目的：探讨CT钙化分型在甲状腺良、恶性结节中的诊断价值。方法：回顾性分析经手术及病理证实的426例492枚甲状腺钙化结节的CT影像，包括良性结节404枚、恶性结节88枚。根据钙化形态，将其分为微钙化、粗钙化、环状钙化，分析不同钙化形态在良、恶性结节中的分布，并统计微钙化在恶性结节诊断中的敏感性、特异性、阳性预测值和准确度。结果：本组492枚甲状腺钙化结节中，微钙化在良、恶性结节中分别占25.2%（102/404）和36.4%（32/88）（χ2=4.506，P=0.034），微钙化在恶性结节诊断中的敏感性、特异性、阳性预测值和准确度分别为36.4%、84.4%、23.9%和67.9%。粗钙化和环状钙化在良、恶性结节中分别占61.6%（249/404）和51.1%（45/88）（χ2=3.311，P=0.069）、13.1%（53/404）和12.5%（11/88）（χ2=0.024，P=0.876）。结论：CT检查中，尽管微钙化在甲状腺恶性结节中更常见，但敏感性和特异性均较低，而粗钙化和环状钙化在良、恶性结节中的分布无统计学意义，提示在钙化结节的CT诊断中，需要结合其它征象综合分析，而不能以钙化形态作为良、恶性判断的唯一依据。
Abstract
Objective: To evaluate the diagnostic value of calcified type in benign and malignant thyroid nodules by using CT. Methods: The CT findings of 492 thyroid calcified nodules(including 404 benign nodules and 88 malignant nodules) in 426 cases confirmed by surgery and pathology were retrospectively analyzed. According to the shape of calcification, it is divided into microcalcification, coarse calcification and annular calcification. The distribution of different calcified shapes in benign and malignant nodules, and the sensitivity, specificity, positive predictive value and accuracy of microcalcification in the diagnosis of malignant nodules were analyzed. Results: Among the 492 thyroid calcified nodules, Microcalcification accounted for 25.2%(102/404) and 36.4%(32/88) respectively in the benign and malignant nodules(χ2=4.506, P=0.034), and the sensitivity, specificity, positive predictive value and accuracy of microcalcification in the diagnosis of malignant nodules were 36.4%, 84.4%, 23.9% and 67.9% respectively. Coarse calcification and annular calcification accounted for 61.6%(249/404) and 51.1%(45/88)(χ2=3.311, P=0.0.069), 13.1%(53/404) and 12.5%(11/88)(χ2=0.024, P=0.876) respectively in benign and malignant nodules. Conclusion: In the CT examination, although the microcalcification was more common in malignant thyroid nodules, the sensitivity and specificity were lower, and the distribution of coarse calcification and annular calcification in benign and malignant nodules was not statistically significant, which indicated that, in the CT diagnosis of calcified nodules, other signs should be combined for comprehensive analysis, and the shape could not be regarded as the only evidence to judge whether the nodule was benign or malignant.
关键词
甲状腺结节；体层摄影术 /
螺旋计算机
Key words
Thyroid nodule /
Tomography, spiral computed
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基金
2015浙江省医药卫生计划项目2015KYB293；2013杭州市重大科技创新专项项目20131813A08； 2012杭州市卫生科技计划项目2012A020。
