊、微钙化方面均具有统计学意义（P＜0.05），单项CT征象中，咬饼症的敏感度、特异度、准确度均最高，分别为84%、94%、90%；两项CT征象联合中，形态不规则+咬饼症的敏感度、特异度、准确度均最高，分别为71%、100%、86%；三项CT征象联合诊断中，形态不规则+咬饼症+增强后范围缩小/模糊及形态不规则+咬饼症+微钙化的敏感度、特异度、准确度最高，均分别为23%、100%、65%；四项CT征象联合，诊断的敏感度、特异度、准确度分别为19%、100%、63%。结论：尽管不同CT征象的单独应用在PTC诊断中具有较高的敏感度，但特异度较低，不同CT征象的联合应用可明显提高PTC诊断的特异度，减少误诊的发生。
Abstract
Objective: To investigate the value of CT features and the combination in diagnosing papillary thyroid carcinoma(PTC). Methods: We retrospectively identified the CT features of 192 lesions in 184 cases with diameter larger than 1.0 cm, including the morphology, the bite cookie sign, enhancement features and microcalcifications, and compared with 222 lesions in 170 cases of nodular goiters with diameter larger than 1.0 cm. Then we evaluated the sensitivity, specificity and accuracy with different CT features pattern. Results: Twelve lesions in 12 cases of PTC and 6 lesions in 5 cases of NG were excluded because of complete calcification, influence from Hashimoto thyroiditis, ambiguous morphology or enhancement feature. Thus, 180 lesions in 172 cases of PTC and 216 lesions in 165 cases of NG were included in this study. Morphology, bite cookie sign, enhancement features and microcalcifications showed statistically significant difference between papillary thyroid carcinomas and nodular goiters(P<0.05 for all). The bite cookie sign showed the highest sensitivity, specificity and accuracy of 84%, 94% and 90%, respectively, compared with the other three CT features. Combining two signs together, irregular shape and bite cookie sign showed the highest sensitivity, specificity and accuracy of 71%, 100% and 86%, respectively. Combining three signs together, irregular shape, bite cookie sign, enhancement features or microcalcifications showed the highest sensitivity, specificity and accuracy of 23%, 100% and 65%. Combining four signs together showed a sensitivity, specificity and accuracy of 19%, 100% and 63%. Conclusion: Single CT feature shows a high sensitivity and low specificity relatively in diagnosing PTC, while the combination of different CT signs significantly improves the specificity, reducing the incidence of misdiagnosis.
关键词
甲状腺肿瘤 /
癌 /
乳头状 /
体层摄影术 /
螺旋计算机
Key words
Thyroid neoplasms /
Carcinoma /
papillary /
Tomography /
spiral computed
朱妙平;周秀艳;韩志江.
不同CT征象及其联合应用在甲状腺乳头状癌诊断中的价值[J]. 中国临床医学影像杂志. 2014, 25(12): 840-843
ZHU Miao-ping;ZHOU Xiu-yan;HAN Zhi-jiang.
The value of CT features and the combination in diagnosing papillary thyroid carcinoma[J]. Journal of China Clinic Medical Imaging. 2014, 25(12): 840-843
中图分类号：
Ｒ736.1
Ｒ730.261
Ｒ814.42
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